LECTURE

      ON




     OF THE
Philadelphia Alms  House.
Delivered at the Opening of the Clinical Lectures,

         October 15th, 1862,


              BY
          %     j

     D. HAYES AGNEW, M. D.  ^cA$r
PUBLISHED BY REQUEST OF THE BOARD OF GUARDIANS.






           PHILADELPHIA:
      HOLLAND & EDGAR, PRINTERS,
           54 North Eighth Street,
                1862.
\ 
  I am indebted to the Board of Guardians for free access to the
records  of the House;  to  Doctors  Girvin and  Benton, Resident
Physicians of the Philadelphia  Hospital, for valuable assistance  in
searching  these records ; to  Mr. Samuel Hazzard, Secretary of the
Philadelphia  Historical  Society, for  information which the works
of that  library supplied; to Mr. Mickley, whose rare collection  o*
old works  is  unsurpassed ;  to Professors  Jackson and Hodge, and
Doctors Gerrhard and Stille, whose  acquaintance  with matters per-
taining to the subjects treated  on, proved of much  consequence  in
enabling me  to ascertain facts  connected with subjects on which
written documents were silent, and to Mr. Cavender,  whose industry
in arranging  the records is most praiseworthy. 
LECTUEE.
Gentlemen :
  I am before  you to-day by appointment of the medical board, to
discharge a service preliminary to the opening of the annual Course
of Clinical Lectures in this  hospital.  For some  time I have been
engaged  in  gathering material  from a  great variety  of sources,
written and unwritten, to secure the history of the Philadelphia A\m
House from  oblivion, if not utter loss.  The field is extensive and
interesting, though its paths have been much obscured by the de-
cay of time.   So interwoven is  it with  the secularities of Phila-
delphia, that no history of this city, Civil, Political, or Professional,
would be complete without it.
  The Medical history of the Philadelphia  Alms House  covers a
period of one hundred and twenty years, during  which time it has
been located in three  different positions.  First, on the square be-
tween Spruce and Pine, and Third and Fourth streets,—at that time
called  the  Green  Meadows; next  on the square between Spruce
and  Pine, and  Eleventh and Twelfth streets, long known as the
Society Grounds; and last on the west side of the Schuylkill river,
where we are assembled to day.
  This, gentlemen, is the oldest hospital on  this continent.   Proud
in his history of Pennsylvania,  a work justly esteemed for its re-
search, says  the Philadelphia Alms House was of a  later date than
the Pennsylvania Hospital, the origin of which, was in 1853.  This is
a mistake.   In 1742 it  was fulfilling a varied routine of beneficent
functions in  affording shelter, support  and employment  for the poor
and indigent, a hospital for the sick, and an  asylum for  the idiotic,
the insane, and the orphan.  It was thus dispensing its acts of mer-
cy and blessing, when Pennsylvania was yet a province,  and her in-
habitants the  loyal subjects of Great  Britain,  more than twenty
years before a school of medicine  was  founded in this city, and in-
deed before most of the great events which  have given  the Ameri-
can people  a historical importance among the nations of the earth. 
4
Who were the first physicians appointed to attend the Philadelphia
Alms House, and at what period were they assigned to this duty?
These  are questions, so far as I know, which cannot be ascertained
either  from record or  tradition.  In  1768, and  probably much
earlier, Doctor Cadwallader Evans, and Doctor Thomas Bond, were
the medical  appointees; and on the 18th of May, 1769, we have a
formal announcement of their re-election.  The institution at this
early period contained two hundred and forty six inmates, and each
of the medical attendants received fifty pounds per annum, and were
required to  supply such medicines as were  needed by  the  sick.
Dr. Bond studied his profession at home and abroad; was the first
surgeon  and physician to  the Pennsylvania  Hospital, in which in-
institution, as early as 1769 he delivered lectures on clinical medicine
and surgery.   Doctor Cadwallader Evans was one of  the first pupils
of Doctor Bond.   In order to finish his education he sailed for Ed-
inburgh, but the  vessel  while on the voyage was taken by a Spanish
privateer, and carried to Hayti, where he remained between two and
three years before being able to renew the  voyage for the Scotch
metropolis, then  the  great  centre  of  medical  instruction.  It was
after his return from Scotland he became  officially connected with
the Alms House.   That the medical police of the House was not of
the strictest character, may be inferred from the fact that a number
of persons were in the habit of  visiting the institution, assuming to
be Doctors, and volunteering their services to  the unfortunate  sick.
This irregularity  continued unquestioned for  some time, until many
of the patients had suffered very great  injury, and  no small amount
of discredit brought upon the management of the  House.  A reso-
lution was at length introduced and passed by the board of managers,
permitting no  one to  prescribe except  the regular appointees, and
requiring them to visit the hospital oftener and with more regularity.
At this period the invaluable discovery of Jenner was unknown to
the medical world, and the only method capable of diminishing the
horrors of small pox was the induction  of the disease by inoculation,
after a careful previous  preparation of  the  system for its reception.
Singular as it  may appear, there were many  who regarded the  prac-
tice  not only improper, but positively sinful.   I remember a few
years ago, whilst  sitting in one of our city churches, taking  up a
bible which bore  on the fly leaf the inscription, over the signature of
the owner, " opposed  to corporation and inoculation."  In 1771 the
institution  contained  a number of destitute children who had never
had an attack of  variola.  For  their own, as  well as  the  safety of 
5
the other inmates,  Doctor Evans called  the  attention of the  man-
agers to this fact, and proposed they should be protected by inocula-
tion.   The board acquiesced in  the suggestion, provided the house
should be subjected to no  expense, other than the medicine required
for their subsequent treatment.  Twenty-one  of these children were
separated from the general mass for this purpose, all of whom perfectly
recovered.   In the  month of February 1778,  there were forty others
subjected to a similar course with a like result.
   In 1772 a proposition was made to the managers to extend the use-
fulness of the House by the admission of students, and an increase
in  the number  of medical attendants.   This proposition  included an
offer of gratuitous service, the institution being only at  the expense
of  purchasing the medicines required for the sick.  On the  25th of
March 1774, the desired addition to the Medical corps  was  effected
by the election of Doctor  Adam Kuhn, Professor of Materia Medica
and Botany, in the  Medical College; Doctor Benjamin  Rush,  who
held the chair of Chemistry in the same institution ; Doctor  Samuel
Duffield, one of  the ten Alumni  who  received the first Medical De-
grees  conferred in   this country,  (21st.  June,  1768,)  and  Doctor
Girardus Clarkson.    An additional physician, Doctor Thomas Parke,
was added to  the  number, March 25th, 1774.  This probably is
 the origin, in  this  country, of gratuitous professional service to
public  institutions, which has become so  general at the present day,
and which I conceive  operates  disadvantageously  to both  he who
dispenses, and  he  who receives.   To advocate such a sentiment
brings no odium on  the profession.  It requires no argument from
me to vindicate our calling from the charge of selfishness.  It is not
saying  too  much when we  venture the  assertion, that among the
professions there are none which contribute so largely their free will
offerings for the relief of human suffering, or  which furnish so many
 examples of disinterested and unselfish benevolence as our own.
    I cannot refrain here from relating an anecdote somewhat appropos
to  this subject.  The late professor Chapman, while discharging the
clinical duties of his chair in the University of Pennsylvania, had
brought before him a poor Irish woman who  had applied for advice.
The Doctor  made a careful  examination of her case, ordered a pre-
scription to be made out, and bade her in a  kindly tone to retire.
With great simplicity of manner she tendered a compensation, which
on being declined, in an air of mingled surprise and doubt, she ex-
claimed: "Take the trifle,  my jewel, for its yourself must be after
living!" " Ah ! my good  woman," said the Doctor, in his own inirni- 
                               6
                        \
itable way, " We Doctors are a very peculiar people, we look for our
reward hereafter."
   To every American the year 1776 is full of historic importance.
A period when  our  revolutionary sires, men  of large hearts, broad
minds, and self-sacrificing spirits, were freely spending their blood,
treasure, and wisdom, to establish a national  independence and gov-
ernment, which their children are to day in  a spirit of unparalleled
venture, rending to pieces.
   On the  5th of September, 1776, the Council of Safety, through
its President, Thomas Wharton, Jun., addressed a note to  the man-
agers of the Bettering House, as it was often styled, asking permis-
sion for  the Quarter Master, (Deputy) General, to quarter  in  the
institution a number of  the  Continental  militia,  who  were very
sick with dysentery.  This was strenously opposed both by the man-
agers and the  medical attendants,  as calculated to endanger the
health of  the house.  They had,  on  former occasions  suffered great-
ly from  the prevalence of  putrid sore throat and small pox; and had
been compelled to move  many of these cases to private lodgings in
order to stay their fatal progress; and  in justice to the helpless and
infirm inmates—most  of whom  possessed  little  ability  to with-
stand disease, they naturally objected to the  introduction of an ele*
ment of danger, such as malignant  disentery, the  scourge of camps
would constitute.  As all military government tends  to  despotism,
the application was merely to maintain a semblance to the legitmate
forms of propriety.  This is quite natural  and proper, when public
necessity  becomes paramount to personal considerations; and ac-
cordingly the council ordered Col.  Francis Guerney, on the 23d of
October, to take military possession of the  Alms House, for the sick
soldiers.   No alternative was  left but  to make  the best of the un-
pleasant position forced  upon them.  The poor were transferred to
the west building, and these  soldiers  were placed in the south east
wing of the  House of Employment, arresting  entirely the indus.
trial operations of the  establishment.   They retained possession of
this apartment until the British  took possession of the city  in
1777, when they were removed.   This removal, however, in no way
relieved  the managers from embarrassment, as shortly after, in the
month of October, the entire east  wing  was  appropriated for the
sick  belonging to  the Kings' troops  under  General  Howe.   For
fear they might in like manner appropriate  the west wing also, the
managers waited on Joseph  Galloway, to secure  his influence with
the General, to prevent an  occurrence which  must  entail so great 
)
                               7
                                                     I
distress on the poor—its inmates at this time being of the most help-
less description.  Joseph Galloway, was a lawyer of distinction  find
wealth,  Speaker of the Provincial Assembly.   In our struggle, he
took the royal side of the  question, and became, under .the  sanction.
of the British  Commander, the General Superintendant of the city.
When, however, the cause of the Colonies brightened, and Howe was
obliged  to evacuate  Philadelphia, he was compelled  to follow his
master, his estates were  confiscated, his fortune melted  away,  and
he  was  obliged to  accept a Secretaryship  to  the Commander-in-
Chief.   It was therefore in consequence of his royal proclivities, the
managers sought his aid.  They were  referred by him to Doctor
Stuart,  Surgeon  General  of the British Military  Hospital, who
promised unless an  emergency  should  arise, to accede  to  their re-
quest.   It was but a short time after this, in November,  at 9 o'clock
at night, when the poor were almost  destitute  of  food,  the barrack
master called on two of the managers, ordering them to  clear the
house for the reception of the King's  troops.  The Board met the
next morning, and after a short deliberation, refused to comply with
the  unreasonable and  cruel  demand.   On hearing their  decision,
the British  official proceeded at once to remove the inmates—about
two hundred  in number, of miserable, decrepid, half starved crea-
tures.  As they would soon have perished, exposed to  the rigors of a
November air, the managers succeeded in securing quarters for them,
some in the Free Masons old Lodge—still standing in Filbert, above
Eighth street;  some in the Friends' Meeting House; and  others in
 Carpenter's Hall, off Chesnut, above Third street; where they were
 maintained  until the last days of June  1778, when  the  invaders
having left  the  city, they were removed back to their old  home.
 The exposure  and deprivation  attending their ejectment, was fol-
 lowed by a heavy mortality,  as  only  eighty-two of the  original two
 hundred survived, to re-enter their former quarters.
   In  1777  Doctors  Benjamin  Rush  and Clarkson,  resigned their.
 posts, and the three remaining members were requested by the Board
 if managers, either to occupy their terms of service, or to choose sub-
 stitutes ; the former of which they concluded to do.  No alteration
 it this arrangement was  made until the 29th of April, 1779, when
 a proposition  was  made  by  Doctors  Glentworth,  Jackson,  and
 Duffield, to attend the sick  of the institution,  charging only  for the
 medicines used in their treatment.  From the 25th of March 1780,
 we may date the origin of the system  of Out Door medical relief as
 £ part of the benevolent operations  of the managers  of  the poor. 
8
In order that  such aid might be  furnished, Doctors Hutchison and
Wilson,  were requested  to  attend  and prescribe for those,  who,
although not inmates of  the  institution, were yet dependent on its
resources for professional aid.   From this small beginning, in which
two gentlemen were able to meet all the demands of the city, have
arrisen  eleven districts,  requiring  twenty-four physicians,  who,
for a very  small  compensation, dispense an  amount of professional
relief truly wonderful.  In passing over the records of this depart-
ment it is pleasant to find, that at one time or another, almost every
name of note  in the ranks of our profession, is found among those
who have  labored in this  sphere  of  humble  usefulness,  and  no
doubt, not a few  of them, laid the foundation of their future reputa-
tion, while thus engaged in visiting  the sick poor  in the secluded
lanes, and  alleys  of this  metropolis.   No  man can  long  labor in
such a field, in daily contact with a  class,  whose  sufferings are
greatly increased  by the  absence of so much  which serves in the
more fortunate to alleviate the presure of disease, without feeling all
the sympathies of his heart  unlocked, and  becoming a wiser and
better  man.
   On  the 7th of  February 1781, Dr.  Bond, who it seems had no
connexion with the house after the  year  1779, being at  this time
Medical  Purveyor of the United  States Army, applied to  the man-
agers  for the east wing of the  building, which had  shortly before
been occupied by the Board of War, to accommodate a number of
British prisoners  who were very ill at that time in  the jail.  This
request was granted, by his  agreeing in behalf of the government,
to pay  a  monthly  rent  of  one  hundred dollars, hard money.   For
some time after 1781, Doctor Samuel Duffield  seems to  have been
the only physician attatched to the institution, giving his attention,
under a contract based on his own proposition, to attend all the in-
mates, and find the necessary medicines, for the sum of two hundred
pounds per annum.  One of two things is evident; either the Doctor
was fond of money, or fond of work.
  At this time it  was the custom to  have the venereal cases, and th«
violent insane, treated  at the  Pennsylvania Hospital. In regard to
the first, it was deemed  necessary in accordance with  the curreat
medical notions on the subject, to subject every case to a mercurial
course, carried  to the extent of  salivation.  In the  Pennsylvania
Hospital, the accomodations for this, were greater, and more complete
than those of the Alms House. In addition to the ordinary expenses of
board and nursing, a fee was always charged against the Alms Hous3 
9
by the Physician under whose care the case had been treated.   There
is a record of two  guineas  for  this object being paid to Dr. John
Morgan, one of the two gentlemen  who  first  established a medical
school in America.   In 1782, the General Assembly passed an act
authorising the managers to bind out all persons treated for venereal
disease, until the expenses were liquidated from the proceeds of their
labor.   These  expenses, it  is presumed, averaged about twenty four
pounds, from that  amount  having been specified  on the record, as
the sum for which  one binding had been made.   Between the morti-
fying annoyance of the disease, the salivation of the doctors, and the
limited apprenticeship;  the worshipper at the shrine of Venus, paid
pretty dearly for  his  whistle.  In 1788 a new organization of the
medical department was made, by the  election of Doctor  Samuel
Duffield, Samuel P. Griffitts—who subsequently became  professor of
Materia Medica and Pharmacy, in the  Medical   College of Phila-
delphia; Caspar Wistar—afterwards professor  of Chemistry and the
Institutes of Medicine,  and still later of Anatomy ;  ----Rodgers,
Girardus Clarkson, Michael Leib, and John Morris.  In less than a
year (in April 1789) Drs. Morris and Griffitts, in consequence of their
private business, tendered their resignations.   Both of these gentle-
men were popular, and although, their official connexion with the
house had been short, the managers, in accepting  their resignations,
acknowledged  in a very handsome and  complimentary manner, the
value of their professional  services to the House.   The same month
in which Doctors Griffitts and Morris withdrew, the  medical organ-
ization was reduced to  six  members, by dropping  Dr. Rodgers, and
electing Doctor N. Waters, and Doctor William Shippen, the latter, the
founder of medical teaching in this country.  On the 29th of March,
1790, the managers addressed a communication to these physicians,
acknowledging the value of  their services to the poor,and begging they
would continue their several offices the coming year.  This letter no
