SOCIAL SCIENCE ASSOCIATION 
PHILADELPHIA. 
OP 
PAPERS OF 1873. 
WHAT SHALL PHILADELPHIA DO FOR ITS 
PAUPERS ? 
READ MARCH 27, 1873. 
DR. ISAAC RAY 
[Reprinted from the Penn Monthly for April, 1873.] 
TO provide public support for its poor—those who are unable 
to support themselves—is now generally recognized as an 
imperative duty of society. How best to discharge this duty so 
as to accomplish the greatest amount of good with the smallest 
amount of harm, has become one of the most interesting questions 
in social science. It is not my purpose now to discuss the general 
subject of pauperism. My paper will be confined to the narrower 
sweep of pauperism as it is provided for in this city, for the purpose 
of showing how far this provision accomplishes its objects under 
the requirements of a wise economy and an enlightened humanity. 
Our paupers are the wards of the city, and it is incumbent on 
every citizen to know whether they receive that care which the 
public sentiment of our time regards as a matter of right. 
In providing for the support and care of its paupers, every 
community is bound to see that certain requisites are kept in 
view, viz., these—the burden upon the tax-payers must be rendered 
as light as possible by a judicious expenditure of money; the mode 
adopted must furnish no encouragement to pauperism; and, lastly, 
it must furnish relief in the most efficient and humane manner. 2 
What Shall Philadelphia do for Its Paupers? 
thus ensuring, where it is possible, a return at the earliest moment 
of the power of self-support. Let us see now to what extent 
these requisites are obtained by Philadelphia in the means it has 
provided for the care and relief of its pauper classes. 
In a continuous pile of buildings, just across the Schuylkill, it 
has gathered them together, from 3,600- to 4,000 in number, 
varying with the season, and constituting one seething mass of 
infirmity, disease, vice and insanity. To understand the merits 
of the questions we are to consider, it will be necessary to indicate 
particularly the different elements which make up this heteroge- 
neous mass of humanity. 
In the first place, we have those who, in consequence of mis- 
fortune, or sickness, or innate shiftlessness, or feebleness resulting 
from vicious indulgences, have become unable to support them- 
selves. Secondly, we have those who are laboring under actual 
disease, and become inmates of the hospital. Thirdly, we have 
those who are both paupers and insane. Fourthly, we have chil- 
dren, some without parents, some deserted by parents, and some 
foundlings. On last New Year’s day the first class numbered about 
1,716 ; the second, 1,025 ; the third 895 ; and the fourth 104. 
In regard to the first requisite in any system of public support, 
that of rigid economy, or, more properly speaking, of a small 
expenditure, certainly no fault can be found with the Philadelphia 
almshouse. For the year 1872 the average cost was $1.77 per 
person per week. 
Now, after allowing the broadest margin for the results of su- 
perior frugality, honesty and skill, the cost of supporting our 
paupers seems at first sight far below what might have been ex- 
pected. For the pauper proper, whose only misfortune it is to be 
desperately poor, and who is supposed to require only shelter with 
such and so much food as will keep soul and body together, the 
figure may not be regarded as remarkably low. But when we 
consider the large amount of attendance, nursing, medicines and 
extra diets required for all the other classes, it is difficult to see 
how the average cost can be much less than that of the most 
frugal living compatible with health, out of a poor-house. Sus- 
picion arises, at first thought, that economy has been carried too 
far for the best interests of all concerned. What foundation there 
is for this suspicion will appear on a closer examination of the What Shall Philadelphia do for Its Paupers ? 
3 
condition of the several departments of the institution. Our at- 
tention will first be directed to that of the insane department. 
The great advance that has been made of late years in the care 
of the insane—an advance which we owe to the progress of science 
and philanthropy—is now manifested in certain principles of man- 
agement which may be regarded as established. No community 
can disregard them without incurring the censure of being careless 
of one of its most sacred duties. In order to cure the curable and 
insure a reasonable amount of comfort to the incurable, we are 
bound to provide for. them pure air, ample room, proper food, 
occupation and medication suitable to their condition, and ex- 
emption from needless annoyance and exposure. How far the 
first two requisites—air and room—have been provided in the 
buildings occupied by the insane at the almshouse, a few facts 
will show. The space occupied by these patients and their attend- 
ants, while within doors, is not, I may safely say, more than half 
of what is declared by competent authorities to be the lowest 
limit compatible with the hygienic conditions of a hospital. An 
accurate calculation, for which I have not the requisite figures at 
present, would probably show that one-third of the proper space 
would come nearer the truth than one-half. Most of the lodging- 
rooms are six feet by ten, and are occupied at night generally by 
two, and frequently by three, persons. The rest of the pa- 
tients are disposed of in large dormitories containing about 
thirty beds, with a few more placed directly on the floor. Of 
course these patients disturb one another, as persons less excitable 
would, and for many, sound, regular sleep is out of the question. 
With those in the single rooms the case is still worse, for they 
not only breathe a highly vitiated air, but they are in danger 
from the destructive propensities of one another. If homicide is 
not committed every night in the year, it certainly is not for lack 
of fitting occasion and opportunity. Twice within the last few 
months it was prevented by the merest accident. Now, it is well 
understood by medical men that if there is one bodily condition 
more restorative in mental diseases than another, it is sleep, and 
here we see how it is provided for at the Blockley. 
This crowded condition is accompanied by another very serious 
evil. It is well known that nothing contributes more to the 
peace, quiet and good nature of the insane than ample scope and 4 
What Shall Philadelphia do fin Its Paupers? 
range of movement, and that huddling them together in close 
proximity produces constant excitement, noise, quarreling and 
collision utterly preventive of recovery or comfort. 
The evils of this crowded condition became so obvious that 
the municipal government ordered the erection of two more 
buildings capable of lodging in a proper way 144 patients. They 
were opened about two years ago, but as the annual increase of 
patients, during the last five or six years, has been about 77, the 
relative capacity of the institution is no larger than it was when 
his addition was made. 
