That the medical police of the house was not of the strictest character, may be inferred from the fact that a number of persons were in the habit of visiting the institution, assuming to be doctors, and volunteering their services to the unfortunate sick. This irregularity continued unquestioned for some time, until many of the patients had suffered very great injury, and no small amount of discredit brought upon the management of the house. A resolution was at length introduced and passed by the board of managers, permitting no one to prescribe except the regular appointees, and requiring them to visit the hospital oftener and with more regularity.

At this period the invaluable discovery of Jenner was unknown to the medical world, and the only method capable of diminishing the horrors of small-pox was the induction of the disease by inoculation, after careful previous preparation of the system for its reception. Singular as it may appear, there were many who regarded the practice not only improper but positively sinful. I remember a few years ago, whilst sitting in one of our city churches, taking up a Bible which bore on the fly leaf the inscription, over the signature of the owner, "opposed to corporation and inoculation." In 1771 the institution contained a number of destitute children who had never had an attack of variola. For their own as well as the safety of the other inmates, Dr. Evans called the attention of the managers to this fact, and proposed that they should be protected by inoculation. The board acquiesced in the suggestion, provided the house should be subjected to no expense other than the medicine required for their subsequent treatment. Twenty-one of these children were separated from the general mass for this purpose, all of whom perfectly recovered. In the month of February, 1778, there were forty others subjected to a similar course with a like result.

In 1772 a proposition was made to the managers to extend the usefulness of the house by the admission of students, and an increase in the number of medical attendants. The proposition included an offer of gratuitous service, the institution being only at the expense of purchasing the medicines required for the sick. On the 25th of March, 1774, the desired addition to the medical corps was effected by the election of Dr. Adam Kuhn, professor of materia medica and botany in the Medical College; Dr. Benjamin Rush, who held the chair of chemistry in the same institution; Dr. Samuel Duffield, one of the ten alumni who received

the first medical degrees conferred in this country (21st June, 1768), and Dr. Girardus Clarkson. An additional physician, Dr. Thomas Parke, was added to the number March 25, 1774. This probably is the origin in this country of gratuitous professional service to public institutions which has become so general at the present day, and which I conceive operates disadvantageously to both he who dispenses and he who receives. To advocate such a sentiment brings no odium on the profession. It requires no argument from me to vindicate our calling from the charge of selfishness. It is not saying too much when we venture the assertion, that among the professions there are, none which contribute so largely their free-will offerings for the relief of human suffering, or which furnish so many examples of disinterested and unselfish benevolence as our own.

I cannot refrain here from relating an anecdote somewhat apropos to this subject. The late professor Chapman, while discharging the clinical duties of his chair in the University of Pennsylvania, had brought before him a poor Irish woman who had applied for advice. The doctor made a careful examination of her case, ordered a prescription to be made out, and bade her in a kindly tone to retire. With great simplicity of manner she tendered compensation, which, on being declined, in an air of mingled surprise and doubt, she exclaimed, "Take the trifle, my jewel, for its yourself must be after living." "Ah! my good woman," said the doctor in his own inimitable way, "we doctors are a very peculiar people, we look for our reward hereafter."

To every American the year 1776 is full of historic importance. A period when our revolutionary sires, men of large hearts, broad minds and self-sacrificing spirits, were freely spending their blood, treasure and wisdom to establish a national independence and government, which their children are to-day, in a spirit of unparallelled venture, rending to pieces.

On the 5th of September, 1776, the "Council of Safety," through its president, Thomas Wharton, Jr., addressed a note to the managers of the Bettering House,' as it was often styled, asking per

[1 The term "Bettering House," in times gone by, was frequently applied to the Philadelphia Almshouse, and probably to institutions of the same kind; occasionally it is still used by the aged; in my boyhood I remember often hearing it. The most probable derivation of the word is from the German Bettler-Haus or Beggar House. The word probably took its start among the German communities of Pennsylvania if this is its origin. In form it would seem to refer to the fact that the almshouse is an institution to which the poor go to be cured, or helped, or to have their condition made better. "Betterment," meaning improvement or making better, is not obsolete, although infrequently used. One definition by Webster of "Bettering House" is a house for the reformation of offenders," but this is an incorrect definition as applied to the almshouse.]

mission for the Quarter Master [Deputy] General to quarter in the institution a number of the Continental militia who were very sick with dysentery. This was strenuously opposed both by the managers and medical attendants, as calculated to endanger the health of the house. They had on former occasions suffered greatly from the prevalence of putrid sore throat and small-pox; and had been compelled to move many of the cases to private lodgings in order to stay their fatal progress; and in justice to the helpless and infirm inmates-most of whom possessed little ability to resist disease-they naturally objected to the introduction of an element of danger, such as malignant dysentery, the scourge of camps would constitute. As all military governments tend to despotism, the application was merely to maintain a semblance to the legitimate forms of propriety. This is quite natural and proper, when public necessity becomes paramount to personal considerations, and accordingly the council ordered Col. Francis Gurney, on the 23d of October, to take military possession of the almshouse for the sick soldiers. No alternative was left but to make the best of the unpleasant position forced upon them. The poor were transferred to the west building, and the soldiers were placed in the southeast wing of the House of Employment, arresting entirely the industrial operations of the establishment. They retained possession of this apartment until the British took possession of the city in 1777, when they were removed.