doubt was designed to be  antidotal; for only a short time before
they had  refused a very reasonable request  of  the medical atten-
dants, which will receive its  proper explanation when  the  Clinical
history of our  subject is reached.   One month after, the  whole body
of physicians resigned, the  institute losing the best medical talent
in the city.
  Shortly after this event, Doctors Duffield and  Leib solicited an
appointment to the House,  who, after their election, were required to
become  the purchasers  of  all drugs consumed by the  sick.  The
increase in the population of  the Alms House,  together with the 
10
private engagements of these  gentlemen, rendered it  necessary for
them  to  ask some  assistance, for  which object  Doctor Cumming,
August the 10th, 1795, was appointed Assistant Visiting Physician,
without salary.
  Whatever may be thought of the credulity of the present genera-
tion, it is no less clear the people  of  1796 were  not  proof against
charlatan imposition.  Every age  has  had some  crotchet on which
to betray mental imbecility.  The whale must have a tub with which
to amuse itself.  At the period above named,  it was  Perkinism, or
the cure  of  disease by metallic tractors.   The  most extravagant
reports of extraordinary cures effected  by this manipulation had been
bruited abroad  in advance of the Doctor's arrival in  Philadelphia.
The eyes of the  blind had been opened;  the ears of the deaf un-
stopped;  the lame man made  to leap as a hart;  and  in fine, a uni-
versal catholicon for human disease and infirmity had at length been
discovered.   On the 27th of February, the Visiting Committee of
the house reported having witnessed  several  successful operations
by Doctor Perkins, with his metallic points, and  had seen the grate-
ful acknowledgments of many others  who  had been subjects of his
new  method;  that the hospital contained numerous cases  which
might be benefited  by his  skill, and   proposed that George Davis,
one  of the members  of  the  Board,  be authorized  to  invite Dr.
Perkins  to attend the institution on the following Wednesday, at 10
o clock, thus giving the other members an  opportunity of beiDg pre-
sent  during his visit.  The Doctor made his appearance on the ap-
pointed  day, and managed so successfully to close the eyes of the
sage  managers, as to secure from  them the purchase of his  patent
for the benefit of the hospital;  and this house  to-day owns the ex-
clusive right to practice in Philadelphia the cure of  disease by me-
tallic points.
   Where is Perkinism to-day ? that  gigantic humbug, which over-
 run with unparalleled rapidity, towns, cities, villages, and rural dis-
 tricts, at home and abroad, and was endorsed by three  American uni-
 versities.  Gone to the tomb of the Capulets, where every other ism,
 system,  and device of  man, not  resting on a substratum of truth,
 must sooner or later sink,  never  to  be unburied unless by the pick
 of some  future Fossilist,  delving among the  caput mortuums  of
 exploded systems, for specimens of human folly, either to adorn a
 cabinet, or point the shaft of ridicule.  That Perkinism could not
 have proved very efficient in the Philadelphia Alms  House, may be
 inferred from  the  fact that on the 20th of March, the sick had be- 
11
come so numerous, as to require an additional number of physicians
to aid Doctor Duffield and his assistant in their labors.  The gen-
tlemen selected by the  Board, were  Doctors Samuel Clements, Jr.,
Wm. Boyce, and Samuel Cooper, at a salary, each, of One Hundred
Dollars annually.   It would appear  Doctor Cooper declined the ap-
pointment, and the  corps  remained without  any substitute  being
elected.   They were  required to visit the  Hospital three times a
week ordinarily, and oftener if  the  state of the sick demanded it •
two were to attend together, and in case  an operation was required
the operator was to be selected by a majority vote.
   In the fall of 1797, Doctor Pleasants died, and on the  23d of
December, the same year,  Doctors  John Church and  Thomas  C.
James, the latter subsequently  Professor of Obstetrics in the  Uni-
versity of Pennsylvania, were   elected, the former  to  supply the
vacancy occasioned by death, and the other in  the place  unoccupied
by Doctor Cooper.
   Until 1801, there  were no changes to notice, when, on the 6th of
April of this year,  Doctor Boyce tendered his  resignation; shortly
after which, Doctor  Elijah Griffith was  elected his  successor.   In
August,  Doctor Duffield, who seemed to be a necessary appurtenance
of the house, having been  connected with it for twenty-nine years,
was dismissed  in consequence of having furnished a certificate ad-
mitting a patient with typhus fever into the institution.   At this
time there seems to  have been  a very close police exercised by Ihe
managers over admissions,  in consequence, no doubt, of the recent
epidemic of yellow fever which  had desolated  so many  homes, and
produced such wide spread  distress, and consternation  in the com-
munity.   After the  removal of Doctor Duffield, the number of medi-
cal attendants was increased, by the election on Sept. 7th, 1801, of
Doctors John Proudfit, Philip Syng Physick—the father of American
Surgery, and Charles Caldwell, familiar to the present generation of
medical  men  as the author of his own biography;   a man  un-
questionably of remarkable intellectual  force,  combined,  however,
with such incongruous elements of character, as  were calculated to
defeat the best appointed plans  of ambition.   These gentlemen were
to receive a salary of twenty-five pounds per annum.
   In 1804 a  very extraordinary event occuied in view  of the very
amiable nature of doctors in general.  This was a quarrel among the
physicians, originating mainly in a private difficulty between Doctors
Caldwell  and  James.   The dispute  grew to such magnitude, that
the managers, as the shortest way to establish the peace  of the insti- 
12
tution, on the 9th of January, proceeded to the election of a  new
board,  consisting of  Doctors  Philip  Syng Physick, John Church,
Elijah  Griffitts,  John Rush,  Thomas C. James,  Benjamin Smith
Barton and Samuel Stewart;  each of whom was to receive the old
salary of £25, subject to all reasonable out-door calls.   Doctor Rush
declined the appointment, and  on the 19th  of  the same month,
Doctor James Reynolds was elected to take his place.
  On the 17th of January, 1805, the  same year  in which he was
elected to the Chair of Surgery in the University, Doctor Physick
offered his resignation.  Very soon after its acceptance, Doctor James
Hutchison was  appointed  his successor.   The latter  gentlemen's
name is associated  with a modification of the Desault splint for  frac-
tures of  the thigh.  His service was of short duration, his resigna-
tion being recorded three months after the announcement of his
election.  During this year a difficulty occurred between the managers
and Doctor Barton, in consequence of the  latter declining to attend
out-door patients.  Their views being irreconcilable, the Doctor was
dismissed, and to supply the two vacancies now existing, Doctors J.
Cathrall, and Peter Miller were selected by  the Board.
  It was also during this year Doctor Church died.  His place was
occupied by the brilliant, but short-lived John Syng Dorsey, who, in
his brief career of professional life, occupied no less than three promi-
nent positions in the medical  department of the University of Penn-
sylvania—first as an adjunct to Physick; then as  successor to Chap-
man on materia  medica, and  last  as successor to Wistar on anatomy.
The next change was produced by the  death of Doctor Reynolds in
1807.   After this event an additional physician was added to the
corps by the election of Dr.  Nathaniel Chapman to supply the va-
cancy  occasioned  by the  death  of  Doctor Reynolds, and  Doctor
Joseph Parrish to make up the compliment of the staff.
   On  the 17th of November 1809, a resolution was introduced and
adopted by  the  managers, constituting  the medical officers of the
Alms  House, a Medical Board.   They were to meet the first Monday
 of  every month, at 4 o'clock, P. M., and report rules for the govern-
 ment of the Hospital department.
    The following year, 1810, furnishes us with the first instance, so
 far as I know, of  a  hospital in this  country receiving a female resi-
 dent physician.   On the 1st of  July,  a Mrs. Lavender made  appli-
 cation to be admitted into the institution,  as an Assistant Midwife,
 in order the better to perfect  her education.  Such a charming  name,
 " Lavender," so overcome the physical senses of the members  of the 
13
board, that they lost their intellectual sense and granted her petition.
During my term of service in the winter of 1856, several  women
from the Female Medical College of this  city, were furnished with
tickets to the clinical lectures,  without my knowledge.   You may
imagine my astonishment, when entering the lecture room to discharge
the duties of the hour, I saw seated on one side of the  amphitheatre,
a number of these misguided creatures.   I had selected  for the in.
struction of the class on that morning, a series of cases all illustra-
ting some disease of the genital organs; and as it was now to late to
recede, I proceeded to operate for phymosis, and to exhibit and treat
some blooming specimens of chancre.  Notwithstanding  there were
a large number of male  students present, and the personal exposure
necessary for the conduct of the Clinic, they never betrayed the slight-
est evidence of shame, but sat  with  the imperturbable indifference
of primeval innocence.   This, I suppose, some would consider praise-
worthy and philosophical, but which I confess exhibited to me a per-
version of character, utterly below any preconceived views ever enter-
tained of strong-minded  women.  The occurrence was never repeated,
as I at once addressed a letter to the board, when their money was
returned, and  admittance refused.
   Two vacancies occurred in 1810, one by the withdrawal of Doctor
Griffitts, and the other  by  the death of Doctor Stewart.  To supply
these,  Doctors Stewart  and Joseph  Klapp  were  elected.  On the
2nd of September, 1811,  Doctor Dorsey  tendered  his resignation,
and on the 9th of the same month, was succeeded by Doctor Thomas
Hewson.
   The service of the various  gentlemen now connected with the
house, was so arranged,  that one portion were to attend to surgical,
and the other  medical and  obstetrical cases.   The surgical staff con-
sisted of  Doctors Cathrall, Miller and Parish ; the medical, of Doctors
Chapman,  Stewart and Hewson.   Between the  Managers of the
Philadelphia Alms  House and Pennsylvania Hospital, there existed
at this period, much unamicable temper, as well as jealousy.  Both
were anxious to secure the  patronage of medical students, and there-
fore stood in the attitude of rivals.   To such a degree were the minds
of the  former influenced by these feelings,  that they were led to pass
a resolution calculated to  act prejucicial,  rather than favorable to
the prosperity of their  institution.   This resolution  rendered  all
physicians or  surgeons holding place in the  Pennsylvania Hospital,
inelligible to an election in  the Alms House.   In  1813 this measure
was re-afflrmed, but from being associated with certain other matters, 
14
drew out an opposition, the influence of which became sufficiently
potential to secure its repeal.   In 1814, Doctor Dorsey again became
a member of the medical board, and it was to his personal influence,
the meritorious poor, recovering from disease, were indebted for the
hcuse carriage purchased by the managers, to afford to convalescents
the benefit of exercise and  fresh air.
  In 1815, in consequence  of the managers assuming to regulate the
the term of  service of the medical board, in a manner not agreeable
to its members, Doctor  Chapman resigned, and was succeeded on the
8th of May, by Doctor Joseph Klapp.   The obstetrical  department
having been placed exclusively under the control of Doctor James,
its duties necessarily absorbed  more time, than was compatible with
the proper discharge of other engagements,  and at his  request,  on
the 2nd of Nov., 1818,  Doctor John Moore  was  elected Associate
Obstetrician to the house.
  In 1818,  Doctor Dorsey, after a few days illness,  terminated his
mortal career in the 35th year of his age.  By the death of Dorsey,
the  profession lost one  of  its  noblest  ornaments; the institution, a
man who reflected honor on its hospital; and the poor a compassion-
ate and devoted friend.   The place thus made vacant by  the hand of
death,  was filled on the 20th of November, by Doctor Joseph Harts-
horne, then among the leading practitioners in Philadelphia.   Two
sons of Doctor Hartshorne, enjoying deservedly high reputations as
men of culture and position, perpetuate  the eminence of their pa-
ternal ancestor in our midst to-day.  Doctor Hartshorne's connexion
with the house, continued until February 28th, 1820,  when an exten-
sive and laborious practice compelled  him to  withdraw.   On the
same day in which his  resignation was accepted,  Doctor John Rhea
Barton  was elected, one of the most  accomplished and ingenious
surgeons of  this city, although not now, it is to be regretted, engaged
in the  active duties of  his profession.
  It was during this year, Doctor William Swaim, the manufacturer
of a panacea which had acquired considerable public notoriety, was
allowed the privilege of  administering his patent medicine to several
patients suffering from certain specific ulcers, and with a degree of suc-
cess which I believe secured unfortunately the endorsement of names,
high in  the ranks of  the  profession.   The large fortune amassed
by  the  patentee of this medicine, may be  said in a great  measure
to have resulted from  the circumstances attending this experiment
   In February 1821 Doctor Moore resigned, and Doctor Henry Neill
was elected, first  as Assistant Obstetrician  to Doctor  James, and 
15
afterwards,  in  March, to  equal  rank with his colleague.  Very
shortly after, Doctor  James, whose service to this charity extended
over twenty-five years, declined  longer  to  discharge the duties of
obstetrician, and on the 5th  of  March 1821, Nathan Shoemaker
assumed the labors of this department.   This year the addition of
two surgeons and two physicians to the medical board was sanc-
tioned by the managers, which in connexion with the resignations
of Doctors Parrish and Rush,  the same year, left four places to be
supplied, and to which Doctors William  Gibson, George McClellan,
Samuel  Colhoun, and Wm.  P.   C. Barton were chosen—all men
holding high rank among the magnates of American  Surgery and
Medicine.
   During 1822 the  leaven  of discord again commenced  working
among the members of the medical corps, and finally attained such
proportions as to demand the interference of the managers, who passed
a resolution to dispense with the  services of the board.  This occur-
red  on  the 12th of  August,  and on  the 26th  they proceeded to
select a new  body, which  consisted  of Doctors  Samuel Jackson,
Joseph  Klapp,  John K. Mitchell, and Richard  Harlan, to serve as
physicians.   Doctors John Rhea  Barton, William  Gibson, William
E. Horner, and J. V. O. Laurence,  as Surgeons, and Doctors Henry
Neill, and Nathan  Shoemaker,  obstetricians.   Doctor Klapp  only
retained his  connexion  with  the house, until  September, when he
was  succeeded by Doctor Nathaniel  Chapman.   Doctor Laurence,
who was one of the most indefatigable workers, especially in morbid
Anatomy,  was  attacked with the prevailing fever of 1822, not-
withstanding which  he very imprudently continued to discharge his
his professional labors, until, after an operation at the institution, he
found himself utterly exausted, was taken home in the  carriage of a
friend, and a few days after expired.  After the death of Laurence,
Doctor  Harlan was transferred  to the  Surgical  staff, and  Doctor
Hugh L.  Hodge elected to the  vacancy thus created in the medi-
cal  department.  In 1827 Doctor Shoemaker declined longer acting
as obstetrician,  and on  the 3d of September  was succeeded by
Doctor  Lukens.  This year indeed was rather remarkable for changes
in the  medical organization.  Doctors Mitchell  and Lukens re-
signed, and were replaced by Doctor Samuel George Morton, the  dis-
tinguished naturalist, and Doctor Ellis.  The latter gentleman main-
tained  his connexion with the  Alms House  until 1831, when he
was removed by death, and on the 2nd.  of May of the same year
Doctor-------Beattie, was selected  to fill the vacancy. 
16
   In March 1828, an act had passed the Legislature of Pennsylva-
nia, providing for the erection of a new Alms House, and the sale of
the old one.   It further provided for the construction of a  hospital,
not to be erected  beyond Schuylkill Eighth, now called 15th street.
The Medical Board pressed the building of this hospital strongly on
the Managers, believing its removal to the west side of the  Schuyl-
kill would destroy its value as a Clinical School.   Their efforts, how-
ever,  proved unavailing, as the enterprise was calculated to involve a
very large outlay of money.
   On  the 30th of April, 1832, Doctor  Chapman  gave up his posi-
tion, and  was succeeded by Doctor Jacob  Randolph.   Up to this
period Doctor Horner  had been  serving  as  physician, but when
Doctor Randolph became a member of the board, they, by mutual
agreement exchanged  situations, Surgery  being  more in harmony
with the tastes of the former.   Almost three years elapsed before
another change is recorded ; or until March 16th  1835, when Doc-
tor Neill resigned, and Doctor Casper Wister Pennock, was  elected,
Doctor Pennock was a highly accomplished physician, and this  hos-
pital  furnished to him a field for those observations on the heart,
which were afterwards presented in a  volume to the medical world.
An earnest and  untiring  worker, he was  soon laid aside from the
activities of a profession which he dearly  loved, and although still
living, is the victim of a  hopeless paralysis.
   On the 13th of October 1835, Dr. William H.  Gerhard was elec-
ted one of the physicians.   The  Doctor had enjoyed  as a resident
pupil the practice of the house for four years, namely in 1828-'29,
'30 and '31.   It was while acting  in this capacity in 1829, he  per-
formed those experiments on the Endermic application of  medicines,
which were made the subject of a thesis, and which have been trans-
lated  into  almost every language.   It was here where he commenced
the cultivation of physical exploration as a means of diagnosis, and
which entitles him to be regarded as the father of auscultation and
percussion in  America.   It was here in 1836 where he made those
careful investigations  in  the study  of intestinal  lesions,  which
clearly established the distinction between typhus and typhoid fever.*
And it was here where by changing the  stereotyped method of treat-
ing cases  of  mania-potu,  he was instrumental in diminishing the
mortality of such, fifty per cent.

