wx M251s 1831 L:,:%l?f iSri>t«4Ht^ | Si ' : w< N 3NI3I03W JO ABVIlail IVNOIIVN 3NI3IQ3W JO A 8 V « 9 I 1 IVNOIIVN 3 N I 3 I 0 3 W JO A Sri b ^*W >? <%*f i NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBR *)*%>* N 3N I 3 Id 3 W JO ABVBail IVNOIIVN 3NI3IQ3W JO AUVDail IVNOIIVN 3NI3I03W JO A i '/V 7 •: ^ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBR ? #v/ I N 3NI3I03W JO AXVaail IVNOIIVN 3NI3I0 3W JO A a V II a II IVNOIIVN 3NI3I03W JO A 1 / f^fj I ; S v /v E NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBR \?v rsXi ' N 3NI3I03W JO A » V Ha I 1 IVNOIIVN 1NI3IQ3W JO A » V M 8 I 1 IVNOIIVN 3NI3IQ3W JO Al I /Vl E V w\ O AIV«ail IVNOIIVN 3NI3IQ3W JO UVltn IVNOIIVN 3NI3IQ3W JO UVIBI1 1VNOI1VI } t .5. ,■**" * LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDIC ^VIVN 1 /VI JO AHV88I1 IVNOIIVN 3NI3IQ3W JO A * V 9 8 I 1 IVNOIIVN 3NI3IQ3W JO A B V « 8 I 1 1VNOUVI „- ' LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDIC IBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDIC j 5. t----- , O ABVB8I1 IVNOIIVN 3NI3IQ3W JO A II V 11 8 II IVNOIIVN 3NI3I03W JO A H V B 8 I 1 1VNOU iT¥i I SOME ACCOUNT OF THE ITS ORIGIN, mjtcte unn mwmt state. BY W. G. MALIN, LIBRARIAN OF THE INSTITUTION. PRINTED BY THOMAS KITE, 64, WALNUT STREET. 1831. WX )832, Published by Order of the Board of Managers. SOME ACCOUNT OF THE PENNSYLVANIA HOSPITAL. The Pennsylvania Hospital was founded by a number of the benevolent citizens of Philadelphia, incorporated in the year 1751, by an act of the provincial legislature, as " The Contributors to the Pennsylvania Hospital." Every contributor of ten pounds, (twenty-six dollars sixty-seven cents) or upwards, being a member of the corporation, with a vote in its elections, and eligible to be appointed to the ma- nagement of its concerns. The design of the Hospital is general, its charter provid- ing for the reception of insane persons, and those afflicted with all other maladies not infectious. A Lying-in depart- ment, authorized by a subsequent act of Assembly, for the accommodation of poor married women, of respectable cha- racter, has been founded on a donation from the First Troop of Philadelphia City Cavalry, of money received by them for military services in the war of the revolution. The number (4 ) of women annually received into this department, is now upwards of seventy. The charter of this institution provides, that no part of its income shall be appropriated to any other purpose, than to the support of the sick and diseased poor, and providing the necessary buildings for their accommodation; and that those whose diseases render them proper objects of the cha- rity, shall be received from any part of Pennsylvania, with- out partiality or preference. The contributors meet annually on the first Monday in the month of May, to elect from their body, twelve Managers and a Treasurer, to serve during the ensuing year.* The law regulating their duty and trust, provides, that they shall re- ceive no emolument whatever for the performance of their official duties. The appointment of the physicians and other officers and servants of the institution; the regulation of its internal economy ; and the general charge of its income, are intrusted to the Board of Managers; of whose number the * The following are the names of the gentlemen who were first elected to discharge the duties of this important trust:— MANAGERS. Joshua Crosby, Samuel Rhodes, Benjamin Franklin, Hugh Roberts, Thomas Bond, Joseph Morris, Samuel Hazard, John Smith, Richard Peters, Evan Morgan, Israel Pemberton, Jr. Charles Norris. TREASURER—John Reynell. \ (5) presence of at least eight, and the concurrence of seven, are necessary for the transaction of business. The stated meet- ings of this board, are held on the last Monday of each month. The Managers elect annually three physicians to have charge of the medical department; three surgeons to the charge of the surgical department; and two physicians for the lying-in department: all of whom must be Doctors in Medicine, and members of this corporation. Two young gentlemen, graduates of medicine, reside in the Hospital, and take charge, alternately, of the surgical, and the medical and obstetrical departments, under the direc- tion of the visiting physicians and surgeons. One of the residents is elected annually to serve two years. An apothecary is engaged at a salary, to prepare and dis- pense the medicines prescribed by the physicians. The physicians and surgeons of this Hospital have uniformly rendered their important aid gratuitously.* The students of medicine who attend the practice of the Hospital physicians, pay a fee of ten dollars each for the privilege: these fees, which in European hospitals are a perquisite of their medi- cal staff, the professional gentlemen, attached to the Penn- sylvania Hospital, have generously devoted to the founda- tion and endowment of a Medical Library, which now con- * The gentlemen who had the honour of originating this practice by a voluntary offer of their services in the infancy of the institution, were Dr. Lloyd Zachary, and Drs. Thomas and Phineas Bond. To these were afterwards added Drs. Thomas Graeme, Thomas Cadwalader, Samuel Preston Moore, and John Redman, as physicians and surgeons for the first year. (6) sists of about six thousand volumes, comprising a large pro- portion of the most valuable ancient and modern works on the science of medicine; with many rare treatises on Botany, and other branches of natural history. Students have the privilege of using this splendid collection, while