In regard to another of the above-named requisites in the man- 
agement of a hospital for the insane, viz., means of occupation, 
the deficiency could scarcely be greater, while its ordinary conse- 
quences are rendered all the more deplorable by the crowded state 
of the house. There can be few more pitiable spectacles than 
that witnessed there every day, of hundreds of men overcharged 
with nervous excitement, whose restless movements are confined 
to the limits of a narrow hall, and of as many more, silent and 
depressed, crouching down in corners and by-places—all of them 
worrying one another, and speedily losing from sheer inaction 
whatever of mind their disease may have left. If there is any- 
thing well settled in regard to the management of the insane, it 
is the paramount importance of occupation, the restorative effect 
of which surpasses that of any other agency, or, I might safely 
say, of all other agencies together. In every hospital in France, 
Germany and Great Britain, every patient is employed who has 
the slightest inclination for employment, while those who are list- 
less and indifferent and self-absorbed, become interested in what 
is passing around them, and are more easily lured into some active 
and healthful exercise of mind. On the ample farm or in the 
numerous workshops, every patient is employed except such as 
are prostrated by sickness or deprived of all self-control by the 
violence of mental excitement. In this country the employment 
most favored is that of farming and gardening, because it is that 
which requires the least preparatory training and has the advan- 
tage which all out-of-door employment has over that which is 
pursued within doors. In this part of the country it has the ad- 
ditional merit of being the most profitable pecuniarily. Accord- 
ingly, no hospital has been erected here of late years without a What Shall Philadelphia do for Its Paupers? 
5 
considerable quantity of land attached to it—not one, if I recol- 
lect aright, with less than one acre to every male patient. Our 
duty to the insane committed to our charge will not be performed 
in the manner required by the advanced sentiment of our time, 
without giving them the means of agricultural employment; and 
that implies a removal of the hospital some ten or twelve miles 
into the country, and a farm of at least 400 acres. 
Again, the close proximity of our hospital to a large city ex- 
poses the patients to the interference of a multitude of people 
who, as loafers, idlers, or sight-seers, are always ready to bestow 
their leisure upon others. They take up the time of the employes, 
they give to the patients what they ought not to have, such as 
money, tobacco, matches; they tell them what they ought not to 
hear,such as news about their domestic affairs; and make remarks 
about patients which reach their friends and cause anxiety and 
distress. Some, bent on a higher degree of iniquity, break into 
the building, through doors or windows. 
Another reason for removal is that the present association of 
the i nsane with paupers is attended with no benefit to either class, 
but with much discomfort and trouble to both. We have no 
right to subject the respectable poor to the constant spectacle of 
misery more deplorable than their own, nor ought the misfortune 
of being insane to draw upon any one the pains and penalties of pau- 
perism. There are many insane in this community, whose friends? 
unable to pay the high prices of the corporate hospitals, would 
gladly avail themselves of the privileges of our hospital, and pay 
according to their means, if it could be done without virtually 
acknowledging themselves to be paupers. 
I might mention other evils incident to our present method of 
caring for the insane, but my limits oblige me to hasten to an- 
other part of the subject. 
The paupers proper are subjected to the same kind of inter- 
ference from outsiders, that the insane are, adding much to the 
difficulty incident to their care under the most favorable circum- 
stances. But the principal evil is the unavoidable idleness arising 
from the lack of suitable means of employment. True, some are 
employed in manufactures; such as making shoes, weaving cloth, 
making tin and wooden ware, accomplishing some iron-work and 
plumbing, but there still remains a considerable number who are 6 
What Shall Philadelphia do for Its Paupers ? 
unfitted for any handicraft, but who might do good service on 
the land. Besides, all this work, except that which is done in re- 
pairs, is unprofitable, costing for the most part nearly if not quite 
as much as it would to buy the articles in the market. It is sup- 
posed, I know, that the House of Correction now building will 
make large drafts upon the almshouse, and probably it will, but 
it is difficult to see how that will remove the evil we complain of. 
Those who are idle here because ignorant of any skilled 
work, and incapable of learning, would be idle there, for the 
same reason, so that nothing would be gained economically by 
separating them from the general mass of paupers. 
For the various reasons mentioned, I regard it as necessary to 
the best interests of all concerned that this department of the 
almshouse, as well as the insane, should be separated from the 
others, and placed in the country, within an easy distance of the 
city, with plenty of land to till. 
Among the various departments of the almshouse is the general 
hospital for the subjects of bodily illness. The number of patients 
at this time is about one thousand. The medical staff, unexcep- 
tionally, is composed of men eminently qualified for their duties, 
by their skill, zeal and fidelity. The city hospital in such a com- 
munity as this, should be second to no other in the country, in 
its power to promote the comfort and restoration of its patients. 
It should be an establishment which, in all its appointments and 
appliances, should be a model worthy of imitation, and an object 
of honest pride to the city. Such, however, is not the fact. The 
institution does not, by any means, fulfill in the highest de- 
gree the proper purposes of a hospital, and is not one which 
we may be fond of showing to visitors acquainted with the hos- 
pitals of other cities. I have time to indicate only very briefly 
its principal defects. 
First and foremost is its crowded condition. With a capacity 
for about five hundred patients, it now has under care nearly one 
thousand. Not only are beds placed as closely as possible along 
the sides of the wards, but a large proportion of the patients lie 
on beds laid about on the floor in every available corner. There 
can be no surer way of making well people sick than that of 
crowding them together in their sleeping-rooms at night. For a 
still stronger reason such arrangements must be followed by simi- What Shall Philadelphia do for Its Paupers? 