  * These  papers may  be found in the  " American  Medical Journal of
Medical Sciences" for the year 1837. 
17
  This year Mr. Isaac Collins, a member of the board of Guardians,
offered a resolution to alter  the medical organization, by establish-
ing a Chief Resident Physician, to reside permanently in the house.
Although it was subsequently reported on as inexpedient, yet it may
be regarded as  the germ of  a  subject, which has at different times
produced no small  amount  of agitation.  On the 7th  of October,
1835, both Doctors Hodge  and  Morton resigned.   These vacancies
were supplied by the election of Doctor Joseph Pancoast, the present
eminent Professor of Anatomy in Jefferson  Medical  College, and
Doctor William Ashmead.
  On  the 28th of December  of this year, Doctors Gerrhard  and
Pennock, suggested to the  Guardians  the propriety of designating
the  hospital department by some  specific name, as that of Alms
House  could not technically be regarded in the sense of a hospital.
When the subject came up regularly before the Board, it was moved
by a member—Mr. Hansel, that it should be styled the Philadelphia
Hospital.  This received the  sanction of a  majority vote, and has
been known under that name ever since.  In the month  of February
1837, Doctor Pancoast was transferred at his request to  the surgical
staff, a vacancy having taken  place  by the  withdrawal of Doctor
Randolph.   To supply Doctor Pancoast's vacancy in the Medical de-
partment, Doctor N. Stueardson, became a member of the board.   In
1837 Doctor Beattie, one of the obstetricians, resigned, and Doctor
William  Brinckle became a member of the board.  Dr. Stueardson's
 connexion with the House did not extend much over one year, or until
 May 1838, at  which time  Doctor  Robley  Dunglison,  the present
 distinguished  professor of physiology in the Jefferson Medical Col-
 lege, was elected.   The year just passed, was remarkable for one of
 those visitations of folly and ignorance, which  seem periodically to
 sweep over the country; providentally I believe, designed to  distin-
 guish the wise fiom the fools.   In the instance referred  to, it was
 Animal Magnetism;—and  of course  if a patent medicine was to  be
 tested,  or any charalatan maneuvre to be practiced, the Philadelphia
 Hospital was the field  in which trial was to be made, like a barber's
 head, everlastingly pulled for stray hairs to  determine the cutting
 qualities of his instrument.   The resident pupils, among others, assfd-
 ously laboured in  the  manipulation of patients, to determine  its
 value, until the Guardians, for fear the remedy should prove too pow-
 erful for the constitutions of the poor, passed a resolution on the 20th
 of June 1837, disallowing all further operations. 
18
   In December 1838, two vacancies were made in the board, by the
withdrawal of Doctors Ashmead and Harlan, to  which Dr. Charles
Bell Gibson, now  professor of Surgery  in a Virginia Medical Col-
lege, and Edward Peace, late  Surgeon to the Pennsylvania Hospital,
were  elected.  The  next change was  the resignation of Doctor
Brinkle, in May 1839, and the appointment of Doctor Robert M.
Huston to supply his  place.  Doctor  Gibson  declining  to serve
longer than  the  fall of 1840, Doctor  James M'Clintock, became
one of the obstetricians  of the house.   In 1841 Doctor Peace's con-
nexion with the medical board terminated, and on the 3d of May, of
the same year, Doctor Ashmead  again become  connected with the
hospital.  In the following August Doctor M'Clintock removed from
Philadelphia, and Doctor William H. Gillingham became one of the
obstetricians to the institution.
   In  April  1843, Doctor Meredith Clymer was elected one of the
officers of the house, and was, I believe, the last member of the old
board of visiting physicians.
   The 30th of June 1845 is somewhat  memorable in consequence
of the culumination of  a  trouble which had  been  developing for
some time.  The resident physicians were  boarded at the table of
the Steward, where, as I understand, in consequence of the want of
due formality, and  decorum in the destruction of an unfortunate cock-
roach,  which had rashly taken a near cut acrossthe table, instead of
going round,  these gentlemen became indignant, and demanded of
the managers to be transferred to the table of the  matron.   Their
refusal to comply with this request determined a unanimous resigna-
tion, leaving the hospital unprovided with  any  medical assistance.
The evening of that day Doctors Horner and Clymer  attended, and
prescribed for the  sick.   Here was a " cassus belli," and the mana-
gers promptly passed a resolution of dismissal.   With the hope of
adjusting these differences, and bringing about a partiaf reconcilia-
tion, a joint meeting was called for July 2nd, at which Doctors Jack-
son, Horner,  Clymer, Gillinham, and Pancoast  attended, represent-
ing as a committee the medical board.   Dr. Jackson who seems to
have been the advocate in the case, spoke in  behalf of  the com-
mittee, urging on the managers to allow the residents to remain, at
least until their places could  be properly supplied, and declining to
pass any censure, or interfere in any way in a matter of personal con-
flict between  the  residents and guardians, as foreign altogether to
their legitimate jurisdiction.   The guardians, however, were inexora-
ble, and refused to recede from their vote of dismissal, thus forever 
19  -
closing the door of compromise.   The seceders after retiring, availed
themselves of the columns of the Ledger newspaper, in which there
appeared a card, betraying, to say the least of it, a good deal of youth-
ful indiscretion.  On the same  day of this meeting, Mr. Flanagan,
offered the following resolution, " Resolved, That the Hospital Com-
mittee be requested to inquire into the expediency of re-organizing
the Medical department of the house, and report to this board."  On
the 21st of July, that report was made; which, after going over the
ground of trouble, recommended the abolishment of the medical
board, and  the substitution  of a  Chief Resident  and  Assistant
Resident  Physician, and two Consulting  Physicians  and Surgeons.
On the 15th of September, the report was taken up and passed, modi-
fied as follows :—" After the 1st of October 1845, there shall be
One Chief Resident Physician, with a salary of $1800 per annum;
one consulting  Surgeon,  one  consulting Physician and  one con-
sulting Accoucher,  each  at  a salary of one  hundred  dollars a
year.  What great results  proceed  from  small and unlikely causes.
Who ever would have thought  the official existence of a medical
board, composed of the ablest men, in their various departments, on
the  continent, was  suspended on the life of a contemptible cock-
roach.  In  this manner the doors of the  Philadelphia Hospital, as a
school of instruction, were  sealed for nine years.

THE ADMINISTRATION UNDER A CHIEF RESIDENT MEDICAL OFFICER.

   On the 6th of October 1845, the  election  took place under the
new  organization, by which Doctor  H.  S.  Patterson  was chosen
Physician-in-Chief;  William Byrd Page, Consulting Surgeon ; Mere-
dith Clymer, Consulting Physician, and N. D. Benedict, Consulting
Accoucher.  Three  months  had not elapsed before  the board com-
plained of the interests of the  Hospital  being neglected.  Doctor
Patterson at that time  held a professorship in the Pennsylvania
Medical  College, and they deemed this  incompatible with his pres-
ent post.  On  the 9th of  November he resigned.  Doctor N.  D.
Benedict was eleeted his successor, and the  office of consulting ac-
coucher abolished.   In January 1848, the annual salary of one hun-
dred dollars which had been appropriated to  each of the consulting
officers, was changed, directing  five dollars to be paid for each con-
sultation, and such visits to be  ordered only in cases of absolute  ne-
cessity.   In February 1850, Doctor Benedict resigned, after which,
on the 18th of this month, Doctor----Haines become Chief Resi- 
20
 dent, which position he continued to hold until the 11th of February,
 1853, when exchanging his profession  for another, and more lucra-
 tive calling, he removed from  the city, leaving his place vacant,
 and was succeeded by Doctor J. D. Stewart.   In July of 1853, an
 effort was made to abolish this office and return to the old system;
 and although it did not prove  successful  as  regards the chief  resi-
 dent of the hospital, yet  it did prevail, in a degree, by  dispensing
 wth the Assistant Resident of the Lunatic Asylum.
   Doctor Stewart's connexion with the  house was very short.  His
 health had for some time been gradually failing, under the progress
 of an  organic affection of  the liver, and which terminated his life in
 April  1854.  The office of chief resident was now temporarily dis-
 charged by Doctor Coleman, then  an interne of the house, or  until
 the 1st  of May,  at  which  time  Doctor Archibald B. Campbell
 was elected.
                     CLINICAL INSTRUCTION.