attending the Hospital practice; and a right to its use during life is granted for the sum of twenty-five dollars. The six physicians and surgeons having charge of the me- dical and surgical departments, divide the year into three equal periods, one physician and one surgeon attending at the same time, and continuing in charge of their respective wards four months. The two physicians having charge of the lying-in department, continue in office six months each. In extraordinary cases, and before the performance of surgi- cal operations, it is usual for the gentleman in attendance, to hold consultation with his colleagues. The Board of Managers appoints monthly, a committee of two of its members to admit and discharge patients, and to exercise a particular superintendance over the internal con- cerns of the institution. This committee, and the attending physicians, meet at the Hospital twice a week (on Wednes- day and Saturday) for the transaction of business. To faci- litate applications for admission, the names of the attending managers and physicians are regularly advertised in several of the daily papers. The usual mode of obtaining admission into the Hospital is, by first applying to one of the physicians in attendance; who, after examining the patient, gives a certificate of the nature of the disease, and the propriety of its admission into the Hospital; this is addressed to the attending managers, who settle the terms of admission, and grant their order di- \ (7) recting the steward of the Hospital to receive the patient. This course is only departed from in two cases—that of sea- men, who, (by a special agreement) after receiving a certifi- cate from the physician, have only to obtain the order of the Collector of the Port;—and in cases of accident,—it being a rule to receive by day or night, every person who meets with an accident requiring surgical aid, without requiring any security of the parties who bring the patient to the Hos- pital ;—provided the accident occurs in Pennsylvania, and the sufferer is brought immediately, or within twenty-four hours. After the accommodation of as many poor patients as the state of their funds will justify, the Managers have authority to receive pay patients ; any profit derived from this source being devoted to increase the fund for the maintenance of the poor. The rates usually charged are from three to six dollars per week, according to the circumstances of the pa- tients. Pay patients are not admitted on a deposit of money, or on the responsibility of strangers; the only security ac- cepted, is that of some respectable resident in Philadelphia. At their own desire, patients may be attended, exclusively, by either of the Hospital physicians they may prefer, but in such cases it is expected that the affluent will pay the phy- sician as though attended elsewhere. As this institution is intended to be a hospital for the cure of disease, not a permanent asylum for poverty and decrepi- tude, the Managers can admit none on the charity list, whose diseases are chronic and incurable, except those afflicted with insanity: and it is imperative upon them to discharge all patients, who, after a reasonable time of trial, may be deem- ed incurable. ( 8 ) The number of the patients to be received on the charity of the institution, is fixed from time to time by the Board of Managers; it is now nominally one hundred, but as no serious cases of accidental injury are ever turned away from the Hospital-gate, the number of its poor patients is frequently one hundred and twenty, and for some time past has rarely been less than one hundred and ten. About one-third of the patients on the poor list are insane: it has been found necessary thus to limit their number, on account of the great length of time such patients have re- mained, to prevent their occupation of the house to the ex- clusion of the necessitous sick and wounded. A new arrangement has, however, been introduced, which, already productive of much good, promises to render this in-. teresting department of the institution of far greater public utility than heretofore. Experience has demonstrated, that mental maladies are almost insusceptible of cure, except in their earlier stages ; every thing appears to depend on the prompt removal of the patient from scenes and persons associated with the mental hallucination, and an early subjection to a proper course of medical and moral treatment. It being, therefore, of great importance to open the door of admission as widely as possi- ble to recent cases, the Managers of the Hospital have agreed, that in future, except under particular circum- stances, insane persons shall be received on the charity, but for limited periods; sufficient security being taken that they shall be removed by their friends when the disease becomes fixed, and the restoration of reason is no longer to be expect- ed. This regulation has already afforded relief in a number (9) of cases which must otherwise have been excluded from the means of cure. The square on which the Hospital stands, is bounded by Spruce and Pine, and Delaware Eighth and Ninth streets. It measures four and a quarter acres. With the exception of about one hundred and fifty feet on Pine street, furnished with an iron railing, which affords a view of the south front of the building, the whole lot is enclosed by a brick wall. About seven-eighths of this square were purchased by the Managers in 1754, for the sum of £.500 Pennsylvania cur- rency. The remaining portion, consisting of a lot on Spruce street of