7 
lar effects when applied to the sick, and our hospital furnishes no 
exception to the general rule, and the evil thus produced is not 
alleviated by any of those contrivances for frequently changing 
the air, such as steam-coils, or fires in the air-flues, or fans. Hot- 
air furnaces furnish the only artificial ventilation ; and, when they 
are not in use, the only dependence is on the doors and windows; 
and when these are closed at night, as they must be most of the 
time, the same air is repeatedly breathed by the patients. It needs 
no stretch of wisdom to see that such a state of things—crowded 
dormitories, and no artificial ventilation—must be a serious draw- 
back on the curative influences of the hospital. It is well under- 
stood by medical men that the sanitary condition of a hospital is 
affected by the state of the air within the wards, more than by 
any other agency, and it is only folly to prepare for every other 
requirement and leave the air to take care of itself. I would not 
have it understood that the air of the Blockley Hospital is less 
pure than it might be expected in the absence of any artificial 
ventilation, because, considering the means used, it is uncom- 
monly free from impurity. Still, we cannot ignore the evidence 
of its presence, in some degree. There, as everywhere else, bad 
air impairs the vital energies of the sick, thus thwarting the resto- 
rative influence of other measures, and depriving the system of 
that conservative power which is especially required after surgical 
operations. 
Another adverse circumstance is found in the condition of the 
floors, walls and ceilings. The floors, badly laid in the first place, 
have been steadily suffering a process of deterioration, which now 
appears in the shape of holes, knots, splinters, and wide cracks 
necessarily filled with dirt, and sending out noxious exhalations 
after every washing. The walls, originally rough, have not been 
deprived by annual whitewashings of their power to retain efflu- 
via full of the latent germs of disease. However trivial these 
things may seem at first sight, no thinking person connected with 
hospitals will deny the fact of their immense influence upon the 
hygienic state of the house. 
Another adverse circumstance is indicated by the character of 
the nursing, which is performed chiefly by discharged patients 
who are ostensibly restored, but who are hardly adequate to any 
steady employment, and are willing for little or no pay to help in 8 
What Shall Philadelphia do for Its Paupers? 
the wards. By means of a few good nurses they are made as effi- 
cient as any people can be who are poorly compensated, and who 
feel only a corresponding degree of responsibility. If any service 
under the sun requires, in the highest degree, vigor of body and 
soundness of mind, it is that of attending upon the sick. No hos- 
pital can achieve the highest measure of success, whose attendants 
are not well paid, and in possession of all the strength and elasti- 
city which only good health can supply. I ought to state that 
this kind of service is the result of economical considerations 
proceeding from the natural principle of saving the public from 
each and every-expense that can possibly be dispensed with. I 
have no fault to find with the motive, but I doubt if the public 
are not, in the long run, actual losers by the arrangement. 
From this same mistaken but imperative economy, very little has 
been done toward producing those mental influences so favorable 
to the recovery of the sick. Very often it is not so much the pills 
or the potions which the patient takes that determine the result 
of the case, as it is the feelings and thoughts that he entertains. 
Especially is this so with the victim of chronic disease. His own 
troubles, which are bad enough, are not likely to be lightened by 
the constant sight of others as wretched as himself, and, as a mat- 
ter of course, he becomes despondent and little cares whether he 
lives or dies. This is the great obstacle which the hospital phy- 
sician is obliged to encounter, and which is sufficient very often 
to thwart his most skillful efforts to effect recovery. He knows 
that whatever tends to draw his patient’s thoughts off from him- 
self, to suggest cheerful reflections, to excite a healthy interest in 
matters foreign to himself and his surroundings, it is one of the 
legitimate functions of a hospital to provide. Pictures on the 
walls, flowers in their season on the tables, books and newspapers 
without stint, the means of playing at popular games—all have a 
restorative influence, and no hospital that lacks them can claim 
to be considered as fully prepared for its allotted work. The re- 
proach of such imperfection our hospital must bear, for it has 
scarcely any of those things. 
Last, but not least, is that great crowning evil which, sooner or 
later, blasts all hospitals which have not met the deteriorating ef- 
fects of long-continued use by an increasing process of repairs 
and improvements. It is a curious fact, but none the less true, What Shall Philadelphia do for Its Paupers? 
9 
that there is in all hospitals a tendency to produce an atmospheric 
condition within their walls, exceedingly adverse to the restoration 
of health, and especially to those conservative efforts of the con- 
stitution necessary to recovery after surgical operations. Of all 
places in the world, a hospital should be that in which the sick 
should find the most chances for relief, and yet not unfrequently 
it presents the least. In this particular, the Philadelphia hos- 
pital is remarkably faulty. Patients do not readily recover after 
severe operations, the mortality on such occasions being exceed- 
ingly large. Indeed, not unfrequently the surgeons refrain from 
operating on that account, even though the patient may be suf 
fering under a mortal disease, sure to destroy life if no operation 
is performed. At the earnest, I might say, the peremptory solicita- 
tion of the surgeons, an appropriation of $5,000 has been made 
this year, for a building outside the almshouse walls, for this class 
of cases. Of course it can be only a make-shift unworthy of the 
honor of the city, but it will be the means of saving many lives. 
In the plan I propose for the disposal of the different classes of 
subjects at the almshouse, the sick are to remain where they are 
A hospital like this is a necessity of a large city, and though, like the 
other departments, it suffers somewhat from this proximity, yet this 
evil is more than balanced by unquestionable advantages. One is 
that it is easy of access, and this is an indispensable requisite of such 
an institution. Speedy and easy transportation is required for the 
safety of the patients, whose ailments might be aggravated in get- 
ting to and from a railway. Close proximity to the city is also 
required for the efficient performance of the medical service, as 
that implies the daily visits of from four to twelve medical gentle- 
men, some of them being made in the night, and some at a sud- 
den call. The surroundings are as favorable as they well could be 
in such a populous community. As a school of instruction, too, 
for which it has been justly distinguished, it has fully done its part 
in drawing to Philadelphia young men who are preparing to en- 
ter the profession. The parts of the almshouse, vacated by the 
paupers, the insane and the children, would furnish the desirable 
amount of room, and all that it could thus get would be none too 
much. But to fit it properly for its work, every floor should be 
relaid, the walls replastered and finished with putty coat, the in- 
terior arrangements made more convenient, an efficient method What Shall Philadelphia do for Its Paupers? 
of warming and a forced ventilation provided. Books, pictures, 
flowers and amusements should be introduced, not merely as a 
matter of ornamentation, but as a necessity—as an indispensable 
means for producing salutary mental influences. All these im- 
provements will fall far short of the end in view, if the hospital is 
to be managed in the spirit of a pauper establishment. The para- 
mount consideration must be, not how cheaply the patients can 
be kept, but how speedily they can be cured, and how far their 
sufferings can be alleviated. 
