table of the matron. Their refusal to comply with this request determined a unanimous resignation, leaving the hospital unprovided with any medical assistance. The evening of that day Drs. Horner and Clymer attended and prescribed for the sick. Here was a casus belli, and the managers promptly passed a resolution of dismissal.

With the hope of adjusting these differences and bringing about a partial reconciliation, a joint meeting was called for July 2, at which Drs. Jackson, Horner, Clymer, Gillingham and Pancoast attended, representing, as a committee, the medical board. Dr. Jackson, who seems to have been the advocate in the case, spoke in behalf of the committee, urging the managers to allow the residents to remain, at least until their places could be properly supplied, declining to pass any censure or interfere in any matter of personal conflict between the residents and guardians, as foreign altogether to their legitimate jurisdiction. The guardians, however, were inexorable, and refused to recede from their vote of dismissal, thus forever 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 youthful indiscretion.

On the same day of this meeting Mr. Flanagan offered the following resolution: "Resolved, That the hospital committee be requested to look into the expediency of reorganizing the medical department of the house, and report to this board." On the 21st of July the report was made, which, after going over the ground of the 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, modified as follows: "After the 1st of October, 1845, there shall be one chief resident physician, with a salary of $1,800 per annum; one consulting surgeon, one consulting physician, and one consulting accoucheur, each at a salary of one hundred dollars a year."

What great results proceed from small and unlikely, causes. Who would have ever thought that the official existence of a medical board, composed of the ablest men in their various depart

ments on the continent, could have depended on the life of a contemptible cockroach. 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 OFFICER.

On the 6th of October, 1845, the election took place under the new organization, by which Dr. H. S. Patterson was chosen physician-in-chief; William Byrd Page, consulting surgeon; Meredith Clymer, consulting physician, and N. D. Benedict, consulting accoucheur. Three months had not elapsed before the board complained of the interests of the hospital being neglected. Patterson at that time held a professorship in the Pennsylvania Medical College, and they deemed this incompatible with his present post. On the 9th of November he resigned. Dr. N. D. Benedict was elected his successor, and the office of consulting accoucheur abolished.

Dr.

In January, 1848, the annual salary of one hundred dollars, which had been appropriated to each of the consulting officers, was changed, directing five dollars to be paid for each consultation, and such visits to be ordered in cases of absolute necessity.

In February, 1850, Dr. Benedict resigned, after which, on the 18th of this month, Dr. Haines became chief resident, which position he continued to hold until the 11th of February, 1853, when, exchanging his profession for another and more lucrative calling, he removed from the city leaving his place vacant, and was succeeded by Dr. J. D. Stewart. In July, 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 resident of the hospital, yet it did prevail in a degree by dispensing with the assistant resident of the lunatic asylum.

Dr. Stewart's connection with the house was very short. His health had been for some time gradually failing under the progress of an organic affection of the liver, which terminated his life in April, 1854. The office of chief resident was now temporarily discharged by Dr. R. T. Coleman, then an interne of the house, or until the 1st of May, at which time Dr. Archibald B. Campbell was elected.

CLINICAL INSTRUCTION.

To Dr. Thomas Bond belongs the honor of inaugurating clinical teaching in this country, while physician to the Pennsylvania Hospital, as early as 1766; but for the Philadelphia Almshouse we may claim the establishment of the first obstetrical clinic. Students of good character were allowed to attend cases of labor, and various stages of the process were explained to them by Dr. 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 the subject. In 1772, the managers were solicited to extend the medical conveniences of the house for the better accommodation of students, increased numbers of whom began to be attracted to Philadelphia from the growing reputation of the medical school. A part of this plan was to increase 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 extensive hospital on the continent, containing about three hundred and fifty persons, and must unquestionably have contained much disease of an interesting and instructive character. Where the governing power of an institution is constantly undergoing change, little stability and permanence can be expected in any plan or system of education. Either the hostility of some of the managers, or more probably the unsettled state of affairs consequent on the revolutionary struggle, interrupted the medical instruction 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 Dr. Bond was in the habit of delivering a course as 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 almshouse for permission to witness the practice in that institution. Drs. 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 proposition, a majority of the votes were recorded in the negative. Immediately 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 instruction to the profession and the community were presented with renewed cogency and sincerity. They begged a reconsideration of the subject, asking the body of managers to concede at least a probationary trial, and volunteering a personal responsibility for the good conduct of the young men in attendance. The plea was not unsuccessful; the vote was reconsidered, and the house opened, by the majority of one vote, for clinical instruction.

Until 1789, hospital teaching continued to be conducted under great embarrassment, partly on account of the war and partly from the opposition of the hostile element in the board, so that while we cannot say it was formally abolished, "de jure,” yet it was almost impracticable, "de facto."

On the 5th of May, 1789, the physicians elected sent a communication to the board, in which they took occasion to say, "that inasmuch as they furnished their services to the institution without expense 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 expla nation, which they received the 4th of July, and certainly left as little room for misunderstanding as did the immortal document associated with this day. On the 29th, the managers framed a communication for the medical attendants, full of compliment, acknowledging their valuable services to the sick, and assuring these gentlemen that they will ever endeavor to make their duties as agreeable as will be consistent with the good order of the house, and the 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 Dr. Cumming, who had been appointed one of the visiting physicians, ventured to approach this hitherto imperturbable body with a request 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, Drs. James and Church proposed to attend the lying-in wards, on con

dition they should be allowed to have one private pupil present at each case of labor. The application was granted, and much invaluable instruction was communicated in this responsible department of medicine. My father, who was a pupil of Dr. James, was among the number who enjoyed this privilege. The same year, on the 23d of March, Dr. Caldwell was allowed to introduce and instruct a select class of twenty-afterwards forty studentsduring his stated visits to the medical wards, on condition of his becoming responsible for their good deportment. Students at this 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 November, 1806, through the efforts of Drs. James and Church, the managers conceded the privilege to deliver clinical lectures 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 his days of regular attendance at the house. Every successive year now removed more and more 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 towards laying a solid foundation of medical usefulness. Hence, in 1806, the buildings for the accommodation of the sick and 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 rested their claims on the state alone 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 Pennsylvania Hospital, rich in estates, had repeatedly received assistance 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 almshouse, containing over one thousand inmates, presented an extensive field for communicating medical instruction to students attracted