three hundred and ninety-six feet in length, by sixty in depth, was presented to the Hospital in the year 1762, by Thomas and Richard, sons of William Penn. The open square lying in parallel lines to the east, togeth- er with several lots to the south and west of the Hospital, containing in all about ten acres, have been purchased at various times, in order to secure an ample space, and free circulation of air, around the buildings. The Hospital, surrounded, on the borders of the square, by majestic forest trees,* exhibits a south front of venerable aspect and considerable proportions, extending east and west, two hundred and eighty-one feet. It consists of a cen- tre building, united by long wards, of three stories in height, to two wings extending north and south. The wings are * These are Buttonwood, or Occidental Plane trees, the largest growth of the North American forest; they were planted in the year 1756, by Hugh Roberts, one of the first managers of the institution. B ( io ) surmounted by cupolas, and finished so as to present respect- able fronts on Eighth and Ninth streets to the east and west. The foundation stone of this edifice was laid on the 28th of May, 1755. It bears the following inscription: "In the year of CHRIST MDCCLV GEORGE the Second happily Reigning (For he sought the Happiness of his People) Philadelphia Flourishing (For its inhabitants were public-spirited) This Building, By the Bounty of the Government, And of many private persons, Was piously founded, For the Relief of the Sick and Miserable. May the God of Mercies Bless the Undertaking." Although able to complete but a portion of the designed building, its founders, with wise foresight, commenced upon a liberal scale, by adopting a symmetrical plan, which has been filled up at successive epochs, as admitted by the funds of the institution, and required by the exigencies of an increasing population. The eastern wing was completed and opened in the year 1756,* the western wing in 1796, and the cen- tre in 1805. * Prior to this time the Hospital was kept in a house, formerly the re- sidence of Judge Kinsey, on the south side of Market street above Fifth street. This house with its grounds, including nearly one-third of a square, was hired at a rent of forty pounds per year. \ (Jl) The centre measures sixty-four feet in front, by sixty-one in depth, and with the balustrade surrounding its cupola, seventy-two feet in height. The long ward to the east of the centre, is eighty-one feel in length, by twenty-seven feet in breadth, and the east wing measures twenty-seven feet east and west, by one hundred and eleven north and south. The western ward measures eighty-one feet by thirty-three, and the west wing twenty-eight feet by one hundred and eleven. The increased breadth in the buildings to the west of the centre, was adopted to allow of the construction of a double range of apartments for the insane: except, however, to a very accurate eye, this difference is scarcely percep- tible. The House is thus occupied: under the basement of its centre are cellars and a bake-house; the basement story contains the kitchen—a'dining-room for the Steward's family —and two sleeping rooms for female domestics. On the first or entrance story, is a handsome hall, with spacious stair- cases and passages to the different parts of the house. The apartments on this floor are four;—the Library, which is also the Steward's office, and in which the Managers meet to transact business—the Apothecary's shop—a parlour, and the Steward's chamber. The second story is occupied by the lying-in department, and chambers for the resident phy- sicians, clerk, and apothecary. The third story contains a circular operating theatre, in which all the surgical opera- tions, of importance, are performed, in the presence of the medical class attending the practice of the Hospital. In this apartment three hundred persons may be seated : it is sur- mounted by a dome with a glass cupola, affording the best ( »*) possible light to the operator. Adjoining this room are apartments for the reception of patients operated upon ; and on this floor, are also the apartments occupied by the sick and lame while females. To the east of the centre building, on the basement story, are, a long hall in which a majority of the insane patients take their meals; eleven sleeping rooms for this class of pa- tients, and their attendants; and some store rooms. The first and second stories are occupied as medical and surgical wards, by the white men. About forty patients can be re- ceived in each ward. The garret over the long ward is at present unoccupied—those in the wing are used as sleeping rooms by some of the domestics. In the line of this wing, to the north, is a detached building of three stories, occupied by a class of white men, and by coloured people. To the west of the centre, the whole range is occupied from the basement to the attic story, inclusive, by insane persons and their attendants. It contains, for their accom- modation, fifty-six separate sleeping rooms, each about ten feet square; four larger apartments generally occupied by patients having separate attendants; the long garret, in which from twelve to fifteen of the most quiet male patients usually sleep; and the garrets of the wing which contain beds for fourteen female patients and attendants. In the first story of the wing are four day rooms, two on each side of the hall; those to the north are used by the male, and those to the south by the female patients: the men have also a day room over one of the out-houses, in which are kept the most noisy and careless of their number. ( 13 ) In the rear of this wing on Ninth street, is a detached building, with separate sleeping rooms, each about ten feet by eight, for eighteen insane females. In addition to the buildings enumerated, there are, on the north part of the square, a wash-house—coal shed—stabling and carriage house—green-houses, and the building on Spruce street in which is exhibited the painting by Benjamin West, of Christ Healing the Sick in the Temple. The exhibition of this superb piece, a present from that distinguished artist, produces a revenue to the Hospital of about five hundred dol- lars per annum.