No department of the almshouse has occasioned so much soli- 
citude to the guardians and all others concerned in its manage- 
ment, as the lying-in-hospital. The number of women who came 
under its care during the year 1872, was 209. By the rules of 
the house they are required to stay fiftelb months and nurse the 
children, but the rule is not unfrequently evaded. The best re- 
sults of hospital care could not be expected from this class of per- 
sons, but after making every allowance on the score of constitu- 
tion and habits, there is reason to believe that much of the sick- 
ness and death is produced by causes peculiar to the establishment. 
It is understood and admitted by medical men that the death-rate 
in lying-in hospitals is larger on the whole than it is in private 
practice. Their statistics show a vast difference among them in 
this particular, some of them showing a mortality much less than 
that of some private practice. During the last five years the aver- 
age mortality at the Blockley has been one in twenty-two. Of 
the twenty-one hospitals, the statistics of which I have examined, 
not one shows so great a mortality as this, while in several the 
mortality has been less than one in two hundred. By statistics 
like these, by the testimony of the physicians, and by my own 
observation, I am led to the conclusion that the mortalit}r would 
be greatly lessened under different arrangements. This conclu- 
sion will be strengthened by considering certain incidents and 
conditions of the hospital that bear directly on the health of its 
inmates. 
In common with all establishments of the kind, it shares in the 
fatal results that flow from the congregation of large numbers 
passing through this notable process of nature. Puerperal fever, 
that scourge of lying-in hospitals, has frequently appeared within 
its walls, in its most appalling forms, carrying off, one year, one What Shall Philadelphia do for Its Paupers ? 
in eighteen of all the patients under treatment. Its ravages were 
stayed by removing the women into the open grounds and shelt- 
ering them in sheds. Like other hospitals, too, this retains at- 
tached to its floors and ceilings, in some inscrutable manner, the 
germs of disease, ever ready, under favoring conditions, to be de- 
veloped into some active form. Not a season passes in which this 
result is not apprehended, and frequently no amount of care can 
entirely prevent it. 
In this as well as other departments, the old wretched policy 
has prevailed of employing paupers for nurses. Occasionally, a 
good one is thus obtained, but it needs little knowledge of human 
nature to perceive what kind of service can be expected from un- 
paid, or poorly paid, irresponsible women. 
Besides the contagion of disease so active at the Blockley, there 
is contagion of another description, no less deplorable in its ef- 
fects—that of vice. Lying-in hospitals are never schools of 
virtue, but if their inmates leave them morally worse than when 
they entered, we are bound to ask whether this sad result could, 
not be prevented by some practicable change. Exposed as these 
women are, by lack of suitable means of classification, to others 
of their sex of the lowest morals, all of them more or less de- 
graded by habits of intemperance, disease and sin, it would be 
little short of a miracle, if any one left without being all the more 
decidedly prepared to pursue the kind of life thus begun. And 
yet among these sinners are many in the very morning of life, 
more the victims of circumstance than the willing slaves of vi- 
cious propensities, anxious, if possible, to retrace their steps; but 
deserted and cast out, they readily yield to the wiles of tempta- 
tion, especially when it comes in the shape of kindness and sym- 
pathy. These patients, at the end of the first month, if not be- 
fore, should be sent to an establishment in the country, for the 
purpose of obtaining better sanitary conditions and shielding them 
from bad'associations. For the others I am not sure that any 
change of location is practicable, even if desirable. The necessi- 
ties of the case require close proximity to the city, and by the 
removal of some of the other departments sufficient room would 
be gained to prevent the evils of crowding, and permit a suitable 
classification. The interior of the house should be completely 
reconstructed, and better architectural arrangements provided for 12 
What Shall Philadelphia do for Its Paupers? 
meeting the varying conditions of the patients. The whole system 
of pauper nursing should be abolished, and a corps of reliable 
nurses employed at fair wages. These changes would unquestion- 
ably effect the saving of many lives, and every year they are delayed 
will only add so many more deaths to our charge. 
There only remains to be considered that department of the 
almshouse called the Children’s Asylum, averaging about one hun- 
dred inmates. It is composed of children sent from the ob- 
stetrical wards as soon as they are weaned, of those who come into 
the house at a later period and of foundlings. They are well 
cared for, and I doubt if much could be done there that would 
increase their comfort or prolong their lives. Their food is 
abundant and of the most suitable kind, and they have the best 
medical attendance and faithful nursing. And yet the mortality 
in the asylum is very large. It is no part of my purpose to dwell 
upon this fact. It will be enough for those who wish to learn its 
details to refer to the carefully prepared paper read two winters 
ago to the association by Dr, Parry of this city. From this we 
learn that while about thirty per cent, of all the children in Phila- 
delphia, two years old and under, died, the mortality of the cor- 
responding class in the asylum was over seventy-three per cent. 
During the last two or three years the death rate has lessened, 
but still it is much higher than it. is in common life. This exces- 
sive mortality can be charged to no single cause, but results from 
a combination of adverse influences, and therefore the evil would 
not be abated by the removal of anyone of them alone, some, in- 
deed, being beyond all human reach. But it is clearly our duty to 
do what we can in this direction—to dispose of these children in the 
manner which has been satisfactorily shown to be most conducive 
to health. Among the things on this subject which may be regarded 
as settled, is this, that foundlings thrive better in the country, 
even when nursed by hand, than they do in the city, though in 
charge of wet nurses. Unquestionably, the best disposition of 
the asylum would be to place it in the country with room enough 
around it to afford ample play grounds, and give it the necessary 
seclusion. If, however, it should be concluded to keep it where 
it is, the building should be thoroughly reconstructed, and the 
apartments differently arranged. 
That a change of some kind, if not precisely that here advo- What Shall Philadelphia do for Its Paupers? 
