main building. This was the first of a series of pavilions which had been provided for by councils and the department of charities and correction. During the year 1888, the last of the rickety and unwholesome wooden pavilions were removed and two additional two-story brick buildings substituted for them. In 1889, an additional story was put on the pavilion erected in 1887.

In 1886, the accumulated income of the Mary Shields' legacy was applied to the erection of a new kitchen-building, with complete apparatus for cooking of the best character. This was nearly finished at the time of the disastrous fire on the night of February 12, 1885, after which the work was rapidly pushed and completed, furnishing much needed accommodation, the old kitchen having been destroyed. A kitchen was also built and furnished for the general hospital in 1886, and during the past year, part of the cost of a third kitchen has been paid.

In 1887, the nurses' apartments and the quarters of the resident physicians were thoroughly renovated. The general laundry was enlarged, new machinery introduced, a drying-room for the laundry of the insane department was built, the outer walls of the buildings were rough-coated, the outside woodwork was repainted, balconies to the fire-escapes were completed, and pipes were laid for increased water supply to the institution.

In 1888, additional fire escapes were erected Much paving in the hospital grounds was completed, the asphalt pavements which are now found in the streets of the quadrangle being first introduced. An important improvement during this year was the building of a trunk 450 feet long, connected with the sewer of the insane department, to carry the drainage beyond low water mark in the Schuylkill. This was built and the sewer cleansed of its contents. This sewer had not been cleansed for a period of fifty years, and from it were taken one hundred and forty-two cart loads of material.

During the discussion arising out of the great fire which partially destroyed the insane department in February, 1885, it was made apparent that one of Philadelphia's greatest needs was a State hospital for the insane, to be devoted entirely to the reception of patients belonging to this county, the city maintaining a small department at Blockley in connection with the general hospital for the reception of acute patients, or the temporary detention of doubtful cases. It was, however, finally decided to rebuild the burned structures on the old site. This was done the first half of 1887, but various alterations and changes in the old plan were made. The main building which formed the southwestern side of the original quadrangle was the one most completely destroyed by the fire. This was rebuilt and the northern wing repaved. In rebuilding it the centre was carried to three stories, but the extensions on each side from the centre were built to only two. Open ways were also left between this building and the wings. Fire-escapes were added to the structures in 1886.

In 1889, the removal of the cobble stone pavements of the quadrangle, and the substitution for them of the cement pavements, was continued. New and greatly improved water closets were erected in the outwards, the nursery, the obstetrical ward, and in the men's medical and venereal wards-a work of vital import

ance to the health of the wards. During this year city councils appropriated money for the electric lighting of not only the buildings but the surrounding grounds; the appropriation included an item for an electrical plant at the institution. This work was placed under the supervision of the electrical bureau, and during 1890 was begun, so that now a portion of the institution and grounds is illuminated by electricity. The wooden door frames of the insane departments were also removed during this year, and replaced by others made of iron.

Connected with the hospital had long been a ward known as the drunkard's ward, or as usually designated, "the drunk ward." This was in the first instance set aside for the reception of those suffering from mania-a-potu, or for such cases as were indicated by the attending physician or by the medical board. It was also a custom to place in this ward patients who were temporarily disturbing or dangerous, or whose sanity was doubtful, sometimes detaining them here until an examination was made with a view of transferring them to the insane department. 1889, this ward was changed into one which is now known as the detention ward, and since then doubtful cases in the general hospital, and similar cases received from the outside through the police department, have been detained in this ward until thorough examination into their mental condition has been made.

In

In 1890, city councils made an appropriation from the almshouse property fund to the department of charities and correction for the erection of additional buildings on the grounds of the almshouse. These buildings, a portion of which are now under way, are to be independent wings from the buildings now existing on these grounds. A competent architect was authorized to prepare plans for them, and these plans were drawn and eventually approved by the department of charities and correction and by the mayor.

The department had a survey made of a portion of the almshouse grounds, and found two available areas for building purposes, one on the west between the wings of the insane department and the west end of the property, a vacant space 635 feet in length, 362 feet wide in the centre, and 202 feet wide at each end; on this space it was recommended to extend the buildings of the much overcrowded insane wards. The real capacity of these wards is 600; the population when the recommendation was made, 883; and it was expected soon after to have returned from Danville 74 insane patients, sent there after the fire, making an excess of 357 beyond the real capacity.