* A fine statue of William Penn, of lead bronzed, (presented by his grandson, John Penn, Esq. of Stoke Pogeis, England) is placed upon a pedestal of white marble, in a conspicuous situation on the lawn before the south front of the Hospital. A chair, once the property of that great man, is preserved in the house. And a scion from the Elm tree, under which was held the celebrated treaty with the Indians in 1682,f has attained considerable size, in the square opposite the western front of the building. The green-houses, containing a handsome collection of ex- otic plants, together with the ornamental lawns in front and * The gross amount of the receipts from this source is $19474 75, re- ceived from 76599 visiters, and for thirty perpetual tickets at $10 each. t Vide a conclusive and interesting memoir on the locality of this treaty, contributed by Roberts Vaux, Esq. to the Historical Society of Pennsylvania—Memoirs of the Society, vol. 1. p. 81. (14) rear of the house, are under the care of a regular gardener. The attention paid to neatness, and even ornament, in the exterior and grounds, as well as in the interior of the house, gives to the whole an air of elegance, seldom equalled in es- tablishments of this nature. This is justified, as well by do- nations to a considerable amount having been received for this purpose, as by the influence it is calculated to exert on the mind and health of the inmates of the institution. A carriage and pair of horses are kept for the use of the patients; money for their purchase and support having been bequeathed by Dr. Samuel Cooper, formerly a resident phy- sician in the Hospital. Another horse is kept for the market- ing and other necessary uses of the establishment; and twelve cows for a supply of milk to the patients: these derive the principal part of their support from the adjacent lots, the property of the institution. The provisions furnished to the inmates of the Hospital are of the best quality; the common diet is plain but nutri- tious, and in necessary cases, delicacies and wines are freely administered, on their prescription by the physicians. It be- ing a recognized maxim, that, while nothing may be admin- istered merely to pamper the appetite, nothing shall be spar- ed which can contribute to the recovery of health. The total number of patients admitted into the Hospital from its opening, February 11th 1752, to the 1st of Decem- ber 1830, was twenty-eight thousand one hundred and five; of whom 14,501 were poor, and 13,604 pay patients. Of these have been discharged, (15) Cured - - - . .. 17436 Relieved - - - - - - 3369 Removed by friends, or at their own request, or as incurable - - - - . 1833 Eloped, and discharged for misconduct - - 998 Died - - - . . . 3040 Pregnant women delivered safely - - 615 Infants taken out in health - - - - 578 27869 Remaining in the Hospital, December 1st 1830.....- 236 28.105 In addition to these a large number of out patients have been attended by the Hospital physicians, and supplied with medicines gratuitously. This attendance on out pa- tients had its origin in an early Rule of the Institution, that no person should be admitted, except such whose cases re- quired the particular conveniences of an hospital. Applica- tions were constantly made for relief, by persons excluded from the house by this regulation; and the Managers and Physicians anxious to extend the benefits of the charity to as many as possible, agreed to furnish such with medicine and advice at their homes. No regular record of these cases was preserved prior to the year 1798, but that the number was very considerable may be gathered from the subjoined extract from a memorial of the Managers and Physicians of the Hospital, presented to the Legislature in the year ( 16) ■ 1792. The effect of this regulation upon the results of the admitted cases, is also worthy of remark. After stating the number of admissions, with their results, the memorialists continue: " But it should be observed that this enumeration doth not include the very great number of out patients, who have received medicine and advice, though their cases did not require admission into the Hospital:"— and " That admissions being only allowed in acute and dan- gerous cases, will account for the melancholy proportion of the dead, to the cured and relieved, it being the natural and unavoidable consequence to be expected from the cases ad- mitted." From the year 1797, to May 1817, when, in consequence of the establishment of Dispensaries, it was deemed unneces- sary to continue this branch of the institution, the number of out patients attended from the Hospital, was sixteen thou- sand and sixty-three—of whom 13,040 were restored to health. Vast as has been the amount of human misery relieved; of life preserved; and health restored, through the direct agency of this institution ; an estimate of its public