13 
cated, in the disposal of our pauper classes, is needed, can scarcely 
be questioned, and it becomes only a matter of time. It would 
seem to need little argument to prove that the city cannot afford 
to keep its paupers on land worth one dollar the square foot. If 
a change of location is to be made, the sooner it is accomplished 
the better. The present buildings need extensive repairs to make 
them habitable, but it is money thrown away to lay it out on 
buildings soon to be abandoned. The Insane Department alone 
requires an immediate outlay of $lO,OOO or $15,000 on the roofs 
and floors, and as much more would be spent by any prudent 
landlord on other parts of the structure. There or somewhere 
else more patients must be provided for in order to meet the reg- 
ular increase of the insane. The need of more room is as im- 
perative now as it was two years ago when the new buildings were 
called for. To continue this crowding together of the insane, as 
is still done at Blockley, is simply to perpetrate a great crime 
against humanity. To ignore the fact and to be reckless of the 
consequences, is no better in point of morals, than it would be 
for a railway company to use a bridge after it had been pronounced 
defective and dangerous. Removing the insane, the children and 
the paupers proper, into the country, ample room, but none too 
much, would be obtained for the hospital, while the land outside 
the present inclosures could be put into the market, if not previ- 
ously given away. It has been proposed to remove our paupers, 
of all descriptions, I suppose, to buildings erected for them on 
the grounds occupied by the House of Correction. I trust this 
project will be abandoned. Besides the sanitary and moral evils 
which make the association of such large numbers exceedingly ob- 
jectionable, the House of Correction would render all the other 
departments disreputable. We could commit no greater breach 
of moral propriety than thus to place upon a single honest pauper, 
sane or insane, the stigma of crime. 
The several departments should be entirely independent and 
distinct from one another. The bad hygienic effects resulting 
from the aggregation of large numbers within a very narrow com- 
pass, are obvious enough at the Blockley. It would be a criminal 
folly to repeat the evil. Each one should be in the immediate 
charge of an executive officer specially fitted for the duty, to 
whom all else should be obedient .and responsible. The moral 14 
What Shall Philadelphia do for Its Paupers ? 
atmosphere around each should be exclusively its own, beyond 
the reach of any other. It is impossible in the nature of men for 
any one person to administer the affairs of such heterogeneous 
bodies as those which compose our almshouse, controlling their 
various movements, harmonizing and reconciling conflicting tem- 
pers, and obtaining the best results of an efficient organization 
of the service. If other evidence of the fact were required, the 
experience of the Blockley would furnish it abundantly. 
DISCUSSION. 
A Report of the Discussion on the Paper by Dr. Ray, read before the 
Social Science Association, held Thursday, March 27th, 1873. 
After the paper had been read, Dr. Ruschenberg was called 
to preside. 
(A member.) I would like to ask Dr. Ray whether he meant 
to be understood as actually saying the hospital was not furnished 
with means of really successful ventilation in the hospital wards ? 
Dr. Horatio C. Wood. Before Dr. Ray answers that ques- 
tion, I would ask whether he has ever been in the colored men’s 
ward in the evening ? 
Dr. Ray. The ventilation furnished by the Blockley is pre- 
cisely that, no more and no less than what is furnished by any 
house that has hot-air furnaces. The air passes over steam coils 
there, and the air thus obtained serves the purpose of warmth and 
ventilation, and if the air entered the wards by many registers, 
instead of one or two, the ventilation would be as efficient as any 
thing of the kind could well be. The coils are numerous, and 
there is a constant stream of fresh air, but still, all inefficient for 
the purpose, especially in the summer time, when the furnaces are 
not in operation ; and in the cold days of April and October, 
when the doors are liable to be shut, and the windows too, and 
no fire in the furnaces, the air must necessarily be breathed over 
and over again. I have never breathed the air in the colored 
men’s ward between seven and eight o’clock in the evening. It 
was enough for my purpose that I breathed it at other times. The 
colored wards do not even have the benefit of hot-air furnace ven- What Shall Philadelphia do for Its Paupers ? 
15 
tilation. They are warmed by common stoves, burning anthra- 
cite, and I dare say they often get very hot, as they do everywhere 
else. The only means of getting fresh air there is by opening 
the windows. 
Dr. Wood. How high are the ceilings in that ward ? 
Dr. Ray. I suppose about eight feet. No hospital ceiling 
should be less than twelve. 
Dr. Wood. How close are the beds together ? 
Dr. Ray. As close as they can be. 
Those wards are unfit for the care of any sick people, 
but they are used solely for the reason that there is no other 
room for them; every other available spot being occupied. It is 
only the result of the crowded condition of the house. The 
house was not built with the intention of having the attics used 
for wards, consequently they were not furnished with flues for the 
admission of hot air from the furnaces. 
Mr. Rosengarten. What will be gained by the use of the 
House of Correction ? 
Dr, Ray. I cannot see that anything would be gained. Very 
much would be lost and nothing gained by putting such different 
elements together. 
Mr. Rosengarten. Has there been no cooperation between the 
guardians of the poor and the directors of the House of Correc- 
tion ? 
Dr. Ray. I think not. The time has not yet come for that) 
as soon as it does they will let us understand what they can do. 
(A member.) What proportion of people, inmates of the 
almshouse, should be taken over to the House of Correction ? 
Dr. Ray. All those, I suppose, who are engaged in manufac- 
turing should be taken, and probably the whole class of vagrants. 
I am unable to speak very respecting the inten- 
tions of those who have the House of Correction in charge. 
Dr. Ludlow. How many are really respectable paupers in the 
establishment ? When I speak of respectable, I mean those who 
by reason of impaired health are unable to help themselves. I 
distinguish between vagrant and pauper. The pauper is one who 
commits himself to the care of the guardians of the poor; a va- 
grant is one who is picked up and committed to the county 
prison, from Saturday night to Monday morning, when the in- What Shall Philadelphia do for Its Paupers ? 
specters let him out, and he becomes transformed into a pauper 
by being carried over the river. So too, there ought to be a dis- 
tinction between some other classes—for instance, there are many 
old men and old women who are really unable, on account of age 
and infirmity, to support themselves; then there are a great many 
who are vagrants, or paupers, just as it happens. When the 
weather is cold they commit themselves to the guardians of the 
poor, or rather they are picked up and sent there from the prison, 
and then they become paupers. The number of really respecta- 
ble paupers in the establishment is comparatively few. 
