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the intestines, which they found in their patients who had died of an epidemic fever which prevailed along the Schuylkill about the year 1824; but they could go no further than to describe what they had seen, without, however, arriving at any conclusion as to the meaning of the pathological appearances.

I may state that Dr. Jackson frequently expressed his regret that the record of the autopsies made by Dr. Lawrence had been irrecoverably lost. Dr. Lawrence fell an early victim to his devotion to pathology.

These certainly were very important steps; but having gone thus far we are met by the recent microscopic investigations into the causation of disease, not only of those fevers of which we have been speaking, but of various other zymotic diseases, and have before us new fields opening which promise to yield rich fruit, both in pathology and therapeutics. Here, indeed, we are amazed not only at the scientific problems which seem to be in course of solution, but also at the anticipation of practical results which, if realized, will throw idto the shade all that has been heretofore accomplished.

If I might be permitted to go a little further in an exposition of the difficulties which surrounded those who immediately preceded us, I woulu cite those connected with diseases of the chest. Dr. Chapman, whose acquaintance with the literature of the profession will hardly be challenged, had come to the conclusion that pneumonia and pleurisy were the same disease, requiring about the same treatment. He remarks: "of all the diseases to which the human frame is liable, with the exception of cynanche trachealis, this is perhaps the best understood and most easily managed." If that were true at that time, our knowledge in respect to this disease has woefully degenerated. Our diagnosis we insist is incomparably superior to his, for we can look, as it were, into the lungs and pleura, and define precisely their condition, but we cannot adopt his words. His heroic treatment by profuse and repeated bleedings we utterly discard, while at the same time it may be fairly doubted whether in all cases venesection is an improper measure, even admitting the ordinary tendency of pneumonia to terminate by crisis or lysis. It is easy to understand how superior our diagnosis is by the use of auscultation and percussion, to which the ear of the world was deaf

until Laennec explained the language of thoracic sounds. While great advances have been made in medicine, we are yet upon the threshold of investigation and discovery.

We have appliances in the microscope and the laboratory for assisting us in questioning the anatomical and pathological structures of the human system, of which our predecessors knew nothing. As has been remarked, we have seen the gradual development of experiment and observation in this direction, and have admired the persistent devotion and enthusiasm with which observations have been conducted, which have added honor to human intellect; and we have rejoiced in the prospect of seeing still further developments of science and of practical results. Whatsoever cavil may have been made in former times. as to the propriety of the use of the term "medical science," there ought to be none now, if careful and extensive investigation and wise generalization contribute toward such a claim.

We have seen the system of auscultation unfolded by the genius of Laennec, brought to such a degree of perfection that the recesses of the bony thorax are laid open even more satisfactorily than the contents of the abdomen, although the latter seems so much more accessible. Both heart and lungs speak to us of their pathology in a language which is as intelligible to the initiated as is French and German; but only intelligible when carefully studied as a language.

Then we are indebted to Dr. Bright for evolving the secrets of the kidneys, and we have learned something of the extensive influence which those organs exercise over the operations of the human organism. Still further, we have watched the wonderful advances in gynæcology (which can be appreciated only by those who had merely such light as from the lectures of Dewees, which was almost darkness); we have also learned much of the power of the uterus and ovaries over the nervous system; and have had placed in our hands such means and appliances as have enabled us to bring health and comfort to women, instead of the sadness and sorrow which they hopelessly endured for so many centuries -a relief which is only second to the moral and social elevation brought about by the divine agency of Christianity in raising her out of a woful degradation into the full dignity and honor of

man.

Last, but not least, we see the efforts now being made to demonstrate that of the great causes of the mortality of the human race, the greatest is the want of pure air, pure water, and physical cleanliness, all of which we know have laid the foundations for disease and death, whereas before we could only imagine some latent and undiscoverable energy at the bottom of the whole trouble.

HISTORICAL MEMORANDA OF THE PHILADELPHIA

ALMSHOUSE.

BY CHARLES K. MILLS, M.D.

The most important medical facts relating to the period which his essay covers are given by Dr. Agnew, but to many events of interest he simply alludes, and to some of the details connected with the history of the almshouse system in Philadelphia, which are in a broad sense part of its medical history, he does not refer. In the following pages, therefore, some of the facts given will be in the nature of addenda to his history of the hospital. Some of the documents relating to the almshouse are of importance to an exact knowledge of the history of the institution; such, for instance, are: the act of 1828, for the erection of a new almshouse; the original deed of the property purchased by the city in Blockley township; the act of 1861 for the sale of the almshouse grounds or any parts thereof; and the ordinance of councils of 1883 setting aside a portion of the almshouse property for a public park. We have, therefore, at the expense of space, considered it worth while to give these documents, or large extracts from them. The history of the Philadelphia Hospital, with which this volume is particularly concerned, is so intermingled with that of the almshouse system in general, and with numerous official acts for the relief of the poor, that a knowledge of these is necessary to an understanding of the hospital and its relations. Descriptions of the almshouse at its three locations may prove of future as well as present value, as may also a consideration of the history of the various forms of government of the poor and of the institutions concerned with their care and treatment.

Dr. Agnew began his history at 1742, with the general statement that the Philadelphia Almshouse was at that time, fulfilling a varied routine of beneficent functions, including hospital and

asylum work. One of the first acts for the better provision of the poor in Pennsylvania was passed in 1700, and repealed by the Queen in council in 1705. A year later the assembly directed that the justices of the peace should annually appoint two overseers of the poor for each township; and also that a levy of one penny a pound should be made upon all real and personal estate of citizens, and four shillings a head not otherwise ratified.

In 1712, the common council ordered that a workhouse be hired for the employment of the poor, and the overseers were empowered to attend to this business. It is not certain that these directions were carried out. In 1713, however, the first almshouse was established, but it was strictly confined to the relief of the poor of the society of Friends. In 1717, the assembly passed an act authorizing the erection of a workhouse in Philadelphia, Chester and Bristol.

In 1729, in answer to a petition made to the assembly by the overseers of the poor and recommended by the city, one thousand pounds were loaned to the mayor and commonwealth for the purchase of ground and the erection of a building for the poor of the city. This money was received in 1720, and in 1721 or 1722, ground was bought from Aldran Allen for two hundred pounds; this was bounded by Third, Fourth, Spruce and Pine streets, referred to by Dr. Agnew as the "green meadows." The building was of brick and probably completed in 1731 or 1732. In it, besides an asylum for paupers, was established a hospital with accommodations for the sick and insane. From 1732 we can, therefore, properly date the history of the Philadelphia Hospital.

The immense growth of this hospital is well shown by reference to two facts. In 1767, according to Scharf and Westcott, 284 persons were admitted into the almshouse, and afterwards the number increased to 368. December 31, 1889, by the report of Mr. Robert Laughlin, president of the board of charities and correction, the entire population of the almshouse, including the hospital, insane department, men's and women's outwards, and the children's asylum, was 3,207. In 1888, according to the report of the chief druggist, 110,875 prescriptions were filled, a number, as remarked by Dr. J. W. White, then president of the board, probably greater than the business of any ten of the largest drug stores in the city. In 1889, the number of

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