usefulness which should omit a consideration of the indirect benefits which it has conferred upon society, would still be far from doing justice to its merits. To the period of its foundation no school of medicine existed in this country. The youth of America, who would then qualify themselves for the practice of the healing art, had to seek instruction in the schools of Ger- many,of France, or of Britain. The Pennsylvania Hospital, un- der the care of some of the first physicians of that day, soon at- tracted a number of students of medicine—Lectures, the first delivered in this country, were given by its physicians—and \ (17) thus were laid the foundations of the distinguished medical school of Philadelphia. The wards of the Hospital have been the theatre of many important improvements in surgi- cal practice. Gentlemen educated within its walls, have attained the highest rank in their profession—and several thousands of young physicians have gone out into all parts of the Union, carrying into their practice the valuable lessons and experience of this institution. The cases of insanity admitted into the Hospital from Feb- ruary 1751, to December 1830, and included in the aggre- gate of admissions, (28,105) were three thousand Jive hundred and eighty-one. Those admitted as Mania-a-potu, or De- lirium tremens, during the last eight years, (prior to which such were admitted as cases of insanity) amounted to two hundred and sixty-two. Of both these classes of patients, the following tables, derived from a careful examination of the Hospital records, exhibit the numbers of each sex, togeth- er with the result of their treatment. CASES OF INSANITY, ADMITTED FROM FEBRUARY llTH 1752, TO DECEMBER 1ST, J 830. Total. Cured. Relieved. By friends without material benefit. Elop-ed. Died. Re-main. Males 2429 Females 1152 868 361 482 279 480 249 187 42 346 166 66 55 3581 1229 761 729 229 512 121 ( 18 ) It may be remarked that a large proportion of the deaths have been the consequence of old age, or diseases having no necessary connection with insanity. Many of the elope- ments occurred before the Hospital was surrounded by a wall. Cases of MANIA A POTU or Delirium Tremens, ADMITTED FROM THE YEAR 1822, TO DECEMBER 1ST, 1830. Total. Cured. Relieved. Removed friends Eloped. Died. Remain. Males 242 Females 20 155 14 14 1 12 1 5 55 3 1 1 262 169 15 13 5 58 2 The number of insane persons in the house, now averages about one hundred and twenty. The last thirty years have witnessed much improvement in the situation and treatment of the unfortunate subjects of insanity, throughout the civilized world; and the circum- stances of the inmates of this asylum, have certainly shared in the general amelioration. Their treatment was, however, always characterized by humanity. At no period has cru- elty towards them been tolerated. The attendant who is known to strike, or otherwise ill-treat a patient, is at once discharged. The medical treatment of this class of patients, varies of course, according to the symptoms of the malady, and its connection with other derangements of the system. V ( 19 ) The confined situation of the buildings, together with their common appropriation to the purposes of a general hospital, unfortunately prevents the adoption of an efficient system of classification, and employment; essential constituents of what is commonly termed moral treatment. Employment is believed to be beneficial in all cases, except of acute delirium;—where cure is possible, it conduces to it; and where this is not even hoped, labour ensures sound repose and a general tranquili- ty, which is rare in the unemployed. This being the belief, founded on experience, of those who administer the affairs of this institution, it is acted upon as far as circumstances will permit. The greater part of the females are employed in knitting, sewing, spinning, and similar avocations. It has been found more difficult to furnish employment for. the men, a number of them are however employed; some in weaving tape or fringe, preparing carpet yarn, and making mattrass- es ; and others in supplying the house with fuel, keeping in order the yards, areas, &c.; in short, every opportunity is taken to promote employment, and every disposition on the part of a patient to occupy himself innocently, is encourag- ed ; to this end chess, drafts, and some other amusements have been introduced, and newspapers and books are furnish- ed to those who can enjoy them. Two musical instruments, a Grand Harmonicon and a Piano-forte, have contributed many pleasant hours to the female patients; and the sooth- ing melody of the flute is not unfrequently heard in the apart- ments of the men. The diet afforded in this asylum, is more generous than that of many similar institutions, judging from the bills of fare, and other statements occasionally published. The fol- lowing is the customary diet of every day. ('•»>) Breakfast. Bread and butter, with, occasionally hashed meat, or fish, and potatoes. Chocolate or Coffee at pleasure, both being provided. Dinner. Beef, veal, mutton, or pork (usually of two kinds) boiled and roasted, with a variety of vegetables. Puddings, pies, or the fruits of the season, as apples, melons, peaches, &c. &c. for dessert. Bread at pleasure. Supper. Bread with butter, and tea. N. B. Milk, sugar, and molasses, are all freely given with the articles with which they are commonly used in private families. The bread is of fine wheat flour. Spirituous liquors, wines and porter, are only administered when pre- scribed by the medical attendant, who