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 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 protection of society beyond that of a mere 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 differ from the most degraded inmates of this house? Nothing; really nothing, but the grace of God. Will any one doubt that the chief instrumentalities 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, when the forecast of friends had provided for personal comfort, and aided in the formation of associations salutary and restraining? These, gentlemen, more than any natural endowments, have made you what you are. Now look on 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 existence, with unformed characters called to struggle with all the temptations incident to a life of obscure want and toil, and without the sympathy of either men 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 mind or body, the result though it 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 or society, that to the support of life they have not. The diet, therefore, it would seem reasonable should be in quantity, quality and variety, such as is capable of maintaining the best possible health consistent with a broken-down con

stitution. The diet should be determined after a careful study of the constitutional characteristics of the population, prevailing disease, 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 importance of this institution, to either the profession or the community. 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 institution will yield in medical experience, the fruits of ten years gathered from an ordinary practice. But to place the statement in another form: a graduate of medicine faithfully improving for a single year his opportunity for 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.

REMINISCENCES OF THE PHILADELPHIA HOSPITAL.1

BY ALFRED STILLÉ, M.D.

GENTLEMEN:-Let me thank you for the compliment you have paid me in making me the first president of your association. I hope that it may flourish for many years to come, and bind all its members to sustain the past, present, and future reputation of the great hospital in which we have all had the honor and advantage of cultivating the art of all arts, the "art of healing." I shall make no attempt to present to you the history of the almshouse hospital, for this work was thoroughly done by Professor Agnew in an introductory lecture to his clinical course at the hospital in 1862; nor shall I pretend to do more than retrace for you an outline of some of the features of the institution as I knew it more than half a century ago. The memories of youth are apt to outlive those of middle age; and certainly many events of my first hospital experience are as clear and vivid in my mind to-day as if they had occurred but a year ago, while not a few of the intervening ones have faded quite away.

In 1836, the buildings composing the almshouse, except the additions to the southernmost one, were substantially the same as now, but the uses of some of them were different. The southern building was then entirely occupied by the hospital-its eastern half by the male, its western half by female patients-while in the centre was the lecturing and operating amphitheatre. The east return wing was filled with insane males, and the west with insane females. The apothecary's shop was on the ground floor of the same building. The lying-in wards were in the west end of the building forming the northern side of the quadrangle, and the children's asylum in the corresponding part of the east end.

1Address made by Dr. Stillé, as first president of the association of the ex-residents of the Philadelphia Hospital, December 6, 1887, at the dinner given by them at the Bellevue Hotel, Philadelphia, at which sixty were present. A brief account of this association will be given

later.

I lived in the children's asylum, of which I had special charge, although I had also charge of medical and surgical wards in the hospital itself. If I were asked what half-year in my professional life was the happiest, I should reply the period that I lived in that asylum. I occupied a vast chamber that looked out upon green fields and a fair river, with a view of the city beyond them. I had no companions to disturb me; I was aflame with the desire of knowledge, and all my time was eagerly devoted to the study of disease and of books.

The board of managers of that day was certainly not composed of very refined men, but they were, according to their lights, competent, and very different from the vulgar, corrupt and venal body which in later years mismanaged the institution. I can recall several of them who were conspicuous for exhibiting their power in season and out of season, not only over the paupers and patients, but over the medical residents also. Ignorance and coarseness have a natural repulsion for knowledge and refinement, and the feeling is more or less reciprocated. Very seldom, indeed, is there a cordial harmony between hospital managers and resident physicians. The exercise of power is as dear to the one as intolerance of it is natural to the other. The one lacks sympathy and the other humility.

It would hardly be credited, were it not unquestionably true, that this great clinical school was closed for nearly ten years, because in 1845 the resident physicians were shocked by a cockroach upon their dining table, and not obtaining redress for their offended delicacy, they incontinently resigned. One cannot but pity a susceptibility that would allow such an incident to imperil the success of a professional life. But we cannot expect to find old heads on young shoulders, nor even the most righteous cause to be temperately promoted.

Another incident may be used in illustration. The president of the board of guardians was the bugbear of the whole establishment, from the steward down to the most abject pauper who had no home but the almshouse. It was natural that some of the quick-tempered and high-minded house-physicians should resent the pompous tyranny of this man, and occasions enough for doing so occurred. Of these I may recall one or two. South of the hospital in those days was a large flower and fruit garden which the guardians reserved for the sole enjoyment of

their senses and appetites, and which all other persons, including the resident physicians, were as strictly forbidden to enter as were Adam and Eve to return to the garden of Eden. One of the residents it seems, not having the fear of the guardians before his eyes, had the audacity to enter the sacred precincts and appropriate a few peaches and roses. A mighty clamor followed, only to be compared to the outburst of Mr. Squeer's wrath when Oliver asked for "more." I do not remember what the upshot was, but certainly not "the brown paper parcel full of groans" which was the net result of the English school boy's flogging. My impression is that a special edict was issued against trespass upon paradise, and signed with the vermilion pencil of the great Mogul of Blockley almshouse.

In those days the residents boarded at the steward's table; the meals were always good, and on Sundays and on the days when the board of guardians met, they seemed to us both sumptuous and abundant. On Sunday, when everything and everybody is later than usual, it happened that the residents were not always punctual to the dinner hour; but the president of the board and some of his colleagues, who were not apt to be behindhand at the feast, were so annoyed by the young men's unpunctuality, that they issued an ukase proclaiming that all the residents who did not arrive within a certain time should be denied a passage through the gates in the yard fences, and be thereby compelled to reach the steward's quarters by passing through the paupers outwards. This indignity was hotly resented, and one summer day a resident physician, being detained by his duties, found the yard door closed between him and his dinner, and was told that he must reach the steward's apartments through the paupers' wards. After parleying for some time, and then sending a request to the president of the board to permit his passage, which was denied, he retreated a little, and with a rush, kicked the door open, and made his way to the dining-room, where he reported to the president of the board what he had done. This gentleman was so amazed that he made no reply, and the combative resident was never called to account for taking the law into his own hands.

As I have said already, I had special charge of the children's asylum, and lodged in it. It was a very interesting field for me from a humanitarian as well as a medical point of view. A hundred or more children were sheltered there on their way to the