As to ventilation, the buildings were erected thirty-nine years 
ago. At that time it was considered a model institution. A hol- 
low square was thought a very excellent feature; all that is changed 
now. 
We have got to consider again, the tremendous increase in the 
population, and all its attendants, as compared with that of the 
present time, and then we have to take into consideration the 
fact, that the gentlemen who compose the Board of Guardians of 
the institution have thrown upon them a mass of people, with very 
inadequate means of accommodation. All these various wards 
are crowded, and those colored wards that have been spoken of 
this evening, which Dr. Ray had his particular attention directed 
to, were never intended for patients. The inmates do not consist 
entirely of blacks, but there is a board partition, on one side of 
which are the white convalescents, and on the other are the col- 
ored people; so there is virtually no distinction on account of 
color. 
They are placed there for the very simple reason that the guar- 
dians can find no other place to put them in, but there is no op- 
portunity in those wards for procuring better ventilation, except 
it may be in raising the window sash to a slight degree. There is 
nothing except what comes through the doors and windows. 
As regards the other departments of the house, and I have had 
the pleasure of being re-elected attending physician of that estab- 
lishment for many, many years, I can testify to the great improve- 
ment which has been made since I first knew it. 
The system of ventilation that has been adopted is as efficient, 
so far as it goes, as it could be in a building of that kind con- 
structed thirty-nine years ago. But in regard to the removal, that What Shall Philadelphia do for Its Paupers ? 
17 
is merely a matter of time, and the tax-payers of the city of Phil- 
adelphia are the ones to answer that question. For my own part, 
I think the sooner it is removed the better. As far as the almshouse, 
and the insane department, and the children’s establishment are 
concerned, I believe fully the place for them is on a farm, so large 
that they can have plenty of air, and be well taken care of. At 
the same time there is an absolute necessity for having the city 
hospital for the city poor; where the poor man may not be done 
to death in taking him too great a distance. That is the most ac- 
cessible point. It will undoubtedly have to be greatly remo'delled 
to have it serve the purpose. 
Dr. Wood. I cannot see that the colored wards not having 
been built to receive patients makes the position better, but 
rather worse; the disgraceful fact remains, that these wards are 
used for hospital purposes. The ward is not over twenty feet in 
width, with ceiling not more than eight feet in height, the beds 
crowded as closely as possible, and almost the only ventilation by 
means of little sliding windows, about two feet long and eighteen 
inches high. In the day-time the colored patients crowd around the 
closed stove used for heating the apartment, until the effluvia from 
their breaths and bodies fills the whole air with a peculiar, sicken- 
ing odor. Many a time I have gone into those wards, in pur- 
suance of my duty as physician there, and have been almost 
driven out of them by the stench. You cannot get patients suf- 
fering from phthisis or other lung complaints, to whom the 
slightest draft is almost death, you cannot get them, even on the 
clearest winter day, to open those little windows above their beds. 
I want it distinctly understood, that in these remarks I do not in- 
tend to throw any reflections on the Board of Guardians, who, as 
the executive of a system, have done all in their power to miti- 
gate the sufferings caused by a radically wrong plan of organiza- 
tion and a scanty supply of funds; but Ido say, that such an in- 
stitution as our Philadelphia Hospital,or rather as Blockley Alms- 
house, with its swarm of unfortunate and vicious, of sane and in- 
sane, of pure and profligate, of sick and well, jumbled together 
and crowded into one heterogeneous mass, would be a disgrace 
to any civilized community. 
Why, sir, not long since there was a commission sent over from 
the French government to investigate the charities of the United What Shall Philadelphia do for Its Paupers ? 
States, and while they praised the institutions of other cities, they 
spoke with words of marked contempt of Blockley Almshouse. 
I conceive that there can be no plainer and more sacred duty of 
a community than that of taking care of its destitute, sick and 
poor ; no greater mistake than that of confounding vicious idle- 
ness with the need that sickness may bring to any of the poor. 
Yet, practically, this is daily done in Philadelphia, and the poor 
man in the hour of sickness finds that he can only get relief by 
being received, clothed and labeled as a pauper. Entering per- 
haps for the first time such gn institution in the Philadelphia 
Hospital, he finds himself classed as a pariah, and compelled to 
associate in the closest contact with the most vicious and profli- 
gate. No wonder that the honest poor of Philadelphia look upon 
being forced into such a hospital as the direst of calamities. No 
wonder that so many return time and again to the institution. It 
is no marvel that the destruction of self-respect, the contam- 
ination of vice, should convert the honest unfortunate into a 
vagrant and a tramp, when the custom, if not the law itself, judges 
sickness and criminal laziness as one. 
To show the force of what I say, let me mention an incident: 
Through a series of unavoidable misfortunes, a thrifty laborer 
with whom I was acquainted had lost all his savings, when one 
day he received an injury. Not knowing at first that he was 
severely hurt, he did not go to the Pennsylvania Hospital within 
the prescribed twenty-four hours, and was forced to enter the 
Philadelphia Hospital. Ongoing into my wards one day, I was 
astonished to see this man, and he on seeing me, with a look of pain, 
shrunk back, saying : “ For God’s sake, doctor, don’t tell anybody 
that you saw me here.” This very day a case came under my profes- 
sional care at the University Dispensary, which shows how the poor 
suffer, and often die, for want of the needed assistance. The 
patient was originally injured by a fall from a scaffold, and was 
treated for a time, until crowded out of the wards, in the Pennsyl- 
vania Hospital. To-day he is crippled in both of his arms, pro- 
bably for life, although under proper hospital care he would, I 
believe, have recovered. 
I do not think I can express more strongly than I feel, the crying 
necessity that there is in this city for more hospital accommoda- 
tion ; the reason of this lack of accommodation is obvious. The What Shall Philadelphia do for Its Paupers ? 
19 
city has trebled itself within a comparatively short period of time. 