has power to order these, as well as any other article of diet at his discretion. No difference is made in the diet or treatment of patients merely on account of their wealth. An attempt is made to class them in some measure according to the society in which they have been accustomed to move, when the mind is sus- ceptible of such distinctions, but no difference exists between the treatment of those who pay for their board, and those who are supported on the charity of the institution ; nor is it thought necessary to inform their attendants to which class they belong. (21 ) Out of one hundred and twenty patients, more than ninety usually eat at table, in companies, their attendants sitting at the same tables, helping them to their food, and partaking of the same fare. The diet of these patients is not portioned, each is allowed to satisfy his appetite. Those who do not eat at table, are the very dirty, the violent, and those placed by the physician upon a prescribed diet. The officers and servants residing in this establishment, and receiving its pay, are— Steward and Matron,.....2 Clerk and Librarian, - - - - 1 Apothecary, -.....1 Gatekeeper, - - - - - - 1 Attendant on West's picture, 1 Gardener - - - - - 1 Baker.......1 Watchman, ------ i Ostler, - -......1 Cow-keeper, - ----- l Washer-women, - - - - - - 2 Cooks,.......2 Housemaids, - - - - - - 3 Nurses in the women's sick wards, 4 Nurses in the men's sick wards, four males and six females,......10 Female attendants on the insane, - - - 8 Male attendants on the insane, ... 4 44 ( 22 ) Seventeen men and twenty-seven women. There is, in addition, one private servant of an insane patient whose wa- ges and board are paid by the friends of the patient. The total expenditure of the establishment, including, however, a considerable outlay on behalf of pay patients (for clothing, &c.) which is repaid by their friends, amounts to about thirty thousand dollars per annum. A considerable sum of money is received for the board of pay patients, but the only fixed revenue of the institution is the interest of the capital stock loaned to various individuals on bonds and mortgages, and invested in ground rents. This amounts to about eleven thousand five hundred dollars per annum. By some it may be supposed that the Pennsylvania Hospi- tal is sufficiently wealthy ; but these should reflect, that the buildings would yet accommodate many poor patients, and that this is their primary destination. The Managers of the institution have also long had in view, the erection of a sepa- rate asylum for the insane. A very desirable measure, on many accounts, for both classes: the repose of the sick be- ing liable to much disturbance from the noise of the insane ; while the narrow limits in which so many of the latter are confined, prevent the adoption of various means, probably adequate to the recovery of many individuals. While this important object remains unaccomplished, it is hoped that the wealthy and beneficent will not, in the distribution of their charity, or the final disposition of their estates, pass by the Pennsylvania Hospital; or, consi- dering it as already independent, give it but a testimo- nial of their respect. The want of an asylum for the insane, founded upon a liberal scale, with the advantage of the in- (23) creased light which modern science has shed on the history of the human intellect, is more urgent than any one who has not deeply investigated the subject can imagine. And those who shall lay its foundation under the benign auspices of the charter of this noble charity, will rank deservedly high, not merely among the contributors to the Pennsylvania Hospital, but on the roll of distinguished benefactors to their country- men and species. Although this institution has received considerable aid, to- wards the erection of its buildings, from the legislature of the state of Pennsylvania, its principal dependence for sup- port has ever been upon the generous benevolence of private citizens. It is necessary that Legacies should be given in the corpo- rate name, viz. to " The Contributors to the Pennsyl- vania Hospital." Contributions and donations are received by Samuel N. Lewis, Treasurer, No. 135 South Front street. PRESENT OFFICERS OF THE INSTITUTION. MANAGERS. Thomas Stewardson, President. Roberts Vaux, Secretary. Thomas Morris, Charles Roberts, William W. Fisher, Charles Watson, John Paul, Joseph Price, Alexander W. Johnston. Mordecai Lewis, John J. Smith, Bartholomew Wistar. Treasurer—Samuel N. Lewis. Attending Physicians. Attending Surgeons. John C. Otto, M. D. Thomas T. Hewson, M. D. John K. Mitchell, M. D. John Rhea Barton, M. D. Benjamin H. Coates, M. D. Thomas Harris, M. D. Physicians to the Lying-in Department. Thomas C. James, M. D. and Charles Lukens, M. D. Steward and Matron. Allen and Margaret Clapp. Resident Physicians. Thomas Stewardson, M. D. George W. Norris, M. D. Apothecary. Franklin R. Smith. Clerk and Librarian. William Gunn Malin. APPENDIX. CONTAINING: I. The names of the gentlemen whojiave served the institu- tion as Managers, in the order of their appointment; to- gether with the dates of their respective elections, and resignations or death, and the time of their continuance in office. II. Treasurers. III. Physicians. IV. A statement of the cases of 28,105 patients, admitted into the Hospital from February 11th, 1752, to Decem- ber 1st, 1830. V. A table exhibiting the number of insane patients of each sex, admitted in every year from the commencement of the institution; and the result of their