continued fevers, as they were then called, could be arrested. Says Dr. Chapman again in glowing language, "Could I for a moment believe in the doctrine of our incompetency to cure fever that all our efforts to arrest its progress are unavailing, that we must remain inactive and patiently watch the operation of the vis medicatrix naturæ till the disease spontaneously subsides, I would at once strike the flag of the profession, and cease to cheat the public by pursuing any longer a system of fraud and imposture." It would seem that with our present views of the self-limitation of typhoid and typhus fevers, we should be as honest as Dr. Chapman asserts himself to have been; but there is no necessity for that, enough remains to be done, even with as much empirical treatment as yet remains with us, to conduct a case of typhoid fever through its slow and tortuous course, even though we adopt the wise course "to give nature a chance.”

If we go on a little further we find that typhoid fever was altogether unknown as a distinct disease. Even after the light which had been thrown upon it by Brettoneau, Louis and Chomel, many of those both in England and in this country who had been imbued with the old notions could not bring themselves to believe that typhoid fever was anything else than one form of continued or synochus fever. When we of that day, in the Philadelphia Hospital, stood by the bedside of our typhoid fever cases with Drs. Gerhard and Pennock, and had pointed out to us their diagnostic symptoms; and had disease in the glands of Peyer verified in the autopsy; and when the petechial typhus came among us from the ships from Ireland and from Philadelphia's summer streets, and we had shown to us the differences and the differential diagnosis of these two diseases, with the confident assurance that, in the typhus cases, we should find no disease in these glands, a new and clear light dawned upon us as to the specific and distinct character of the two affections. At once was dissipated the obscurities which had hung around us in regard to these fevers, and each stood out before us—individualized. No argument or description could so effectually have convinced us of the truth of the diagnosis, as did such demonstrations from the book of nature.

I think that I am not mistaken, and, if I am, can be corrected by my friend Dr. Stillé, that Dr. Samuel Jackson and Dr. Lawrence were the first in this country to describe the ulcerations in

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, eyen 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