This removal, however, in no way relieved the managers from embarrassment, as shortly after, in the month of October, the entire east wing was appropriated for the sick belonging to the King's troops under General Howe. For fear they might in like manner appropriate the west wing also, the managers waited on Joseph Galloway, to secure his influence with the general to prevent an occurrence which must entail so great distress on the poor-its inmates at this time being of the most helpless description.

Joseph Galloway was a lawyer of distinction and wealth, speaker of the Provincial Assembly. In our struggle he took the royal side of the question, and became, under the sanction of the British commander, the general superintendent of the city. When, however, the cause of the colonies brightened, and Howe was obliged to evacuate the city, he was compelled to follow his master, his estates were confiscated, his fortune melted away, and

he was obliged to accept a secretaryship to the commander-inchief. It was therefore on account of his royal proclivities the managers sought his aid. They were referred by him to Dr. Stuart, surgeon general of the British Military Hospital, who promised, unless an emergency should arise, to accede to their request.

It was but a short time after this, in November, at 9 o'clock at night, when the poor were almost destitute of food, the barrack master called on two of the managers ordering them to clear the house for the reception of the King's troops. The board met the next morning, and after short deliberation, refused to comply with the cruel request. On hearing their decision, the British official proceeded at once to remove the inmates--about two hundred in number-of miserable, decrepid, half starved creatures. As they would soon have perished exposed to the rigors of a November air, the managers succeeded in securing quarters for them, some in the Freemasons' old lodge, still standing in Filbert above Eighth street; some in the Friends Meeting House; and others in Carpenters' Hall, off Chestnut, above Third street, where they were maintained until the last days of June, 1778, when the invaders having left the city, they were removed back to their old home. The exposure and deprivation attending their ejectment, was followed by a heavy mortality, as only eighty-two of the original two hundred survived to re-enter their former quarters.

In 1777 Drs. Rush and Clarkson resigned their posts, and the three remaining members were requested by the board of managers either to occupy their term of service or to choose substitutes, the former of which they concluded to do. No alteration in this arrangement was made until the 29th of April, 1779, when a proposition was made by Drs. Glentworth, Jackson and Duffield to attend the sick of the institution, charging only for the medicines used in their treatment.

From the 25th of March, 1780, we may date the system of out door medical relief as a part of the benevolent operations of the managers of the poor. In order that such aid might be furnished, Drs. Hutchison and Wilson were requested to attend and prescribe for those who, though not inmates of the institution, were yet dependent on its resources for professional aid. From this small beginning, in which two gentlemen were able to meet all

In

the demands of the city, have arisen eleven districts, requiring twenty-four physicians, who for a very small compensation dispense an amount of professional relief truly wonderful. passing over the records of this department it is pleasant to find that, at one time or another, almost every name of note in the ranks of our profession is found among those who labored in this sphere of humble usefulness, and no doubt not a few of them laid the foundation of their future reputation, while thus engaged in visiting the sick poor in the secluded lanes and alleys of this metropolis. No man can long labor in such a field in daily contact with a class, whose sufferings are greatly increased by the absence of so much which serves in the more fortunate to alleviate the pressure of disease, without feeling all the sympathies of his heart unlocked and becoming a wiser and a better man.

On the 7th of February, 1781, Dr. Bond, who it seems had no connection with the house after the year 1779, being at this time medical purveyor of the United States Army, applied to the managers for the east wing of the building, which had shortly before been occupied by the board of war, to accommodate a number of British prisoners, who were very ill at that time in jail. This request was granted by his agreeing, on behalf of the government, to pay a monthly rent of one hundred dollars hard money. For some time after 1781, Dr. Samuel Duffield seems to have been the only physician attached to the institution, giving his attention, under contract based on his own proposition, to attend to all the inmates and find the necessary medicines, for the sum of two hundred pounds per annum. One of two things is evident, either the doctor was not fond of money or was fond of work.

At this time it was the custom to have the venereal cases and the violent insane treated at the Pennsylvania Hospital. In regard to the first, it was deemed necessary, in accordance with the current medical notions on the subject, to subject every case to a mercurial course, carried to the extent of salivation. In the Pennsylvania Hospital the accommodations for this were greater and more complete than those of the almshouse. In addition to the ordinary expenses of board and nursing, a fee was always charged against the almshouse by the physician under whose care the case had been treated. There is a record of two guineas for this object being paid to Dr. John Morgan, one of the two