The senior was to attend the sick, keep a history of all the cases which the medical student 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 of the house. The 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 in the summer season, each to pay one hundred 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 election must have been under the instruction of some practitioner for two years, must have attended one course of medical lectures, and were required to pay before entering on service one hundred dollars into the hands of the treasurer, and to 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 in their stated rounds with the sick.

In 1816, the house pupils' fee was increased to one hundred and fifty dollars, and the term of service reduced to twelve and six months. This year, at the suggestion of the visiting physicians, the managers believing there were ample duties to employ one person constantly in the apothecary's 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 year's trial the office was abolished, but so injudiciously that on the 2d of February, 1818, they were compelled to re-establish it again. Gerald S. Marks was appointed to this office and continued to occupy it until his death in 1832. He was succeeded by his son, Samuel P. Marks, and next by James N. Marks, first as an assistant and afterwards as principal, which position he continued to fill with unexampled ability until March 8, 1852-seventeen years. Mr. James N. Marks was for

many years a member of the board of guardians, a man of practical ability, whose record I have no doubt stands unimpeached. After the resignation of Mr. Marks the board elected Mr. Huffnell apothecary, in which capacity he continued to act until 1856, when Mr. Bender, who had been acting as assistant, became 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 the wants thus arising eight were elected, to serve 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 that 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, who were to receive, instead of a salary, an honorarium in the form of a piece of plate, with a proper inscription, not to exceed one hundred dollars in value. The plan proposed was adopted without the contemplated plate, but could not 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 service of the hospital, that they might be able to secure the best qualified talent, and this 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 it 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 treasury of medical knowledge unequalled in value in any country. Nothing practical or important, however, emanated from this office. Here and there among musty, 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 symmetrical pieces.

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, 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, 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, among whom the names will be found of the most distinguished physicians and surgeons, dead and living, from the north and south, for the last quarter of a century. Here is one of those examples of moral reaction 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 observation, 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 exception 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 both from smallpox 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 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 institution, was about eighteen pounds. The year under consideration, 1776, the expense of burying amounted to forty-seven pounds, sufficient to show that the mortality 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 February was admitted from Southwark, indisposed from some undeveloped affection. Shortly after, his disease proved to be smallpox which spread with great rapidity among the inmates. This was among the most terrible scourges, as vaccination had not been discovered, and against inoculation there was a wide-spread prejudice.

In 1793, Philadelphia was visited by 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 at the appearance of this desolating plague. There is something very appalling in the moral effect of those unseen agencies with which God sometimes scourges a city or a nation. Men can preserve their composure on the field of battle, where the mailclad hosts of contending armies, struggle for victory amid the roar of artillery and the shouts of their captains; but let the angel of pestilence, that walketh in darkness or wasteth at the noonday, shake from his sable wings the invisible spores of infection and death, the merchant sinks at his desk, the artisan totters and falls at his bench, an acquaintance making a transient call suddenly grows 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 prevalence of the fever the whole face of the city was changed. There were then no funeral trains attended with the usual pomp and pageantry of mourning; no coffins of elaborate workmanship 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 common civilties of recognition as though they never expected 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 hurry 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 lewdness slunk into their dens of infamy. As a means of protecting the inmates, the medical attendants recommended 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 sources of information from which any statistical light can be drawn, either to determine number of cases or the mortality. That it was great there is little room for doubt. When the disease was at its height most of the managers infected by the common panic and widespread 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 enclosure.

In 1801, there was a pauper, Thomas Wilkinson, in the house, who during the epidemic assisted in placing in coffins and burying 1,500 victims of yellow fever; and in consideration 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 fortitude. I should have given much to know 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