treatment. VI. A similar table of the cases of Mania a potu, or Delirium tremens, from the year 1822. VII. A tabular view of the Lying-in department. VIII. A table shewing the whole number of pay and of poor patients, admitted into the Hospital, and the average number of patients resident in it, during each year from its commencement. IX. The native countries of 5613 patients, admitted into the Hospital from April 22nd 1825, to December 1st 1830. D (11) MANAGERS OF THE PENNSYLVANIA HOSPITAL. The following is a list of those who have served as Managers from the commencement of the institution to the present time ; with the date of their respective elections, and the length of time they continued in office. NAMES. Elected. Resign- Served the ed. Institution. Joshua Crosby 1751 1755 4 years. Benjamin Franklin — 1757 6 years. Thomas Bond — 1752 1 year. Samuel Hazard — 1754 3 years. Richard Peters — 1752 1 year. Israel Pemberton, Jr. — 1779 28 years. Samuel Rhoads — 1781 30 years. Hugh Roberts — 1756 5 years. Joseph Morris — 1757 6 years. John Smith __ 1756 i 1761 1751 1762 1752 > 6 years. Evan Morgan > 11 years. 1753 1763 Charles Norris 1751 1752 1 year. Isaac Jones 1752 1756 ) 1760 1764 1762 1773 > 15 years and 5 mo's ) (died.) John Reynell 1752 1780 28 years. William Griffitts — 1753 1 year and 5 months. Thomas Lawrence, Jr. — 1753 1 year. Joseph Fox 1753 1756 2 years and 7 months. William Grant 1754 1756 2 years. Thomas Crosby 1755 1757 1 year and 11 months. (28) NAMES. Elected. Resign- Served the ed. Institution. Daniel Roberdeau 1756 1766 1758 1776 > 12 years. Charles Jones 1756 1761 5 years. Isaac Greenleaf — 1771 15 years Joseph Richardson, Mer't — 1770 14 years and 6 mo.(d.)* Jacob Duchee — 1758 1 year and 9 months. Plunket Fleeson 1757 1759 2 years. Anthony Benezet — 1758 1 year. John Sayre — — 9 months. Stephen Shewell 1758 1760 2 years. Thomas Gordon — 1766 8 years. Samuel Mifflin — 1760 2 years. James Pemberton — 1780 22 years. Jacob Lewis 1759 1774 15 years. John Mease 1760 1768 7 years and 10 mo. (d.) Henry Harrison 1762 1766 3 years and 9 mo. (d.) Thomas Wharton — 1769 7 years. John Gibson 1763 1764 > 3 years and 7 mo. 1767 1770 Joseph Redman 1766 1767 1 year and 1 month. John Nixon 1768 1772 4 years. Joseph Morris 1769 1781 12 years. jlsaac Cox 1770 1776 5 years and 8 mo. (d.) William Logan — 1775 4 years and 6 months. Thomas Mifflin 1771 1773 1 year and 11 months. Thomas Wharton 1772 1779 7 years. Edward Penington 1773 — 6 years. Robert Strettell Jones — 1781 8 years. George Roberts 1774 1776 2 years and 3 months. Thomas Fisher 1775 — 1 year and 3 months. Joseph Swift 1776 1786 9 years and 9 months. William West — 1778 2 years. Jacob Shoemaker — 1781 5 years and 3 months. William Morrell — 1782 6 years and 8 months. * Died. t It appears from the minutes of the Board, that Isaac Cox was lost at sea, on his return from the island of New Providence, in the winter of 1775-6. (29 ) NAMES. Elected. Resign- Served the ed. Institution. Samuel Powell 1778 1780 2 years. Joshua Howell 1779 1782 3 years. Samuel Pleasants — 1781 2 years. Peter Reeve — 1786 7 years. George Mifflin 1780 1785 5 years and 2 mo. (d.) Thomas Franklin — __ 3 years. Tench Coxe — 1781 1 year. Reynold Keen 1781 17-90 9 years and 7 months. Jonathan Shoemaker —. ■ — 9 years and 1 month. Owen Jones Jr. — 1795 13 years and 9 months. Isaac Wharton — 1784 3 years. Josiah Hewes — 1812 30 years and 5 months. John Morton — 1785 3 years and 8 months. Adam Hubley 1782 1784 2 j&ears and 4 months. Nathaniel Falconer __ 1783 5 6 years and 6 mo. 5 years. 1784 1783 1790 1788 Andrew Doz Thomas Moore — — 5 years. Samuel Howell 1784 1789 4 years and 10 months. William Hall 1785 1787 1 year and 11 months. Samuel Coates — 1825 40 years and 4 months. Joseph Paschall 1786 1795 8 years and 10 mo. (d.) Thomas Penrose — 1798 12 years. Richard Rundle 1787 1789 2 years. Samuel Clark 1788 1802 13 years and 6 mo. (d.) Pattison Hartshorne — 1823 85 years. Elliston Perot 1789 1806 17 years and 2 months. Bartholomew Wistar — 1796 7 years. Cornelius Barnes 1790 1793 3 years and 5 mo. (d.) Lawrence Seckel — 1820 29 years and 9 months. William M'Murtrie 1791 1794 3 years. Thomas Morris 1793 1809 15 years and 11 mo.(d.) Samuel M. Fox 1794 1797 3 years. Robert Wain 1795 1800 5 years and 2 months. James Smith Jr. — 1805 10 years. Israel Pleasants 1796 1800 4 years. John Dorsey 1797 1804 7 years. Robert Smith, Merchant 1798 1805 ' 7 years. ( 30) NAMES. Zaccheus Collins Paschall Hollingsworth Richard Wistar Joseph Lownes Peter Brown Edward Penington .Zachariah Poulson William Poyntell Thomas Stewardson Thomas P. Cope Reeve Lewis Joseph S. Morris Samuel W. Fisher Joseph Watson Mordecai Lewis Israel Cope Thomas Morris Henry Hollingsworth Alexander Elmslie Matthew L. Bevan Joseph Johnson William L. Hodge Roberts Vaux Charles Roberts William W. Fisher Charles Watson John Paul Joseph R. Jenks Joseph Price Alexander W. Johnston John J. Smith Bartholomew Wistar Elected 1800 1803 1804 1805 1806 1808 1809 1811' 1812 1814 1828 1817 1818 1820 1822 1823 1824 1825 1827 1828 1828 1814 1817 1824 1818 1828 1823 1827 1828 1824 1828 Served the Institution. 22 years. 12 years. 3 years and 4 months. 16 years. 6 years and 7 mo. (d.) 15 years. 1 year and 10 months. 5 years and 2 mo. (d.) 9 years. years and 3 months. years and 3 mo. (d.) years and 9 mo. (d.) 12 years and 5 months. 3 years and 8 months. 11 years. 5 years and 6 months. 7 years. 7 years and 10 months. 7 years and 10 months. 2 years. 