   To Doctor Thomas Bond belongs the honor of inaugurating Clin-
 ical teaching in this country, while physician  to  the Pennsylvania
 Hospital as  early as 1766.  But for the Philadelphia Alms House,
 we may claim the establishment of  the first obstetrical clinic.   Stu.
 dents of good character were  allowed to attend cases of  labor, and
 the various stages of  the process were explained to them by Doctor
 Bond or Evans, under whose personal direction these instructions
 were conducted, as early as 1770, and in all probability much earlier,
 as  may be inferred from  the  phraseology of the minutes  touching
 this subject.   In  1772, the  managers were solicited to  extend the
 medical conveniences of the house  for  the better accommodation of
 students, increased numbers of which began to be attracted to Phil-
 adelphia, from  the growing  reputation of her  medical school.  A
 part of this plan was  an increase of the medical officers;  and at this
 date, some of the  first names in the profession were associated  with
 the enterprise,  such as Huhn, Rush, and Clarkson; but the records
 are too meagre  to furnish  any  details of the manner in which these
 public instructions were conducted. It  was then the  most exten-
 sive hospital  on the  continent, containing about 350  persons, and
 must unquestionably have  contained much disease of an interesting
 and instructive character.  Where the  governing power of an in-
 stitution is constantly  undergoing change, little stability or perma.
 nence may be expected in  any plan  or system of education.   Either
the hostility of some of the  managers, or  more probable  the un- 
21
settled state of affairs consequent on the revolutionary struggle, in-
terrupted the medical instructions for some time before 1778, nor is
there any  evidence that  clinical  lectures were  delivered  in  the
Pennsylvania hospital for several years subsequent  to 1771,  where
Doctor Bond was in the habit of  delivering a course as a part of the
instruction of the Medical College.   In November 1778 the subject
was revived by the  students present in the city.   They  presented a
formal application to the physicians of the Alms House for permis-
sion to witness the practice in that institution.   Doctors Rogers and
Leib  waited on the board of managers in  their behalf, and pressed
the importance of such a measure with great earnestness.  On the
17th of November, the subject came up formally before  the board,
and although there were several  altogether favorable to the propo-
sition, a majority of the votes were recorded in the negative.  Im-
mediately after, the physicians renewed their application, and solicited
a personal  conference with  the  managers.  A second  meeting in
consequence took place, at which the  advantages of hospital instruc-
tion  to the  profession  and  the community were presented with re-
newed cogency and sincerity.  They begged a re-consideration of the
subject, asking  the body of managers to  concede  at least a proba-
tionary trial, and volunteering a personal responsibility for the good
conduct of  the  young men  in  attendance.  The plea was not un-
successful ;  the vote was re-considered, and the house was opened by
a majority of  one vote, for clinical instruction.   Until 1789 hospital
teaching continued to be conducted under great embarrassment, part-
ly on account of  the war, and partly from the opposition of the hos-
tile element in the board, so that  while we cannot say it was formally
abolished, udejure," yet it was almost impracticable, " de facto."
   On the 5th of May 1789, the physicians elected  sent a communi-
cation to the board, in which they  took occasion to say,  " that inas-
much as they furnished their  services to this institution without ex-
pense to the managers, they ought to  have such facilities offered, as
would make their practice  useful  to the  public."   Their meaning
not being sufficiently explicit, the board asked an explanation, which
they received on the 4th of July;  and certainly left as little room
for misunderstanding, as did the  immortal  document of the declara-
tion  associated with this day.   On  the 29th the managers framed a
communication  for the medical  attendants, full of compliment, ac-
knowledging their valuable  services to  the sick, and assuring these
gentlemen they will ever  endeavour to make their duties as  agrea-
ble as  will be consistent with the good order of the house, and the 
22
 delicacy due to the patients under their charge.  One month after,
 all the physicians withdrew from  the institution.  For six years the
 subject was allowed to  slumber, until  October 1795, when Doctor
 Cumming, who had been appointed one of the visiting physicians,
 ventured  to approach this  hitherto imperturbable body, with a re-
 quest to be allowed the  privilege of introducing his private students
 to the wards on the days of his  official visits.   The proposition was
 promptly  rejected, on the ground of such  publicity being calculated
 to do harm to  the sick.  In 1803 Doctors James and Church pro-
 posed to attend the lying-in ward, on condition they should be allow-
 ed to have one private  pupil  present at each case of labor.  The
 application was granted, and  much  invaluable instruction was com-
 municated in this responsible department of medicine.  My father,
 who was a pupil of Doctor James, was among the number who  en
joj'ed this privilege.   The same year, on the 23d of March, Doctor
 Caldwell  was  allowed  to  introduce and  instruct a  select class  of
 20—afterwards 40 students—during his stated visits to the medical
 wards, on the condition of his becoming  responsible for their good
 deportment.   Students  at that time were  regarded with  no small
 amount of suspicion;  and even at the present, there are not wanting
 many persons  who entertain  toward them a good deal of reserve and
 distrust.  It is a shocking thing,  gentlemen, to cut up dead people;
 and one might suppose from the horror with which some people shun
 you, that  students were in the habit of eating them.
  In September  1817, through  the efforts of Doctors James and
 Church, the managers conceded  the privilege to deliver clinical lec-
 tures to a class of students twice a week, in the green or dead house,
 during the winter season.  Shortly after Dr. Barton was permitted to
 give instructions to his  class  on the days of his  regular attendance
 at the house.   Every successive year now removed  more and more
 the prejudices which had so long operated against the admission of
 medical students.   The Managers were seized with an active desire
 to promote and foster a system which contributed so largely toward
 laying a solid foundation of  medical usefulness.  Hence, in 1805,
 the buildings for the accommodation of the sick and the poor being
 inadequate for their proper  comfort, the administrative part of the
 board addressed the Legislature by petition, soliciting aid to enlarge
 the house.  In presenting their prayer, they rest their claims on the
 State in the fact, that the charities of the institution had not been
 confined to the city and county of Philadelphia alone; one fifth  of
 the inmates being from  other parts of the commonwealth :  that the 
23
Pennsylvania Hospital, rich in estates, had repeatedly received assis-
tance from the munificence of former Legislatures,  and was at that
time before the Assembly for help;  and yet its  doors  were closed
against the poor, and more than an equivalent for board and lodging
exacted:  that moreover the Alms House, containing over one thou-
sand  inmates, presented  an extensive field for communicating med-
ical instruction to students, attracted from all sections of the country,
by the celebrity of the school.   This petition anticipating extensive
preparation for clinical accommodations, was regarded by the general
board as an unwarrantable  assumption of power  on the part of the
managers, and produced a very tart  correspondence, which I have
no doubt produced the passage of the supplement to the poor law of
1808.
   Until October the 25th, 1805, no fee was demanded from those
attending the instruction of the institution ; but  at the above date a
 ticket was directed to be issued, signed by the  President and Secre-
 tary  of the Board of Guardians,  at the price of  eight  dollars—two
 purchasing a perpetual  privilege.  The office pupils of the Medical
 officers were  free  to attend without charge.  In November, 1806,
 Doctor James was delivering lectures  still in  the  green room, and
 there they continued to  instruct, until 1811, when the  Surgeons
 connected with the Alms House, asked for more suitable apartments,
 in which operations  could be performed, and thus  remove  from the
 ward a source of mischief to  the other sick.  To correct  this evil
 the board had the building called the dye and wash-house, carried up
 an additional  story, fitted up as a lecture room,  with two adjoining
 wards, capable of holding each twenty or  thirty patients,  and here
 were next delivered the Clinical lectures.
    During 1813, the Managers, anxious to advance the reputation
 and  popularity of the house, were induced to  tender to any student
 taking their ticket,  the privilege of attending a case of labor, and
 to give the proposal greater publicity, it was by their  authority an-
 nounced in the public papers.   This scheme of indiscriminate admis-
 sion to the ward of the  lying-in department, brought out a minority
 protest, which was  not only a sensible paper on the subject of differ-
 ence, but which introduced and exposed the suicidal measures of the
 board on another matter closely allied with the success of the Alms
 House, as a medical school, by making the simple  circumstance of
 holding  an appointment in the  Pennsylvania Hospital, a disqualifica-
 tion for  a similar one  in the  institution over which the  managers
 presided.  They urged  the wisdom of selecting the very best talent 
24
 wherever found, and especially the propriety of seeking as many from
 the Medical School as possible.  That the force of this may be un-
 derstood, it must be remembered every student was required, as a con-
 dition of graduation, to take a ticket in the Pennsylvania Hospital.
 If, therefore, they could identify the  interests of the faculty of the
 University with the Alms House, it would in all probability procure
 such  a modification of the rule, as would,  at least, leave it at the
 pleasure of the student, whether this ticket was taken at one or the
 other.  This protest effected a change of sentiment in the Board,
 securing not only a more circumspect  modification of the obstetrical
 privilege, but a repeal of the law so far as it  effected the eligibility
 of professional men serving in a kindred institution, and on  the 6th
 of November 1815, produced the very result contemplated.
   A more noble spirit on the part of the managers this year,  also led
 to a pleasant interchange of civilities between these sister hospitals.
 The Steward was authorized  to address a note to  the Residents
 of the Pennsylvania Hospital, inviting them  to an operation to be
 performed at the Alms House, and this privilege was afterwards
 made perpetual.
   On the 5th of January, 1818, a  conference  was  held between a
 Committee of Trustees of the University, and the Board of Guardians,
 with a view of establishing  more extended clinical teaching in the
 Alms House.  The number of students had been gradually increas-
 ing.  In 1818  there were  53 in  attendanse; but the succeeding
 three  years being remarkable for the prevalence in the house of ma-
 lignant  disease, had no doubt  some  influence in  diminishing the
 class,  for in  1819  it does not appear there were more than 43, and
 in 1820 but 22  in  attendance.   In 1822, however, the number ran
 up to 110.   This was the year in which  Dr.  Barton,  having been
allowed to convert the area in the rear of the centre building into a
botanic  garden,  was in the habit  of taking  the  class  among the
plants to illustrate the subjects of his lectures ;  and the year also in
 which Gibson, Barton,  Horner, Mitchell, Laurence,  and Chapman,
all accomplished gentlemen, learned and  eloquent men in medicine
and surgery, were  wont to pour forth the treasures of their expe-
 rience and observation.  The subject of a botanic garden on a large
 and liberal  scale, and to be placed under a scientific head, had been
a favorite idea  with members  of both the medical  and managers'
 board, but  could not be  successfully accomplished.   After Doctor
Barton left the board, the old garden passed into the hands of Doctor
Samuel Jackson, by whose suggestion a green-house was constructed 
25
for the more complete  protection  and preservation of the plants.
Between the years  1822 and  1828  I have no data for determining
the number of students attending the clinical instruction.
   In  1827 it was announced in the  public newspapers that cases of
recent fractures would be received and  treated in the institution.
The suggestion came from the surgical staff, and would enable them
to furnish illustrations of the  management of a very important class
 of accidents.
   During  1827, Doctor Thomas Harris asked the privilege of de-
livering a course of lectures on Surgery in the lecture room of  the
house; which was granted by the guardians.  This course was didac-
tic in its character and had no connexion with  the  ordinary instruc-
tion of the institution.  In 1828 the number of students amounted
to 75, and in 1830 rose to 185.   In 1834, August 11th, Doctor Bur-
 den,  then a member of the board of guardians,  offered a resolution
 to appoint a committee to confer with the Trustees of the University
 and Jefferson Medical College, on subjects  connected with the in-
 terests of the Alms House.   The scheme which the  Doctor had in
 contemplation, was in the first place, to make the ticket of the house
 essential  to graduation, and  in  the  second, the organization of a
 summer school of  practical medicine and surgery in the institution;
 neither of  which received the sanction of the board.  The first was
 asking a  discrimination, which ought not, we conceive, ever be grant-
 ed to any hospital, the second was a wise  public-spirited, practical
 suggestion, which ought not to have been refused.
   It was this year the  Faculty of  Jefferson Medical College, then
 growing into deserved importance, requested of  the guardians to be
 placed on an equal status with the  University in regard to Clinical
 teaching.  The plan  they proposed was to set  apart two wards for
 them in  the  hospital—one for medical  and one for  surgical cases,
 and  alternate weeks for their Clinical lectures.  Those representing
 the interests of the University objected to such an arrangement, as
 calculated  to mar  the harmony of both of the schools and the  hos-
 pital.  They declare having  undertaken the development of a Clin-
 ical  school at a time when scarcely a ticket was sold, and at length
 succeeded in making it a source of  revenue to the board, and a for-
 midable  rival of the  Pennsylvania Hospital—the latter not selling
 over 30 tickets; and  last, that their connexion with the Clinic, in no
 way prevented the students of another College enjoying equal  advan-
 tages with their own.
    This year (1834) was one  of  great prosperity to the Philadelphia 
26
Hospital.   Two hundred and twenty students were  in attendance;
the proceeds accruing therefrom  amounting to fourteen hundred and
twenty dollars.  The board of managers appreciating the courtesies
due  to  men of liberal  education and position in the profession,
with commendable  propriety  tendered gratuitous admission to all
medical men attached to the army and navy.   These lectures were
delivered on Wednesday of every week during  the winter months.
In 1835, at the request of Doctors Patterson and  Calhoun, the day
was changed to Saturday, in accommodation to the instruction in the
Jefferson College, which sent this year 79 students to the clinic.
  The transportation was no inconsiderable item.  Long lines of om-
nibuses, (for there were then no street cars,) were stationed about
Ninth and  Chesnut streets,  on  Saturday morning, in a few minutes
crowds of students, full of life and  excitement, were stowed away—
not seated—in glorious, good-natured  confusion ;  and at the usual
salutation of the knight of the whip, " all right," were whirled away
at a spanking speed, some to the South street ferry, to be carried over
in a boat, which has  long been suspected  as one of Charon's—and
in so far as the transportation of spirits was concerned, not untruly;
others by the Market  street bridge.   Some of my  most pleasant re-
collections  of college life in 1837, are  associated with these weekly
trips, so admirably calculated to relieve the tedium of  the town, and
regale the  lungs with a more invigorating  -air.  The lecture room
was  situated in what is  now the lunatic  department, and only re-
cently  abaudoned.   It was  the most capacious and finely  arranged
amphitheatre in the  country, and  capable of seating from seven to
eight hundred persons.   Until  1845, this hospital continued to be
the great clinic school of the country, annually opening its exhaust-
less  treasures  of disease  to  crowds of  educated,  zealous inquirers
after medical knowledge.  The unfortunate  events which  in  1845
succeeded  the death of  the cockroach, terminated the  instructions
for several  years.
                  CERTIFICATES AND TICKETS.

   In 1817 a diploma, or certificate, was ordered to be engraven, the
impressions from which were made, some on paper and some on parch-
ment,  designed for the resident pupils, and which were furnished at
three and four dollars a copy.  In September  1832 a new  plate was
produced, altogether more artistically executed, and in 1835, a small
vignette view  of the house was  ordered to be engraven and printed
on the tickets.  In  1860, another ligthographic engraving of a cer-
tificate was executed.  The design represents a front view of the in- 
27
stitution, and was signed by the President of the board of Guardians,
the President of the Medical board, and the Secretary.
  After a pause of several years, and the profession becoming more
and  more  sensible of the great injustice and tyranny perpetrated
against the reputation of a  city enjoying such unexampled prosperi-
ty as a center of medical education, by excluding them from an in-
stitution supported largely from their own pockets, and possessed of
the most ample resources as a clinical school, began to move in the
matter.   On the 1st of  May  1854, the Philadelphia  County Medi-
cal Society addressed a  communication to the Board of Guardians,
asking that its doors be  opened to students of medicine.  The docu-
ment was forcibly written, but  produced no  change in the views of
that body.  In August of this year, Doctor John Reese, register of the
Medical Faculty of Pennsylvania College, in behalf of that institution,
communicated with the board on the same subject, and guaranteed
if its wards were opened to public instruction, the sale of fifty tickets
from that school alone.   These appeals,  no doubt, had some weight
with the guardians, but, to Doctors Henry H. Smith, and James L.
Ludlow, (and I speak from personal knowledge,) more than to all
others combined, is the profession of Philadelphia, and the country
at large, indebted for the re-establishment of a Clinical school, with-
in  the  walls of this institution.  Neither must Doctor Penrose be
overlooked in this important work, as he labored indefatigably for
the same  end.  I  make no mention of my own efforts in the same
direction, for while I did what I could, I was comparatively a stranger
in the city, and had no   influence  whatever.   These gentlemen vis-
ited each  member of the board of guardians personally, and by an
unwearied, persevering  presentation of the subject in every possible
shape, finally succeeded by their importunance, as the widow with
the  unjust judge, in revolutionizing  the  settled sentiment of the
board, securing a favorable report from the hospital  committee, and
its adoption on the motion of Doctor Henley, by the general board
of guardians.   The rules for the government of the Clinic were re-
ported on the 6th of  September 1854, and provided for the election
of two physicians, and two  surgeons in addition to the chief resident
officers.