Our hospital beds to-day number scarcely more than they did 
thirty years ago. We have, it is true, largely increased in the 
number of hospitals, but they are nearly all very small. The 
need of new hospitals will, in a measure, be met by private cha- 
rity, but individual beneficence will probably never suffice for the 
whole. The city must have a municipal hospital, unconnected 
with and uncontaminated by association with the workhouse—a 
hospital maintained purely and solely as such, where the poor 
man, or woman, or child, can always go, knowing that poverty 
and sickness are the only needful passports for admission. 
J. R. Sypher said the paper as read presented these points for con- 
sideration : First, The establishment west of the Schuylkill is over- 
crowded. Secondly, There is lack of classification. The poor, the 
sick, the insane and the children, are included in what is substan- 
tially one building and under one government. Third, The exces- 
sive economy exercised in the management is inimical to the proper 
treatment of the several classes. This last is an unheard-of 
charge against a public institution ; nevertheless it is easy to see 
how it may be hurtful. The paper suggests removal in such 
manner as to procure the proper classification—that is, so that 
the insane, the sick, the children and the poor may be provided 
for in separate establishments, each provided with facilities for 
the proper employment of the classes who would be benefited in 
body and mind by labor. A hospital for the sick and injured 
must be maintained on the present site. 
This is a subject on which the public is not informed, and if 
by these efforts public attention is drawn to it, a good work will 
have been accomplished. The public should not be assailed but 
instructed. 
John M. Whitall. About 1864 the guardians of the poor be- 
came dissatisfied with the ventilation of the institution, and the 
City Councils liberally granted means enough to thoroughly ven- 
tilate it, as far as it was capable thereof. The result has been 
that in the surgical wards the disease called pyemia has disap- 
peared, as I have understood from the surgeons. One of the 
surgeons of one of the newest hospitals in the city, asked me 
why they were losing their patients. The hospital had been built 
within fifteen years, and yet when they had grave operations, 20 
What Shall Philadelphia do for Its Paupers? 
pyemia would take the patients off, and they would die in spite 
of all they could do. The mortality in our hospital has been 
very much decreased since the present ventilation was introduced. 
When we had relapsing fever, a couple of years ago, the mor- 
tality was very small among those who took it in the building at 
the time. There were a great many brought in from the city 
who died—being brought in in a dying state. There is no case 
on record where the disease was communicated to patients in the 
immediate vicinity of the sick, the ventilation being so perfect. 
In the medical wards, particularly in the second story, there was 
not a single case. 
In relation to the colored ward up-stairs, the ventilation there 
is very good. It is true we have not fresh hot air, introduced 
from the chambers below, but we have a thorough ventilation 
there from below in the chimneys which run up. I have been in 
it a great many times—I made it my business to go there—and 
I must confess I never was offended by its bad odor. The 
house is entirely too small for the accommodation desired. 
The hospital has had an average of patients this winter, occupying 
beds of 700. At one time our whole population numbered 4,024; 
It is now down to 3,600, or about that, but the mortality has not 
been excessive. I was very much surprised to hear from Dr. Ray 
—I suppose that there is no doubt, but that he is correct—that the 
mortality was so very high among the children, and in the lying- 
in wards. Ido not say it is not so, but I was very much surprised 
to hear it. 
The ventilation, I would say in closing, is perfect, especially in 
the surgical wards, and in all portions of the house. In 1871 
councils appropriated means to build an addition to the insane 
department, and at that time this matter of ventilation was at- 
tended to. There being about eight hundred patients in that de- 
partment, they built two extensive wings, 116 feet by fifty feet, 
three stories high. They were built with reference to the system 
of ventilation that has been introduced into the other parts of the 
institution, and at this day/summer or winter, when you go into 
them, there is no effluvium,"or unpleasant order, at all. You may 
go in there to-day and you will smell nothing but new wood. It 
has been built two years, and it is a wonder to the citizens. I 
know that the mortality of the house has been very small. What Shall Philadelphia do for Its Paupers ? 
21 
Dr. Wood. I would ask the member of the Board of Guardians 
for the precise figures as to the present mortality ? 
Mr. Collins. (A member of the Board of Guardians.) The 
house has now an average population of 3,600, and the average 
mortality in 1872 was 9.33 per cent—a little increased on account 
of having some cases of small-pox. That is the average. 
Mr. Rosengarten. I heard Dr. Wood make some suggestion in 
respect to the statistical comparison of the number of beds here 
and in New York: Is not one solution of it that there are fewer 
wanted here. There, it is said, owing to the large number of tene_ 
ment houses they need more room and space. But here they 
have more facilities; every man his own house. Is there any- 
thing in that ? 
Dr. Wood. There is no doubt but that a larger proportion of 
hospital accommodation is needed in New York than in Philadel- 
phia. If you simply consider the difference in crowding in these 
two cities, you may say that three or four times as much is wanted 
in New York, but when you remember that we are a great manu- 
facturing center, and that practically there is no hospital in the 
whole State of Pennsylvania, except in the far western portion, 
outside of the city of Philadelphia, and that the larger proportion 
of the people of the State are engaged in mining, working on rail- 
roads, and manufacturing occupations which are of necessity more 
or less dangerous, the differences of need in the two cities will be 
seen to be much less than at first sight. I think myself that we 
ought to have at least half of the hospital accommodation that 
New York has. Above all, let us have what we do have free from 
the taint of the workhouse. 
If you leave out the medical wards of our almshouse there are 
not in the city of Philadelphia over 300 free hospital beds. 
What is that amongst so many ? 
J. G. Rosengarten. Is there not another matter to which the 
medical faculty can call attention ? Is it not thought that these 
German, Episcopal, Jewish, Protestant and other separate hospitals 
are a detriment, and is there not a want which can only be supplied 
by special hospitals instead of these denominational hospitals ? 
Dr. Wood. Large hospitals are superior to small, in that they 
can be carried on at about two-thirds the proportional cost. 