The department also reported that on the north end of the property was a plot irregular in shape, 118 feet wide and 927 feet long, its greatest length being 1021 feet, on which it was suggested to erect ten two story pavilions, costing about $5,000 each, which would be capable of accommodating 100 patients each, and would be better suited for hospital purposes than the present buildings. These additions were earnestly recommended, and it was believed if this was done the complaint of overcrowding, lack of accommodation, and their attendant evils would be removed, and the department would possess the required space and facilities to take care of its population for many future years.

Much work for the improvement of the almshouse and its hospital department is expected to be done during the year 1891. The additional wings for both male and female insane patients will probably be completed. Directly west of the centre of the

main building is to be built a refectory, or consolidated diningroom, 208 feet long and 50 feet wide, of a general height of one story, and 45 feet high to the top of the dome. This building is to be divided into two apartments, for male and female patients respectively, and will have a seating capacity for one thousand. It is to communicate with the wards by an underground passage lighted with electricity. Attached will be a two-story brick building, the basement to be for the kitchen; the first floor to be the sewing-room; and the second floor for the sleeping apartments for male and female attendants. It is also proposed during the year 1891 to construct from the Mary Shields' legacy, a steam elevator in the centre of the hospital building, capable of holding a cot to enable patients to be better transferred from floor to floor. An additional electric light plant is also to be established, with a dynamo to light incandescent lamps in all the hallways of the institution, the superintendent's office and the private apartments.

At various times, and particularly during the last five years, efforts have been made to remove the pauper element of the almshouse to some other place than its present location. On January 22, 1883, for instance, a request was sent by the medical staff to the board of guardians asking for this removal; also on November 24, 1884, a communication was made to the board concerning the desirability of removing the almshouse to the grounds of the house of correction. At a meeting of the board July 12, 1884, a committee of three was appointed to confer with councils as to the removal of the pauper element and the erection of a new almshouse.

Shortly after the great fire which resulted in the destruction of a large portion of the insane department, these efforts were renewed, and a committee was appointed by the medical board to circulate a petition for this removal, which was signed by a large number of physicians. In the report of the board of charities and correction for 1887, Dr. J. W. White again urged this removal and the use of the entire space at Blockley for the sick. So far, however, this step has not been taken.

The main reasons advanced for the separation of the almshouse and hospital have been the relief thereby of the great overcrowding, the removal from the sick poor of the stigma which attaches to the name almshouse, and the increased opportunities which would be afforded to improve and perfect both the hospital and the almshouse service.

The mayor, and the present board of directors, have not favored this separation for reasons given in the annual message of the mayor for 1889. The chief of these reasons are, that it will be necessary to build an additional hospital in connection with the new buildings to accommodate the cases of sickness constantly occurring in the institution; that the removal of the almshouse to Holmesburg would greatly add to the cost of conducting two institutions separated by nearly ten miles; that for reasons of convenience and expense, the almshouse should be near to the city; that nearly all the inmates of the almshouse are proper subjects for hospital care; that the separation would cause not only a large expenditure of money for the erection of a new building, but would make necessary large additional fixed expenditures for management, with inconvenience and injury to the patients required to be moved from one to the other.

SANDALWOOD OIL AS A REMEDY FOR COUGH.

BY ROLAND G. CURTIN, M.D.

While "the world is all agog" over the newly discovered "germ destroyers," it may not be amiss to offer to the medical profession a palliative and in some cases a curative agent, the use of which may save our patients from much suffering.

In some cases a persistent cough disturbs the rest, and perhaps causes vomiting, which may not only rob the patient of his nourishment and medicine, but also even hasten his death.

A mere accident led me to find out that santal oil was a successful alleviant for some obstinate coughs. The discovery was made as follows: Early in the year 1890, I had under my charge a case of chronic bronchitis, with a dry, hard cough, which had been persistent and harassing for years. The patient had been treated by many physicians without finding relief. I tried among others the following remedies: Deodorized tincture of opium, morphia, hyoscyamus, lactucarium, Hoffman's anodyne, inhalation of the spray of Dobell's solution, and a saturated solution of hyoscyamus and cyanide of potassium, inhalations of chloroform and carbolic acid, etc., but with little effect.

The patient came to me suffering greatly from specific urethritis. I said "we will omit remedies for cough and treat only the local disorder." I ordered santal oil, ten drops on a lump of sugar after meals. He came back in a week and said, "Those drops have relieved my cough more than any remedy that I have ever taken." As a test, I gave him a copaiba mixture. He came back and said that the cough had returned as soon as the sandalwood oil was stopped. I again gave him the oil, and the result was the same as before the cough was almost stopped. The case interested me so much that I made a number of observations on cases with obstinate coughs. I will give the results and then give my conclusions.