THE ADMINISTRATION  BY A RESIDENT-IN-CHIEF;  AND A BOARD
      OF LECTURERS  ON CLINICAL MEDICINE AND SURGERY.

   On the  same day in which the rules were reported, (6th of Sep-
tember 1854,) the guardians proceeded to elect the medical officers, 
28
when Doctors  J.  L. Ludlow and  Robert Coleman were  selected
physicians, and Doctors  Henry H. Smith  and D. II.  Agnew, sur-
geons.  Doctor Coleman being compelled by previous arrangements
to resign, Doctor Casper Morris was elected in his place, and on the
30th of the following October, the staff was increased by the  appoint-
ment of Doctor R. A. F. Penrose, obstetrician  to  the institution.
Tickets of admission were fixed  at  ten  dollars, including transpor-
tation, two days in the  week—Wednesday and Saturday—for four
months.   The  West  Chester Rail road, which passes  through the
grounds of this institution, was just being completed, and an  arrange-
ment was made with  the superintendent, to run  cars  from Broad
and Market  streets to some point opposite  the building,  on  the days
of Clinical lectures.   The second week in  October 1854,  an  im-
mense train  left Broad street, filled to repletion with  medical stu-
dents, to witness  the inauguration of this  important event.  This
passenger  train, I believe, was the first which passed over  the long
stretch of  tressle  work  supporting the road  across  the meadows of
this property.   Its living freight was landed opposite the river point.
Certainly not less  than  700 persons were present in the old amphi-
theatre, and the first  Clinic of the new  era was held, after  some ap-
propriate  remarks by Drs. Smith and Ludlow.   On the following
June of 1855, the hospital committee deemed it proper to increase
the number  of medical officers, and by their recommendation, two addi-
tional, were  added to each staff.   These were Doctors Joseph Carson,
and  J.  B. Biddle, to the medical, Doctors  John Neill, and R. P.
Thomas, to  the surgical,  and Doctors  Wilson Jewell,  and Casper
Morris, to the  obstetrical departments,  the  latter gentlemen being
transferred from the  medical  to the obstetrical at his own request.
   On the 2nd of July 1855, the period for the annual election of
a chief-medical officer, Doctor Robert  K. Smith was selected by the
guardians, and who co-operated most efficiently with the Clinical board,
delivering in October an excellent introductory, and participating in
the clinical instructions  communicated to  the class.  On the 21st
of July, 1856, Doctor A. B. Campbell was elected  chief  resident
physician.   A remarkable change this year came over  the  board of
guardians in reference  to the house  instruction.   It  is altogether
foreign to my purpose to enter into  any analyses of  the instrumen-
talities employed to sway the opinions of these gentlemen,  although
they were quite patent, I presume, to any  member of  the medical
organization connected with the institution.  It is sufficient to say,
that on the motion of a  member, offered on the 22nd of December 
29
1856, Clinical instruction in the Philadelphia hospital was abolished
after the termination of the lectures  then in progress.   The reason
adduced in justification of this act, was the failure of the Clinic to
meet its own expenses.   The record stultified the allegation; and
those who were  cognizant of  the facts, could not but feel indignant
at so audacious a falsification of  the case.   There were at that  very
time seventy-five students in attendance, a larger number than usually
attended hospitals either in this country or Europe.
   On the 8th of June 1857, Doctor Campbell resigned, and was sue"
ceeded by Doctor James  M'Clintock, very shortly after which event
the visiting members of the medical organization all resigned, several
of the residents physicians withdrew from the house, and again the
institution ceased to administer  to  the wants  of the  medical class
of Philadelphia.
   On the 5th of July 1858, Doctor Robert K. Smith  again became
chief resident officer, and on the 19th of the same month, under the
auspices of this new medical head, Mr. Reall, a member of the board
of guardians, proposed to re-establish a board of Clinical lecturers.
The subject for a time was laid over, until the 11th of October, when
the students of the different Medical  Colleges in the city, addressed
a communication to the  guardians, praying  for  the revival of medi-
 cal instruction.
   On the 22nd of November, they  acceded to  the  request; and
 proceeded at  once to ballot for gentlemen  to discharge this duty.
 Doctors Joseph Carson, J. B. Biddle, J. Atkin Meigs, and Samuel
 Dickson were elected lecturers on Clinical Medicine;  Doctors John
 Neill, W. S. Halsey, Richard J. Levis, and D. H. Agnew, on Clin-
 ical  Surgery; and Doctors R. A. F. Penrose, and E.  McClellan, on
 Obstetrics and diseases  of Women  and Children. Doctor Dickson's
 health not allowing him  any increase in his labors, was compelled
 to decline serving, and  in his place Doctor J. Da Costa was elected
 one of the Physicians ; and under  this organization, the hospital
 commenced  again to discharge one of its legitimate  functions to
 the community.  On  the 4th of July, 1859, the old board of  guar-
 dians  was abolished, which for many years had  been selected by  a
 popular vote, and a new one consisting of twelve members appointed
 by the  Courts  and Councils, came  into  power.   This organization,
 consisting of  the most respectable and intelligent gentlemen in our
 community,  men of enlarged liberal  views, conjoined with superior
 practical ability, after a careful survey of  the  field, entered on the
 work of reform.   Among the subjects which earliest occupied their 
30
attention, was the medical department of this  institution.  The re-
sult cf these investigations was a return to the old system, dispen-
sing with the office of chief resident, and placing the hospital de-
partment  under the charge of a medical board, consisting of twelve
members, to act as physicians,  surgeons, and obstetricians, and who
were to visit the institution four times a week.   The election for
these officers took place on the 8th of August, 1859, at which Doc-
tors James L.  Ludlow, William F. Mayburry, Charles P. Futt, and
Robert Lucket, were selected  to constitute a medical staff;  Doctors
S. W. Gross, Richard J. Levis, Robert Kenderdine, and D. II. Ag-
new, a Surgical staff; arid Doctors R. A. F. Penrose, John Wiltbank.
William D.  Stroud, and Lewis Harlow, an obstetrical staff.   It was
in August, of  this year the professors of the  Homoeopathic  College,
proposed,  in a communication  addressed  to  the  guardians, to take
the entire  charge of the medical  department, and furnish all the
medicines for the sick, without any charge whatever.    On the 27th
December, 1859, the medical board underwent some changes, in con-
sequence of questions connected with  the political state of the coun-
try, and which have since inaugurated a revolution of unparralleled
magnitude, the issue of which on  the destinies of race, nation, and
the world, no human mind can foresee.   Doctor Lucket, espousing the
Southern view of  the question, induced a large number of medical
students, to  abandon the Medical Colleges of Philadelphia, and enter
the institutions of their own States.   The Doctor becoming the med-
ical Moses of this exodus, left his place in the board, to which Doctor
J. Da Costa was elected in December 1859.   In the month of  De-
cember 1859,  Doctor Wiltbank resigned, and to supply the vacancy,
Doctor  George Zeigler  was elected.  Again, in  May 7th,  1861,
Doctor Mayburry was compelled, by  the  extent  of his professional
duties, to  withdraw  from the  board, and to  which  place Doctor
0. A. Judson was elected.
   Since the  new organization of the  board of  Guardians, by which
in a great measure this house  has been  rescued from the vortex of
politics, its medical  prosperity and popularity have been steadily in-
creasing, until it may now be  pronounced the great  Clinical school
of this country.  The change was not accomplished without a  strug-
gle.   There is a class of persons who can only subsist in the  seethiDg
cauldron of  political agitation, and who cling to official place  like
barnacles  to  a  ship's bottom.  Of such, there were some who lost no
opportunity  to prefer charges of  mismanagement in  order  to shake
the confidence of the  public in the administration  of the present 
31
organization.  On the 25th of June, 1860, it was  stated  in Com-
mon Council  that  a  great  increase had taken  place in  the mor-
tality of the institution since the change in the medical  system, and
a committee was appointed to investigate the facts of the case.*   In
the report of these gentlemen, it will be seen that instead of the mor-
tality being increased, it had been  greatly diminished.   They took
the last year of the old board of guardians  which expired on July
the 1st, 1859, and contrasted it with the first year of the present board;
which terminated on  July the 1st, 1860.   By examination, it ap-
peared the  year  ending July, 1859, the average population of the
house was 2513,  and the deaths for the same period were 657, or
26.15 per cent, of the average  population.   For the  year ending
July 1st, 1860, the average population was 2520, and the deaths for
the same time were  589 or 23.30  per cent, of the average population.
This showed  a decrease of 68 in  the number of deaths, or 11 per
cent, on the mortality of the previous year.  In the Insane Depart-
ment for the same years—that is 1859,  with an average population
 of 400, there  were  96 deaths or 24 per cent, on the above average.
In 1860  the  average population was 425, and 72 deaths—or not
quite  17 per  cent,  of  the  average  population, a decrease of 38 per
 cent, on the mortality of  the  previous year.   They go on further to
state, that it must be  remembered  only a part of the population of
the Alms House is under  medical treatment, and that the proper
basis to determine  the per-centage  of mortality among  the inmates,
 should be taken from  the Hospital.   For this purpose, the Commit-
tee took the last published report of the late Chief Resident of the
 former board, for 1858.  Its author declares, during that period the
 institution  shows a smaller mortality than had been known for many
 years.  By that  report, in the various wards of  the Hospital, Chil-
 dren's Asylum and Nursery, there were treated 5335 cases of disease,
 of which number 549 died, or 10-29 per-cent.  The books of the
present board showed  6176 cases  treated, and 478 deaths, or 7-74
per cent, exhibiting a decrease of  25 per cent,  on  the  mortality of
the former  year.   This, then, was a vindication of the wisdom of the
guardians,  in establishing the present medical organization, and
rested  on a  mathematical demonstration  which even  its enemies
dare not gainsay.  On the 10th of  September 1860,  the medical
board addressed the  guardians on the propriety of throwing open
the wards of  this hospital for free clinical instruction.  This propo-

   * Journal of  CoramoD  Council, from  May to November, 1866.   Pnge 121. 
32
sition was considered from a liberal  and intelligent stand point, in
its broader and more general bearings, and, on the 24th September,
1860, received their cordial sanction;  and to this time, and it is to
be hoped, through all time to come, its doors  may never be closed
against, or a fee craved from, those who enter its  halls in search of
that knowledge which can  alone render them qualified to discharge
the functions of a divine art.
  In the month of April  1861, the guardians furnished another
proof of the  confidence which  they reposed in the medical  board,
by authorizing the construction of the  present  lecture room,  which
for elegance and convenience has no  superior; and which was form-
ally inaugurated on  the 16th of October 1861, in an able address
from Dr. James L.  Ludlow, on the subject of the Rise and Progress
of Clinical Instruction.
                          MUSEUM.

  On the 25th of November, 1814,  the first  effort  was made to
establish a Hospital Museum.   The  Board required  every resident
pupil to leave in the  house a preparation made by himself.   That
the rule was enforced  for a time there can be  no  doubt, for  on the
26th of February, 1822,1 find the acknowledgment of the following
anatomical preparations:—A Corroded Kidney, by J. T. Sharpless;
A Side View of the Head, with the  Vessels  Injected, by J. M.
Fox; A Specimen showing the  Anatomy of Scrotal Hernia, by Ed-
ward  L. Dubarry, and a  Foetal preparation,  showing  the  vessels
peculiar to the  circulation.   Where are these now ?   The 23d of
November 1840, Doctor Burden, one of the  guardians, presented  a
resolution to fit up a room  in the centre building of the hospital for
a museum, which was to be placed  under the charge of the apothe-
cary, to whom all the  morbid specimens were to  be  given for pre-
servation.   The first museum contemplated, was evidently to be only
a depository for  normal anatomical specimens:  this  last  may be
considered as the inception of a pathological cabinet.  There  were
three things  which,  of course, rendered it impracticable.  First,
the curator was to be the apothecary, who, of course, knew nothing
of pathology; second, there were no provisions made for dissecting
the  specimens;  and  last,  at this very period, the  subject  of post
mortems was embarrassed  by more  formalism than would be neces-
sary to  ratify and induct an Archbishop into his holy calling.
   On the 10th of September 1860,  the present board of guardians,
actino- on  the recommendation of the medical board, authorized the 
33
founding of a pathological museum, to which the writer was assigned
as Curator.  For the perpetuation of this important undertaking,
an annual appropriation of two hundred dollars  is made, and which,
if judiciously expended, will serve to preserve a large amount of
pathological material.  The work has begun.  Already a considerable
collection has been  placed on the shelves of this  museum; some of
them quite unique of their kind, and all most valuable illustrations
of morbid structure.   Although much of this  work has been done
at considerable personal inconvenience, yet I assure  you it is with
no ordinary feelings of pride and pleasure, that  I regard the associa-
tion of my name with an enterprise, which if prosecuted with ordi-
nary industry and  intelligence, will in a  few  years  secure  to the
Philadelphia  Hospital  the  most   valuable  collection  of morbid
anatomy to be found anywhere in this country.

                            LIBRARY.