On the other hand, owing to the crowding together of the sick 22 
What Shall Philadelphia do for Its Paupers ? 
and the difficulties of ventilation, the mortality is certainly 
greater in them than in the smaller institutions. In order to com- 
bine the advantages of the two, hospitals are now built in 
such a way as to be a collection of small, distinct hospitals, con- 
nected generally by corridors with a central building, used for 
executive purposes. It is in this way that the new hospital of the 
University of Pennsylvania is being built. If it ever reaches its 
proposed size of six hundred beds, it will be formed of six distinct 
hospital buildings, spread over as many acres of ground, and 
simply joined to the central executive building by narrow corri- 
dors, furnished with air-tight iron doors. Another advantage of 
such a hospital is the fact that in it alone can be found all the 
appliances for the treatment of all forms of disease. In the Uni- 
versity hospital, each medical specialty will have its proper place. 
Thus to-day there is nowhere in the city of Philadelphia prop- 
erly arranged baths for the treatment of skin diseases; not even 
the rich can command the best appliances unless by leaving our 
city. To show the importance of this, I may mention, that the 
bathing apparatus attached to the skin ward of St. Thomas’s 
hospital, London, is said to have cost SIO,OOO. Skin diseases, 
nervous diseases, eye, ear and all other special forms of human ills, 
will in the new hospital find the most approved methods of treat- 
ment, and it will be the only completely furnished general hos- 
pital in our city. 
Mr. Whitall. I would like to make one more remark, in rela- 
tion to the estimate of the Philadelphia hospital, made by gentle- 
men who have visited it from Europe. I know of several such, 
who said that they have nothing in Europe so well ventilated as 
the Philadelphia hospital. My attention was particularly called 
to the fact, from the circumstance of being very much interested 
in carrying through the ventilation, when these gentlemen were 
there. 
Dr. Ludlow. Ido not wish to occupy the attention of the 
audience, except to bring one suggestion before them, I see by 
the paper that to-morrow afternoon a committee of councils is to 
visit the grounds where the almshouse and hospital are located. 
I think it has been an opportune affair that this meeting has been 
held to-night, and that the citizens have been deliberating about 
this matter. They are going to make investigations as to the What Shall Philadelphia do for Its Paupers? 
23 
removal of the hospital and the almshouse from that location. 
Now, sir, I think that this is one of the good things, at any rate, 
that we have done; that we have taken into consideration this 
matter. Unquestionably there is a necessity for removing the 
almshouse, and a necessity for retaining the hospital in that 
locality. Ido not know of any better place where the wants of 
the city poor can be better attended to, and where they will not 
be subjected to the excessive hauling and jolting that will be 
necessary if the hospital is removed into the country. I say noth- 
ing in regard to the insane department, because as to that I 
think as almost every one else does, it ought to be removed far 
away into the country, where they can have all the adjuvants 
necessary for an establishment of that importance. They should 
be placed on a farm of at least 400 acres, where all the necessary 
appliances for making them comfortable can be procured, so that 
if not restored to a perfect state of health and a sound mental 
condition, their deplorable state can at least be much benefited. 
J. G. Rosengarten moved that the thanks of the Association 
be tendered to Dr. Ray for his able paper, and that a copy be 
printed for distribution among the members, together with an 
abstract of the proceedings. 
Carried. 
Adjourned. 
The following is a list of the Papers read before the Association : 
1871. Compulsory Education. By Lorin Blodget. 
Arbitration as a Remedy for Strikes. By Eckley B. Coxe. 
The Revised Statutes of Pennsylvania. By R. C. McMurtne. 
Local Taxation. By Thomas Cochran. 
Infant Mortality. By Dr. J. S. Parry. 
1872. Statute Lazo and Common Law, and the Proposed Revision in Penn- 
sylvania. By E. Spencer Miller. 
Apprenticeship. By James-S. Whitney. 
The Proposed Amendments to the Constitution of Pennsylvania. By 
Francis Jordan. 
Vaccination. By. Dr. J. S. Parry. 
The Census. By Lorin Blodget. 
1873. The Tax System of Pennsylvania. By Cyrus Elder. 
The Work of the Constitutional Convention. By A. Sydney Biddle. 
What Shall Philadelphia Do with its Paupers ? By Dr. Ray. Hjiilabtlpjp Social Science Association. 
OFFICERS FOR 1873 
HENRY C. LEA. 
PRESIDENT, 
EXECUTIVE COMMITTEE! 
DR, ISAAC RAY, 
« RUSCHENBERGER, 
Department of Public Health. 
BLOMFIELD H MOORE, 
DR. H. EARNEST GOODMAN. 
Department of Education. 
DR. CHARLES J. STILLE, 
“ D. R. GOODWIN, 
JAMES L CLAGHOR 'f, 
LORIN BLODGET, 
Department of Economy, Trade and Finance. 
T. W. BRAIDWOOD. 
JOSEPH WHARTON, 
JOHN WELSH, 
WM. A. INGHAM, 
E. A. ROLLINS, 
Department of Mining and Manufactures. 
C. IT. CLARK. 
ECKLEY B. COXE, 
T. GUILFORD SMITH, 
JOSEPH D. POTTS. 
J. S. WHITNEY 
T. S. EMERY, 
Department of Jurisprudence and the Amendment of Laws 
W. HEYWARD DRAYTON, 
R. C. McMURTRIE, 
J. VAUGHAN DARLING. 
E. SPENCER MILLER, 
R. L. ASPIHURST, 
SAM’L DICKSON, 
Members and others interested in any of the subjects included in these De- 
partments are requested to take part in their proceedings, and, for that purpose, 
to prepare papers on topics connected with the study of Social Science, so that 
they may be read and discussed at the stated public meetings of the Associa- 
tion. The members of the Association are requested to notify the Committee 
of the Department with which they wish to be especially connected. 
By order of the Executive Committee, 
J. G. ROSENGARTEN, Secretary, 
532 Walnut Street, Philadelphia. 
Subscriptions to the Printing Fund, and for membership, Five Dollars 
annually, payable in advance, or One Hundred Dollars for Life Membership, 
are received by 
E. A. ROLLINS, Treasurer. 
First Nat. Bank, Philada.