   Among the wants specified by the board in 1805, when they went
before the Legislature for aid, was a room to be appropriated for a libra-
ry.   About the beginning of the year 1808, this work commenced,
and on the 9th of May, one hundred and fifty dollars were appropriated
by the managers for  the purchase of books, to be selected  by the
physicians of  the institution.   Rules were  reported shortly after for
its management, and the senior resident student appointed librarian,
at which time the books were labelled and numbered.   In 1810
another appropriation  of one hundred and  fifty dollars was made for
the  same  purpose.   On the 28th of December  1812,  a committee
was appointed to draft rules for the management of the library, and at
this date there was an unexpended balance to its credit of four hundred
dollars, which was  money received from the house pupils.  In 1813
a rule was passed conferring a life  privilege to the use of the library,
for the sum of thirty dollars.   This year three hundred dollars was ex-
pended in books, duplicates of all  elementary works being ordered.
In 1815 free access was allowed to physicians and students who should
attend the practice of  the house  for two years, and also to private
pupils of the medical officers of the institution.  In 1816, the apothe.
cary was appointed librarian, and  the library  catalogued.  On the
18th of August  1818, by a report of Doctor M'Clellan, the  library
contained 1022 volumes, and 597  different  works.   On  the 8th of
November 1824, the managers  passed a resolution making an annual
appropriation of two hundred dollars for the benefit of the library.  In
1827, Doctor Horner presented the institution with  one hundred and 
34
twenty theses from Edenburg.   In 1831 it was again catalogued by
Doctor Rivauus, one of the resident physicians, and contained some
very valuable works.  In November 1836, Doctor Charles Pickering
applied to the board for certain  works in  their possession, for the
use of the United States Exploring Expedition, and which were not
attainable in this country ; offering a large advance on the importa-
tion price as an inducement to sell.   The matter was referred to the
medical  board  and refused.   Accessions were made  from time to
time,  by  appropriations made out of the proceeds resulting from the
sale of clinical tickets, until it numbered over 3000  volumes; the
finest collection of ancient  medicine and  surgery,  probably any
where to be found.  For the last fourteen years very little attention has
been bestowed on this important appendage to a great hospital.  On
the contrary, it has been plundered by the vandalism to which it has
been exposed, of much valuable matter.   At present, however, it has
been  placed under the  care  of Doctor Tutt,  and having been re-
moved from the lunatic department, is being re-arranged in a very
excellent room  appropriated to its use, in  the  north end of the hos-
pital  building.   An appropriation  is now annually  made by the
present  board of guardians  for its  improvement  and preservation
and we may hope to see it again growing in value every year.
INSANE DEPARTMENT.
   The Alms House buildings, as first constructed, were not adapted
 to  the reception  of insane patients, especially if laboring under a
 violent type of mental disease.  The managers, therefore, were in
 the habit of placing such cases in the Pennsylvania hospital, whose
 arrangements were much safer and better for the control, of lunatics.
 The expense of supporting them in this institution was an item of
 much complaint on the part of the managers of the Alms House, and
 on July the 4th, 1803, the physicians had a meeting on  this subject
 They recommended, in order to accommodate the insane poor, to con!
 vert as much of the new range  of buildings (at 11th  and Spruce
 streets) as could be spared, into cells for their accommodation.  The
 board not thinking this locality altogether  safe, fitted up the cellar
 under the west wing of the house, then occupied as a dining-room.
 This improvement was completed  in December 1803, and thither to
 this subterranean prison, were ten persons  removed from the Penn-
sylvania hospital—the  number of the violent class  then under the
care of the managers.  The names of these first ten occupants  were
John  Savage,  Robert Crawford, George  W.  Odenheimer,  John 
35
McClean, Stephen  West, Mary McFall, Catharine Erringer, Chris-
tian na Griskey, Sarah Tomb, and Abbe Conly.
  The portion thus set apart in a few years became insufficient, some
of the cells  containing  two maniacs.   The  medical officers again
pressed the necessity of additional buildings, as a measure  enforced
by every consideration of humanity.   These underground cells were
damp, chilly caverns, with insufficient light, and imperfect ventilla-
tion : they were  close to the sick and surgical wards, and the noise
of these creatures, bereft of reason, howling like  caged beasts, ex-
erted not only an unpleasant influence on the sick, but even shocked
the public ear.  In 1833 the insane  were removed, in common with
the  other poor, to the present building, a part of which had been
constructed for  this unfortunate class; that is  furnished with those
mechanical contrivances  which were deemed essential to their treat-
ment.  Among the results of scientific medicine, there are none,
gentlemen, which have been fraught  with  so  much of blessing, as
those which  have  crowned the rational  study of mental  disease.
The damp and gloomy cells of the old Alms House on Spruce street,
and the walls  and  subterranean  vaults of  the present,  furnished
familiar demonstrations of the frightful armamentarium at their com.
mand, not indeed for restoring reason, but to scare her forever from
her seat in the soul.  You have but to cross the area of this enclosed
square, to see still the iron hooks  in the floor wh.ere they were tied
down hands and feet, the rings in an outer wall to which they were
chained like wild animals, when led from their gloomy abode to enjoy
for a little the pure  air and sunlight of heaven.   There,  too, may
be still seen the traces of blood, and  the marks  of the teeth, as they
have in their agony, vainly  endeavored to  gnaw  through the doors
which restrained their liberty, and, not the least horrible of these
inquisitorial  mechanism, there still  stands the Composing chair in
which the doomed lunatic was  secured, his  head supporting a capa-
cious box filled with ice, which melting, poured its chilling streams
adown his  person for hours  together.  In  1835 the hospital com-
mittee authorized the purchase  of books, prints, and  musical instru-
ments for the use of  the  lunatic department, and more than usual
interest for a time was manifested in improving their condition.  In
the beginning of 1845 a ball was given for their amusement, and with
such satisfactory results that Doctor Dunglison in the following April
asked its repetition.
  On the  17th of  September  1849, Doctor Henley was appointed
assistant physician to  this department and to the small-pox  hospital, 
36
 at  a salary of  $500.  In this position  he continued  until Feb-
 ruary 1852, when he resigned,.and was succeeded by Doctor-------■
 Benton.  Shortly after, however, Doctor Benton was superseded by
 the re-appointment of Doctor Henley  to  his old post, with a salary
 increased to  seven hundred dollars.  This  office  was abolished,  I
 think in 1854, and from that time forward the Asylum, until a recent
 period, was lapsing rapidly  into disorder and decay.  Among the
 noblest acts of the present  board of  guardians, was the  reorganiza-
 tion  of this department.  None but those who were conversant with
 the house, can form any conception of its utter  inefficiency to ful-
 fill  the purposes contemplated by such an institution.  It was visited
 for the most part by  sight-seers,  attracted  by the same motives as
 one  who visits an exhibition of animals.  The hallucinations and
 eccentricities of these poor God-smitten creatures were the subject of
 thoughtless sport, and became strengthened and confirmed, by being
 maintained  in  a state  of constant activity.  It was  a burning
 shame on the good name of this christian community;  that such
 a cage  of idleness, uncleanness, and  disorder, should  have been
 tolerated for a moment in their midst.  On the 24th of September
 1859, the insane were separated from the hospital  department, and
 placed  under  the  charge of a chief medical officer, Doctor S. W.
 Butler, at a salary of  one thousand  dollars per annum.   Since this
 event, a new state pf  things has been introduced.    An air of order,
 comfort, and cheerfulness is noticeable on  every side; industry has
 taken the place of idleness; and there  may be seen numbers of the
 inmates busily engaged, some cultivating with judgment and evident
 gratification, a garden of vegetables; some in sewing and making up
 garments of various kinds;  some working at shoes, and some enliven-
 ing the ear  with the delightful  sounds of music, executed with no
 ordinary degree  of taste  and  skill.   By the last year's report it will
 be seen that nearly all the  vegetables used by the house have been
 cultivated by  the insane, amounting in money value to $958 63.
 They will soon, it is further stated, make  all  the clothing and  shoes
 consumed by  the department.   Another ameliorating and salutary
 feature is the revival by Doctor Butler of the musical entertainments
 when the inmates, at the sound of the  violin and piano, select their
 partners, and with all the decorum   and conventional proprieties of
rational society, thread the giddy mazes of the dance, exhibiting the
most striking expressions of mirth and enjoyment.   Such a regimen
is well calculated to  introduce new trains of  thought, which serve
either to  substitute those  which  constitute  the phenomena  of 
37
their insanity, or  enable the individuals  to correct, by a legitimate
induction, the delusions under which they may labor.
  I am indebted  to Doctor Butler for tables which furnish the fol-
lowing results.  From 1834 to 1861 (inclusive) there have been re-
ceived into the men's department, 3858 insane persons,  whose social
state was as follows: 1803 single, 1054 married, 332 widowed, and
669 unknown.  Of the habits of the number, the following may be
stated : 449 were temperate, 371 moderate, 528 intemperate, leaving
2510 unknown.   In the women's department, from 18o5 to 1861
(inclusive) there have been received 3473—the social state and hab-
its of which, however, are not compiled later than  1845, and which
are as  follows:  329 single, 299 married, and 222 unknown;  214
temperate, 14 moderate,  67 intemperate, and 635 unknown, in  a
total of 928.
               APOTHECARIES AND HOUSE  PUPILS.

   Until June the 6th,  1788, there is  no evidence that  the medi-
 cines requisite for the sick were prepared in the house, or that per-
 sons instructed in medicine resided in the institution.  The apothe-
 cary shop was established at  the date  just stated, and John Trust,
 being recommended by the physicians, was appointed  to that office.
 The duties were both pharmaceutical  and medical, and this officer
 was required to be either a graduate or an advanced student.  Under
 the first he was  to  prepare  and dispense the prescriptions of the
 attending physicians; and  under the second, he  was to attend to
 the ward dressings, keep a record of the name, date  of admission,
 sex, age, disease, event of each  inmate, and preserve an account of
 the number of women delivered in the  obstetrical ward.  The re-
 muneration  was board, washing and lodging.   In 1789 an addi-
 tional  one  was  deemed necessary, and  we find the name of  John
 Davidson mentioned as apothecary and  house pupil.   In  1802 the
 number was increased to three;  and the system of juniors and seniors
 first introduced.
   The eldest was styled the senior student, the next the junior stu-
 dent,  and the third  called the apothecary to the  infirmary.   The
 senior  was to attend  the  sick, keep a history of all cases  which the
 medical attendant might direct, with a register of  the  name, date of
 admission,  age, sex,  disease and  event.   The junior  was to dress,
 cup,  bleed in the surgical  wards, visit  the working wards  daily, and
 if any were sick, report the  same to the senior, and  keep in order
 the surgical instruments and apparatus belonging to the house.   The 
38
apothecary, besides preparing the prescriptions, was required to cup
and  bleed in the medical  ward.  Each of these  house pupils  was
to pay eighty dollars,  and serve, the senior two and a half, and the
others, three and a half years.
   In 1811 the number of house pupils or apprentices,  as they were
occasionally termed, was increased to four during the winter,  and
three the summer season,  each to pay one huudred dollars into the
treasury, for the benefit of the house.   In 1813, the  number  was
fixed at four for the entire year; two seniors  and two juniors.   All
candidates, to be eligible for an election, must have been  under the
instruction of some practitioner for two  years, attended one course
of medical lectures, pay before entering on service one  hundred dol-
lars into the hands of the Treasurer, and give bonded security for
the faithful performance of his duties.  The seniors rotated monthly
in the different  departments of the hospital, the juniors  every two
months.  The  obstetrical cases were  attended alternately by both
juniors and seniors.   The juniors prepared all prescriptions, kept a
careful record of the same, and were present with the seniors during
their stated rounds with  the sick.   In 1816 the house pupils' fee
was  increased to one hundred and fifty dollars, and the term of ser-
vice reduced to six and twelve months.   This year, at the sugges-
tion  of the visiting physicians, the managers, believing there were
ample duties  to employ one  person  constantly in the apothecary
shop, disconnected  the office of apothecary to the infirmary from
that of house pupil, and established it as a distinct position, with a
salary of three  hundred dollars a year.   After a single years' trial
the office  was abolished, but  so injudiciously, that on the  2nd  of
February 1818, they were  compelled to re-establish it again.  Gerard
S. Marks  was appointed to this office, which  situation  he  continued
to occupy until his  death in  1832.  He was  succeeded by his son,
Samuel P. Marks, and next by James N.  Marks, first as assistant,
and  afterwards  as principal, which position he continued to fill with
unexampled ability until March the 8th, 1852—seventeen years.
Mr.  James N. Marks was for many years  a member of the board of
guardians, a man of practical ability, and whose record, I have no
doubt, stands unimpeached.   After  the  resignation of Mr* Marks,
the board elected Mr.-------Huffnell apothecary,  in which capa-
city  he continued to act until 1856, when Mr.-------Bender, who
had  been acting as assistant, became now the principal.  In 1817
the population  of the  hospital had so  increased  that it was found
necessary to provide a larger number of resident pupils, and to meet 
39
the wants thus arising, eight were elected, to serve for six and twelve
months.   In  1820 the title by which these gentlemen were called
was changed from house pupil, to that of house surgeons, and house
physicians.   The following year, 1821, the resident fee was increased
to two hundred dollars.   In November 1822, the managers believing
fewer residents could meet all the demands of the institution, reduced
the number to six, and  the next year, 1823,  in consequence of a
civil strife between some of the managers and the house physicians,
the medical board advised a  change in the  mode of attending the
sick, by  dispensing altogether with resident  under-graduates,  and
electing two graduates in medicine,  of known  ability, and who were
to  receive, instead of a salary, an  honorarium, in  the  form of a
piece of  plate, with a proper  inscription, and not to exceed one hun-
dred dollars in value.   The plan proposed was adopted, without the
contemplated plate, but could cot have met the expectations of the
board, as the  resolution was rescinded the same year, and resort had
to the old plan.   On  the 8th of November 1824, the Medical board
recommended the examination of all candidates  for the medical ser-
vice of the hospital,  that  they might be able  to secure the best
qualified talent,  and which received the  sanction of the managers.
Another  suggestion of the medical board, which  was endorsed by
the same gentlemen, was the election of two additional  pupils, to be
called Recorders, whose  duty  was to keep an  accurate  history of all
cases of disease in the institution, a work which, had it been carried
out in good faith to this day, would  have constituted  a treasure of
medical  knowledge unequalled in  value by any country.   Nothing
practical  or important, however, emanated from this office.  Here
and there, among musty and defaced papers, I discovered a  few
histories,  as  one searching  among ancient  ruins  meets  with
broken pillars, and fragments of  dismembered arches.   They never
can be   gathered  together  from  amidst the  dust of time  and
decay, and framed into  a symmetrical piece.  In 1828 the seniors,
by  a  resolution  of the Board of Guardians, were styled Resident
Physicians, and  the  juniors, Resident Students.  In  1835 the
fee  exacted   from those  elected   to  either  position  was  two
hundred  and  fifty dollars,  and which seems to have  so remained
until  September 1839, when it  was  reduced to  fifty  dollars and
the price of board.  From that period to the present the number
of resident physicians has been  eight, boarded and lodged at the
expense  of the  institution, and  required to  deposit one hundred
dollars as a collateral assurance for  the fulfillment of their contract, 
40
and to be returned at the  expiration  of  their  term of service,
or  when  honorably discharged.  There have  been  since  1788,
the year in which  it  may be said the system of residentship was
established, three hundred and fifty pupils, or physicians officiating
in this capacity; and among whom will be found those of the most
distinguished physicians and  surgeons, dead and living, North  and
South,  for the last  quarter of  a century.   Here  is  one  of those
examples of moral re-action or compensation, as  noticeable  among
the groups incident to the social state, as between the kingdoms of
nature elsewhere.   Poverty,  misfortune, and sickness, universally
regarded  as evils,  yet  counterbalanced by yielding  as  fields  for
scientific observations,  a  rich  harvest of solid, practical medical
knowledge.
                          EPIDEMICS.

  In  an institution giving shelter to the  destitute, decrepid  and
broken-down;  the existence of epidemic and malignant disease may
very naturally be anticipated;  and this house has proved no  excep-
tion to the rule.   In  the early period of its existence, very little
satisfactory information can be gathered in regard to the details of
its  prevailing  maladies.   During  the  Spring months  of  1776  the
inmates suffered very severely from both small-pox and putrid sore
throat.  Many cases of the  worst character were  taken  from  the
house, and quartered in private lodgings, with the hope of staying
their fatal progress.   No mention is made,  either of the number of
cases attacked, or the deaths, and therefore the extent of the mortality
can only be approximately arrived at.   The  cost of burials,  with a
population of two hundred, and in the  ordinary health of  the insti-
tution, was about £18.  The  year under consideration—1776—the
expense of burying amounted to  £47, sufficient to show the mor-
tality had been doubled.
  In 1779, a form of intermittent fever prevailed during the  month
of April, concerning which it is said, "there were deaths daily, and
much distress in the house."  For nine years following 1779,  the
institution appears  to  have enjoyed a wonderful exemption from
fatal diseases, or until  1788,  when a person in the month of Feb-
ruary was admitted  from  Southwark, indisposed from some unde-
veloped affection.   Shortly after, his disease proved to be small-pox,
which spread  with great  rapidity among the inmates.  This  was
among the most terrible scourges, as vaccination had not been dis-
covered, and against inoculation  there was a wide-spread prejudice. 
41
  In 1793 Philadelphia was visited by the yellow  fever, and this
institution was doomed to  pass through the severest ordeal which it
had ever sustained.   It is quite impossible for us at this day to form
any just conception  of  the panic which  seized  the public mind on
the appearance of this  desolating plague.  There is something very
extraordinary and appaling  in the  moral  effects  of those unseen
agencies with which God sometimes scourges a city or nation.  Men
can preserve their  courage  and  composure  on the field of battle,
where the mailed-clad  hosts of contending  armies struggle for vic-
tory amid the roar of artillery and the shouts of their captains, but
let the Angel of pestilence, that walketh in darkness, or wasteth at
noonday, shake from his sable wings  the invisible spores of infection
and death, and the merchant sinks at his desk; or the artisan totter
and fall at his bench; or an. acquaintance making a transient call on
a friend, suddenly grow pale  and feeble, is borne  home to his bed,
to struggle a little, gasp and die:  I say, let  men witness a few such
scenes as these, and they soon betray the veriest cowardice and fear.
  During the prevalance of the fever, the whole face  of the city was
changed.   There was then no funeral trains attended with the usual
pomp and pageantry of mourning;  no coffins of elaborate workman-
ship,  to  contain  the mortal remains of the dead, and  borne  with
formal steps to  their last resting-place.   On  every hand the beholder
encountered  open  and unattended  carts,  containing rude boxes,
exposed to the public gaze, and hurried with  all despatch to be buried
out of sight—not in single graves—but numbers together in capacious
pits.   Men cared not  to tarry on the street, but  hastened on  with
furtive glance, as though the  fell destroyer  followed on their track.
There were no hearty,  joyous salutations.  Men exchanged the com-
mon civilities of recognition  as  though never  expecting to  meet
again.   The ties  even  of kindred blood lost their wonted power;
families became a  terror to one  another, fleeing  asunder, as one
would  hasten from devouring flame.  The song of the drunkard had
ceased; the saloons of dissipation were closed;  the  haunts of vice
were unfrequented; and even the shameless votaries of lust and lewd-
ness,  slunk into their  dens  of infamy.   As  a means of protecting
the inmates, the medical attendants reccommended the board to grant
no admissions whatever.  Still the  precaution proved unavailing;
the disease broke out in the house, and large numbers were attacked.
Very many were removed to the hospital on Bush Hill.   There are no
records or other  sources of information, from which any statistical
light  can be drawn, either  to determine the number of cases, or 
42
the mortality.   That it was great,  there is little  room to doubt.
When the disease  was at its height,  most of the managers, infected
with the common panic and wide-spread distress, did not venture to
attend the institution.  But there were the medical attendants, and
the steward, who never deserted their posts, but stood by this flock
of decrepid, friendless poor, with a devotion  and moral  heroism,
which, I rejoice to say, has ever been the glory of our profession.
During the prevalence of the epidemic, the  demand for  graves was
so great,  that the  poor were unable to dig them with proper care.
Potter's field, now the beautiful Washington Square, was the public
burying-ground.   The interments were so numerous and incomplete,
as to call forth  a remonstrance  against depositing  any  more bodies
within the inclosure.   In 1801,  there was a pauper, Thos. Wilkin-
son, in the house, who during this epidemic, assisted in placing in
coffins, and burying 1500 victims of yellow fever; and in considera-
tion of his having accomplished so unparalleled an office of danger
and humanity, he was pensioned with a little extra food and clothing.
Here  was a man possessed  of a wonderful degree of faithful forti-
tude.   I should have  given much to  have known such a  one;  for
depend upon it, had such a nature been properly understood, it could
have been taken by the hand, and conducted into some nobler sphere
of activity  and duty, than is usually found  within the walls of a
public charity.   On the 30th of December, the disease having dis-
appeared, the doors of the house were again thrown open to persons
entitled to its aid.
   The managers, after witnessing  the  horrors of the late epidemic,
had become exceedingly sensitive  on the subject of what they con-
sidered as contagious diseases;  and in 1795, when the city board
sent to the institution cases  of dysentery, which was then prevailing
both in the wards of the hospital  and throughout  the  town, they
remonstrated strongly against their action.
   In  August  1798,  Doctors  Pleasants  and Boyce communicated
to the managers the unwelcome intelligence of the re-appearance of
yellow fever in the city; and asking the  adoption of additional pre-
cautionary measures to avoid the introduction of any affected person.
The steward was accordingly directed to allow no admission without
a certificate  from one of the attending physicians.   The subject of
ventilation began at  this time to receive some attention.   The win-
dows were so altered as to lower from above, and I may add here,
in passing, that this subject has not yet been  exhausted, even in
the present  palatial building.   Frequent conferences  took place at 
43
 this time between the managers and the board of health, and between
 the former and  the managers of the  Marine city  hospital, with a
 view to provide accommodations, and sustenance for the poor of the
 city and districts, and to aid such persons as desired to move from
 the city limits.   It  was certainly a  period of the most  deplorable
 suffering among the poor.   On the 10th of September 1798, they
 concluded to solicit a loan  on subscription, to be re-imbursed out of
 any  fund afterwards  designated by  the  Legislature.  During the
 month of November, between two and three hundred children utterly
 destitute, were sent to the  managers, their parents having fallen vic-
 tims  to the fever.  Some idea may be formed of  the state of the pub-
 lic mind, when it is stated, that during  the fever of  1793, 17,000
 persons fled the city;  and during that of 1798, 50,000; leaving only
 something over 3000 persons in Philadelphia; and that from August
 the 8th to October the 3d of these two visitations, 4625 individuals
 fell victims to the disease.*   This year the whooping cough prevailed
 to an unparalleled degree;  it visited almost every house, and in order
 to  isolate  the children, Luke Morris, one of the managers, took a
 house some distance  from the institution.
   In July 1802, great apprehension was again entertained of another
 visitation of the  fever.  The doors were closed against the admission
 of  any paupers :  no  stranger was allowed  to visit the house : the use
 of  the hearse was not permitted for  any burial, but such as took
 place from  the  institution:  nor were  the resident  pupils allowed
 to visit any persons in the city.  This interdict was maintained until
 the 8th of November, and whatever influence it may have exerted,
 certainly the house enjoyed a comparative immunity from the disease.
 Again, in September 1803, another alarm  prevailed, in consequence
 of the re-appearance of fever in the  city; and again were admis-
 sions   refused except to the officers of  the house.  The board, with
 the consent of the Governor of the State, took the Pennsylvania Arse-
 nal as a temporary accommodation for the poor.  They afterwards
 procured a house on the banks of the Schuylkill at Race street, be-
longing to Doctor Curry, which was  supplied with twenty-five bed-
steads and  bedding, a horse-cart, and other  necessary appliances.
This proved to be the last visit which the  Alms house received from
the yellow fever.
  During the  month of  August 1807,  an  epidemic influenza broke
out in  the institution, attacking both inmates and  officers,  and pre-
*Hazzard's Register Penn. Vol.  10, p. 112. 
44
vailed in so violent a form, and so general, as to interrupt the ordi-
nary routine of business.
   The health of the institution appears after this to have been gene-
rally  good until 1811.  In August of  that year, a violent type  of
dysentery made its appearance in the wards, and proved so extensive
and malignant that the board had many of the worst cases carried
out of the house and  quartered in a barn, which stood on a  vacant
piece  of ground  near  by, called  the pasture lots, and which, it ap-
pears, was followed almost immediately by salutary results.
   In  order to isolate the cases of small-pox which from time to time,
made  their appearance, a house was taken in 1S15, directly opposite
the institution on Spruce street, into which such patients were placed.
   The Fall of 1817 was one of much sickness, distress and mortality
in the Alms house.   The ordinary diseases of the house all tended to
assume an adynamic type, throughout the winter, and after the com-
mencement of the new year 1818, in January, typhus fever prevailed
to such a  degree as to invite an inquiry into the sanitary state of the
wards, from the board of health.   The disease commenced about the
1st of November 1817, and as near as I can ascertain, up to January
5th, 1818—two months—there had been  eighty-six cases;  sixteen
had died,  twenty were discharged,  fifty remained, and twenty-five of
these  were considered to be convalescing.   What number of this re-
maining  fifty  died, it is  impossible to learn.   This statement was
made  by  Doctor  James, after  which  there   is a  record of nine
cases, of which six died.   By February the number  and malignacy
of the cases increased to such an extent, the managers requested the
general board to issue  no more admissions, and accordingly,  on the
28th,  the  latter body  concluded  to send all  cases of undeveloped
disease to  the quarantine house, until their character was declared;
which, should it prove typhus, was  then sent to the sugar-house, an
old building which stood on the  Alms house grounds, contiguous to
the institution.   It was about this  time, the general board framed an
address to the medical officers, asking their opinion on the contagious-
ness of the fever then prevailing.   Their answer  was like some
oracular response, characterized by a degree of caution and non-com-
mittal which would have done credit to  the most adroit politician  of
1862 ; yet it might be gathered from the counsel which they gave,
urging the " separation of the affected from the others"—they all be-
lieved what they did not care to express.   Among their recommenda-
tions was  the increase in both the quality and quantity of the diet for
the poor, as calculated to enable these helpless  beings to resist mor- 
45
bid influences.   The managers thought it better, however, to refuse
this, and regale them by the highly nutritious and stimulating beve-
rage of molasses, ginger and water.
  In 1823 cases of small-pox becoming numerous, it was thought best
to take the hospital at Bush Hill;  the superintendance of which was
committed  to Doctor John K.  Mitchell, on the 2nd of December of
that year, and who continued to discharge his duties with devotion,
alike creditable to the goodness of his heart, and his well-known pro-
fessional ability, until February the 2nd 1824, as long as the neces-
sity for his services existed, at which time he  received the compli-
mentary thanks of the board, and was voted a piece of plate, which
his son, Doctor S. AVeir Mitchell, informs me, was a pitcher bearing
an appropriate inscription.
  I find also, a report containing the results of this service, and from
which it appears  there were one hundred and fifty-eight persons re-
ceived into the hospital.  Of  this number, one hundred and fifteen
cases were unprotected, and seventy of these died : twenty-five had
been vaccinated,  of which all recovered : five had been inoculated, of
which two  died :  four had  suffered a previous attack  of  small-pox,
and of these two died, and of  the  remaining nine  nothing of  their
previous history was known.   Eighty-four of the   cases occurred in
males, of which forty-seven died;  seventy-four in females, of which
thirty died.   The greatest mortality was among the males, and curious
as it may seem, the fatality among those previously inoculated, or who
had  had variola, was  greater  than among  those  vaccinated.  On
June  21st, 1824, the thanks  of  the guardians were  tendered  to
Doctor John  Bell, who  was associated with Doctor  Mitchell, for his
humane and faithful attention to such as labored under this loathsome
disease.  Doctor Bell's name  continued to  be associated with the
small-pox hospital until very recently, when  it was closed.
   In  1827,  Doctor Thomas Brinkle had  the care of  this hospital.
A report was made in  September of that year, from which it would
appear there  were received one hundred and seventy-six patients;
sixty-one of whom died, and one hundred and fifteen recovered.  In
eighteen of these cases the patients had passed through a previous
attack, three  of whom  died;   fifty-three cases had been previously
vaccinated, and  eight  died;  a result corroborating the report of
Doctor Mitchell, and tending  to  establish,  what I believe is at the
present asserted,  that vaccination  is a better protective than either
inoculation or variola itself.   As early as 1818, the subject, of erect-
ing a building, or pest-house, as it was termed, had been agitated by 
46
the board, and while it was the conviction of a majority of the mem-
bers, that the matter of providing for contagious  diseases did not
legitimately belong  to the  guardians, yet,  as a necessity, the con-
struction  of such a building was  recommended.   On  the  5th of
June 1835, a resolution to the same effect was passed, but was never
carried into effect, while the Alms house stood on the  east side of
the Schuylkill, the old sugar-house being used for that purpose.   In
1841, however, after consultation with the medical board, a site was
selected on the  west side of this  institution, on  which a building
was erected and  called the outer hospital, into which cases of an in-
fectious nature were placed.  This  was afterwards occupied as  the
residence of the physician-in-chief, having been moved in its totality
to its present situation on the Darby road, at the very trifling cost of
about ?2100, and is now occupied by Doctor Butler,  the physician
in charge of the lunatic department.   To provide for cases of small-
pox, the guardians have been in the habit of using the old mansion
house, between the  institution, and  the gate of entrance from  the
Darby road.  The liability of the  board of health to take care of
cases of small-pox, has  been, and I believe still continues to be  a
point on which a wide difference of views exist.   In 1850 the solici-
tor of  the  board  of  guardians was  requested  to frame a petition to
the  legislature, praying that their  body might be relieved of this
duty;  still in 1852  an act was passed giving to the board of health
the right  to charge three dollars a week for  every case of contagious
disease, for which their body provided.  The hospital on Islington
lane having been closed on the 1st of April 1860,  strange as it may
appear, in a community proverbial for its wise and  liberal provisions
for almost  every species of physical, moral, and mental  destitution
and suffering;  Philadelphia is to-day without a public place where
either citizen or alien could  command the  services of physician or
nurse, if  overtaken  by contagious disease.
   In 1832 Philadelphia was visited by the cholera, which produced
a degree of alarm only  equalled  by that of  the yellow fever in 1793
and 1798.   In July the medical staff advised the non-reception of
cases, and an immediate provision for such  as occurred  within their
jurisdiction outside  of the  house.   The  physicians to the out-door
poor held a meeting, at which Dr. Condie presided,  and recommended
the establishment of temporary hospitals, to  be placed under their
care, and receive all such cases  as  were not thought proper subjects
for admission to  the Alms House.  At that time  the present house
 was in process of erection,  the present lunatic  department being 
47
almost completed.  About the  21st of July a case appeared in the
infirmary of  the  institution, then in charge  of Dr. Hodge, and it
was at once resolved to remove all the healthy paupers over the river
to the West building, designed then for the hospital, and these were
the first occupants of the new institution.   The guardians next made
application to Commodore Baron for the privilege of moving others,
still remaining, into the Naval Asylum, but which was declined, as
the commodore did not feel  himself authorized to allow its occupa-
tion by the civil authorities, other than as a hospital.   A subsequent
resolution empowered the President of the Board of Guardians—Mr.
Lippincott—with the Mayor of the city, to arrange for the admission
of a  number  of their  cholera  patients into this asylum.  In  the
house the cases increased daily, until a  general  panic took place.
Nurses became clamorous for an increase of wages, and it was granted.
These, between terror and a want of moral sense, were seized with a
kind  of mad infatuation.   They drank the  stimulants provided for
the sick, and  in one ward, where the  pestilence raged in its most
fearful forms, and where between  the dead  and the dying the sight
was most appaling, these Furies  were seen lying drunk upon,  or
fighting  over,  the  dead victims of the disease.  Persons  rescued
from  shipwreck  have  furnished  histories of  some very singular
mental  phenomena, the product  of utter, hopeless despair, disar-
ranging the complex machinery of the intellectual and  emotional
organization, so that while the great hulk, freighted with  living souls,
was settling down  into its  grave of waters, some would laugh as
though in an ecstacy of joy, and others command, in vehement tones
of authority, the billows to roll back, and the tempest to hush.   We
call all such extravagant exhibitions hysterical,  but the mental and
physical  re-actions are none the less  curious to either the metaphy-
sician or the psychologist.  In this state of disorder, application was
made  to Bishop Kendrick for Sisters of  Charity.  The request was
granted, and  these devoted ministers of mercy, at once entered on
their  mission of danger, restoring order  and  diffusing  hope by  the
calm and self-composed manner with which they moved among  the
diseased.  These  sisters remained at  their post until  the  20th of
May 1833.  During the epidemic, the utmost  attention was given
to the study and treatment of the  disease.   Doctor Hodge informed
me, that at the suggestion of Doctor Horner, the saline solution was
thrown into the veins, in order  to provide for the blood lesion which
was alleged by several prominent authorities to exist, but in no case
were any good  results obtained.   Large double tin cases were like- 
48
wise constructed, in which the patients were placed, while external
warmth was communicated by filling  the interval between the case
and its metallic lining with hot water.  Little  if any benefit was
experienced from this mechanism.
  In 1849 the  cholera returned, and  in  July a  meeting was called
by the Mayor, to consult on the best measures for the exigency again
likely to be forced  on the community.  This meeting took place at
the office  in  the  city, and was attended by Doctors Benedict and
Page, from the institution; and Doctors Harris, Meigs, Pearce, and
Dillingham, of the city.   The Board of Guardians, after receiving
all the  light possible from  an interchange  of views, concluded to
appoint a committee to carry out any suggestions made by the medi-
cal officers of the house.   The cases increased rapidly in the insti-
tution.   The wash-house, which stands in  the centre of the hollow
square, was occupied at first as a  cholera hospital, and I remember
well of passing through that building, and witnessing with sad
interest, the poor  victims in every stage of the disease.  It was an
excessively hot day, yet  they  were all as cold as a block of ice, and
the  lines  of death were legibly traced on every face.  Doctor Mas-
senburg,  from Hampton, Virginia, was appointed temporary resident
of  the hospital at this time, a most amiable and intelligent gentle-
man, one of the first medical acquaintances I made after coming to
the city.   He was attacked  with the disease while absent a few hours
 on a visit to the town, and died in great agony, notwithstanding the
 most untiring efforts were made in his behalf.
   The earliest case of the disease in  the house was on the  27th of
 June 1849.   A colored  man, William Jones, was brought into the
 black medical from the city on that day, and died before night.  The
 second case  was likewise a  negro, Isaac Wood, brought  from the
 city on the 29th, and died the same day.  Between this date  and the
 1st of  July nine  other  cases occurred.   At this  time the second
 story of the building, called the wash-house, was arranged  for a hos-
 pital, and the patients  conveyed there as soon as attacked.  For
 several days after this, the cases were so numerous and fatal, that in
 the alarm and confusion no register of admissions was kept.  After
 the 7th of July there is an account of ninety-nine  males admitted,
 eighty-seven of whom died;  and one hundred and one females, ninety
 of  whom died.  On the 13th, the medical attendants recommended
 the erection  of two temporary hospitals outside of the walls.  The
 workmen commenced the  16th,  and by the 23d had up two board
 tents in the field  by the gate as  you enter the lane from the Darby 
49
road.  They were  occupied the  same day  by twenty  males and
eight females.  Of the former, seventeen died; of the latter, three
died.  Sixty-eight  additional cases were treated  in  the  tents, of
which number thirty died.  From  these  data, which from personal
observation I believe to be far short of the truth, the total number
of cases  were 307, and the deaths 229.*  The disease disappeared
about the 20th of August, at which time these provisional hospitals
were taken down.   During much of this time the guardians could not
raise a quorum for the transaction of business, but no record remains
of any medical officer having left his post, except poor Massenburg,
the stranger, who was called, I hope, from probation to fruition.
   The Sanitary Committee of the  Board of Health, under the im-
pression the virulence of the disease in the  hospital was due to an
improper diet,  sent a communication to the  Board on that subject.
The statements  made  in their answer  showed that any  trifling im-
propriety of this nature had little to do with  its prevalence.  The
mode of burying the dead was changed for a time.   Trenches were
dug so as  to hold  only four coffins, two abreast,  and twenty-four
inches apart.   This space was filled in with dirt, twenty-five pounds
of chloride of lime were added to each grave, and the whole covered
with four feet of earth.
   In 1854 a third epidemic of cholera prevailed.  It commenced on
the 7th of July, and  attained  its greatest  fatality the last days of
this month and  the beginning  of August.  Straggling cases of it
appeared as late as the 7th of November.  During this period there
were about 300 cases, most of which were treated in  the small-pox
hospital, near the  gate, with the addition  of a wooden tent.   On
examining  the  sources  calculated to throw light on the result, it
would appear 150 cases of the number attacked proved fatal.
   During the  months of January and February 1849, a very fatal
epidemic of puerperal fever  prevailed in the lying-in department of
the house.  I have not been able to ascertain the number of cases,
but am told by a very reliable and  intelligent nurse of the house,
that almost  all attacked, died.   For four weeks  the wards were
vacated, and every means used to disinfect the  place.
   In 1855 the disease again appeared, and lingered in the wards for
three months,  carrying  off almost all puerperal  women attacked.
Doctor Penrose, who has some valuable tables in course of prepara-
tion, informs me that there have been cases of this  formidable  dis-
ease in the  obstetrical  department every year, from  7841 to 1858

  * A careful examination made after writing the above, shows 255 deaths
to have taken place. 
50
except the years 1844 and 1845 ; and that since the change in the
medical administration of the institution,  he is not cognizant of a
single case having  occurred.   This exemption he attributes to the
sanitary measures advised by himself and colleagues.
  The Children's  Asylum has  often been invaded  by destructive
epidemics.  The first one recorded was in April  1835, th? year after
the children were moved to  the present house.   This was the can-
crum oris.  That the mortality was large may be inferred from a
single allusion, in which it is stated twenty children had died in nine
days  from the  disease.  The existence of  the affection,  and the
fatality, was in a great measure  due to the very imperfect organiza-
tion of the department.   Doctor Hodge,  who  declined this year
longer to attend the asylum, addressed the managers on  this subject,
advising, as an act of imperative humanity, an  immediate attention
to the interests of this department.   Among the suggestions made,
were  the  appointment of a  resident  physician  exclusively for the
Asylum, the selection of experienced and conscientious nurses,  more
room  and  ventilation, and more hospital conveniences.
  The other diseases peculiar to  this period  of life, which  have fre-
quently from that time to the present existed, are opthalmia,  measles,
and scarlet fever.
  On the 26th of November 1804, the Managers arranged for the first,
a Diet Table for the use of the house.   By this  table, every pauper
in the Medical, Surgical, and Incurable Wards,  was allowed for
                           BREAKFAST.
  One pint of Coffee or one pint of Chocolate.            £ lb. of Bread.
                             DINNER.
  i lb. of Meat.   1 pint of Soup.   1 lb. of Potatoes.   J lb. of Bread.
                             SUPPER.
            1  pint of Tea.               \ lb. of Bread.
Every other pauper on Sunday, Tuesday and Thursday, received:
                            BREAKFAST.
  1 pint of Coffee or 1 pint of Chocolate.               \ lb. of Bread.
                             DINNER.
  \ lb. of Bread.    J lb. of Meat.   1 pint of Soup.   1 lb. of Potatoes.
                             SUPPER.
           i  lb. of Bread.                1 pint of Tea.
Every pauper on Monday received :
                           BREAKFAST.
  1 pint of Coffee or  1 pint of Chocolate.              \ lb. of Bread.
                             DINNER.
  1 lb. of Potatoes.         1 qt. of Hash.            J lb. of Bread.
                             SUPPER.
            1  pint of Tea.                \- lb. of Bread.
On Wednesday  and Friday:
                           BREAKFAST.
  1 pint of Coffee  or 1 pint of  Chocolate.             \ lb. of Bread.
                             DINNER.
          Mush at pleasure—3 gills of  Molasses to 10 persons. 
51
                             OII1U i-V •
            1 pint of Tea.                J lb.  of Bread.
For the Lying-in Wards every day in the Week:
                            BREAKFAST.
            J lb. of Bread.     1 qt. of Coffee or Chocolate.
                             DINNER.
  £ lb. of Bread.    1 lb. of Potatoes.   Meat as ordered by physician.
                             SUPPER.
            J lb. of Bread.                 1 qt. of Tea.
   In this table there is  a fair  amount of food to each person, but
very little variety.   There is no subject connected with the admin-
istration of an institution of this kind which  is more important than
the one under consideration.   It  is adopted by many as a foregone
principle, that the objects of public charity should be confined to the
simplest, plainest, coarsest kind of fare, in quality;  and in quantity as
moderate as may be consistent with their needful  support.   (I may
add here, in a parenthesis, that I do not make any charge of such
views against  the  Board of  Guardians.)   Connected with  this snb-
ject, I conceive there are very nice questions of  moral ethics and
political science involved.  I presume, both  as regards clothing and
food, the justification is drawn from  the fact  that the inmates of
these public charities are compelled to  seek a refuge in consequence
of their misfortunes being self-inflicted, the result of their own vices
and evil habits, and therefore  they surrender any claims to the pro-
tection  of society beyond those of bare support.   This is not the
place to discuss a subject of such ample nature.  Let me only throw
out a few thoughts in passing which may  aid us  somewhat  in its
proper  treatment.   What is it which makes us to differ  from the
most degraded  inmates of this house?   Nothing;  really nothing
but the grace of  God.  Will any one doubt that the chief instru-
mentalities  concerned in giving him position, reputation, moral and
social standing in society, were the influential operations of parental
care and tenderness, extended during  those  years when the human
character is as plastic as the clay in the  hands of the potter, and
still later, where the forecast of friends had provided for personal
comfort, Ind aided in the formation of associations, salutary and re-
straining.   These,  gentlemen, more than any natural endowments,
have made you  what  you are.   Now look at the  other side of the
picture.  The  vast proportion of the  inmates of this  house have
never enjoyed such all-controlling agencies.   Born,  most  of them,
in humble life, with perhaps a vicious  training, thrown on the world
to their  own resources during the  most impressible period of ex-
istence, with unformed  characters, called to struggle with all the
temptations  incident to a life of obscure toil and want, and without 
                                                                            {

                               52

the sympathy of either man or government, is it a marvel, that with
such a moral organization as the race carries with it, these creatures
should be driven to shipwreck by the  tempests which come up from
the human heart?   These  considerations  at least commend them to
our generous sympathy and charity, and to this end, God has wisely
implanted in the human heart a principle to compassionate  misery
and misfortune in all their multiform aspects.  Whenever, therefore,
disease or decrepitude, either of body or mind, the result, though it
may be of vicious habits, compel such to seek an asylum at the hands
of their fellow-beings, whatever other claims  they may have forfeited
from law and society, that  to  the support of life they have not.  The
diet, therefore,  it would seem reasonable,   should be in quality,
quantity,  and  variety, such  as is capable of maintaining the best
possible health, consistent with a broken-down constitution.  The
diet should be determined  after a careful study of the constitutional
characteristics of the population, prevailing diseases, and their usual
complications.  Looking at  the  subject in  an  economical point of
view, that regimen will prove  the most desirable which exerts the
largest influence in keeping  the  inmates  out of  the hospital, as by
the report for 1862 it will conserve the difference between seventy-
two cents and  two  dollars.
   In  conclusion, gentlemen,  it is difficult to over-estimate the im-
portance of  this institution, to either  the  profession  or the com-
munity.   To say nothing of  the multiform types of destitution and
want which it meets  and relieves, look  at the field which it offers to
the disciple of medicine, and  which no man  will lightly esteem, who
contemplates the prosecution  of his profession with a conscience void
of offence towards God and man.  There, is a Hospital, in which over
eight thousand cases  of  disease are  treated  annually;  a Children's
Asylum, offering illustrations of all  the complaints incident to this
period of  life; and there, is  an Obstetrical department, in which as
many as seven cases of labor have occurred  in  twenty-four hours,
and where in the last thirteen  years, over two thousand six hundred
children have been born.   One year  industriously spent in this  in-
stitution, will yield in  medical experience, the  fruits  of ten  years
gathered from an ordinary private  practice.   Or to place the state-
ment in another form, a graduate of medicine, faithfully improving
for a single  year his opportunity for the study of disease  in the
wards of the Philadelphia hospital, will be better fitted to assume the
responsibilities of his profession, than one who labors ten years in an
ordinary city or country practice.