10 months. ( 31 ) TREASURERS. • NAMES. Elected. Resign- 1 Served the ed. Institution. John Reynell 1751 1752 1 year. Charles Norris 1752 1756 4 years. Hugh Roberts 1756 1768 12 years. Samuel P. Moore 1768 1769 1 year. Thomas Wharton 1769 1772 3 years. Joseph King 1772 1773 13 months. Joseph Hilborn 1773 1780 7 years. Mordecai Lewis 1780 1799 18 years and 8 mo. (d.) Joseph S. Lewis 1799 1826 27 years. Samuel N. Lewis 1826 PHYSICIANS. The following are the names of the gentlemen who have serv- ed the Institution as Physicians and Surgeons, in the order of their appointment; together with the date of resignation or death, and their respective periods of service. NAMES. Elected. Resign-ed. Served the Institution. Lloyd Zaehary Thomas Bond Phineas Bond Thomas Graeme Thomas Cadwalader Samuel Preston Moore John Redman William Shippen Cadwalader Evans John Morgan 1751 1753 1759 1773 1778 1753 1784 1773 1752 1777 1759 1780 1778 1773 1777 1783 1 year and 5 months. 32 years and 6 months. 21 years and 8 mo. (d.) 6 months. 25 years and 6 months. 7 years and 6 months. 28 years and 6 months. 25 years and 2 months. 14 years and 1 mo. (d.) > 8 years and 11 mo. C 32 ) NAMES. Charles Moore Adam Kuhn Thomas Parke James Hutchinson William Shippen Jr. John Jones Benjamin Rush John Foulke Caspar Wistar Philip Syng Physick Benjamin Smith Bar John Redman Coxe Thomas C. James John Syng Dorsey Joseph Hartshorne John C. Otto Samuel Colhoun Joseph Parrish Thomas T. Hewson John Moore William Price John Wilson Moore Samuel Emlen John Rhea Barton John K. Mitchell Benjamin H. Coates Thomas Harris Charles Lukens • , Elected. Resign-ed. 1773 1774 1774 1781 1782 1798 1777 1823 — 1778 1779 1793 1778 1779 1791 1802 1780 1791 1783 1813 1784 1794 1793 1810 1794 1816 n 1798 1815 1802 1807 1807 1810 1818 — 1821 1813 1816 1821 1829 1818 1820 1829 1821 1823 — 1827 1823 1828 1827 1828 1829 i — Served the Institution. 10 months. i 22 years and 6 mo. 45 years and 9 months. > 15 years, (died.) > 11 years and 11 mo. 11 years and 1 mo. (d.) 29 years and 10 mo.(d.) 10 years. 16 years and 5 months. 22 years and 1 month. 17years and 10 months. 4 years and 9 months. 8 years and 6 mo. (d.) 11 years and 2 months. 5 years. 12 years and 8 months. 9 years. 1 year and 10 months. 5 years and 3 months. 5 years, (died.) ( 33) A STATEMENT Of the Cases of 28105 Patients, admitted into the Penn- sylvania Hospital from the Uth of February 1752, to December 1st 1830. The following, although a transcript of the recorded causes of admission, cannot be regarded as an adequate ^statement of the diseases treated in the Hospital. The mercantile* method in which the register of cases has been kept—assigning but one disease, or cause of admission, for each patient,—in order to produce an annual balance sheet, on which the lists of diseases, and of per- sons, should be numerically equal—is evidently insufficient to a fair exhibit of the practice of the house ; inasmuch as one patient may labour under a complication of disease; and, in another, the physician has ta cope with several successive maladies; each, perhaps, more formidable than the recorded cause of ad- mission. The physician too, who Visits persons desirous of ad- mission, cannot always ascertain, in one short visit, the precise nature of a case then first submitted to his eye ; even supposing no obstacles interposed by the ignorance, misapprehension, or wilful concealments of his patient. The absence, therefore, of any disease from the following list, is no evidence that it has not df v occurred in the practice of the Hospital. • j> Abscess Amenorrhoea Anchylosis Aneurism Angina Angina pectoris 122 Aphonia 1 92 Apoplexia 9 7 Asthma 75 17 Asthenia 62 38 Burns and Scalds 168 3 Cancer 78 (34 ) Caries 153 Haemoptysis ) Catarrhus 218 & > 84 Cephalalgia 52 Hgemoploe ) Cholera 17 Haemorrhoids 59 Colica 62 Hepatitis 89 Chorea 10 Hernia 109 Contusions and wounds 2090 Hernia humoralis 13 Convulsions 66 Hydrocele 44 Cramp 17 Hydrothorax 14 Deafness 18 Hydrophobia 1 Diabetes 5 Hypochondriasis 45 Diarrhoea 311 Hysteria 43 Diseased eye9 676 Icterus 29 ears 12 Imperforate Anus 2 joints 349 Inflammations 364 spine 34 Insanity 3581 glands 6 Mania a potu or ) Delirium tremens ) 262 Dislocations 121 Dropsy 627 Leprosy 14 Dysentery 494 Measles 2 Dyspepsia 67 Morbus vesicae 32 Dysury 18 Morbus uteri 11 Epilepsy 109 Morbus testis 46 Eruptions 160 Nephritis 11 Erysipelas 30 Nervous affections 26 Exostosis 5 Palsy 227 Fever 1904 Paronychia 29 Bilious 26 Pectoral and ) Pulmonary affections $ 292 Intermittent 1063 Remittent 331 Pneumonia 123 Yellow 10 Peripneumonia 12 Fistula 163 Pleurisy 245 Fluor Albus 6 Phthisis pulmonalis 336 Frosted 166 Poisoned 13 Fractures 1196 Polypus 13 Gangrene 32 Prolapsus ani 7 Gunshot wounds 6£ Prolapsus lingua 1 Hare Lip 7 Prolapsus uteri 13 Haemorrhage n 1 Ptyalism 4 (35 ) Rheumatism 2109 Scrofula 92 Scurvy 213 Strictures 92 Sprains 94 Strangury 16 Surfeit 5 Syncope 5 Syphilis 3120 Small pox. 42 Splenitis 8 Tetanus 15 Tinea Capitis .* . t. 19 Tumours and wens 338 Ulcers *"■ 2543 Urinary, calculi 68 Varicose veins 19 Vertigo 38 Visceral obstructions 139 White swellings 37 Wounded Soldiers and Sai- lors 38 Wounded Hessians 26 Sick continental soldiers 104 Sick wives of do. 7 ChSdren of do. 4 Pregnant women Infants born in the Hos- pital 26777 701 627 28105 (36 ) INSANITY The following table exhibits the number of insane patients of each sex, admitted into the Hospital from February 11th 1752, to December 1st 1830 together with the result of their treatment. Admit- | Reliev- Removed ted. Cured. ed. by friends. Eloped. Died. > I \ to a> 13 6 CO 13 S a> fa 6 CO R5 1 CO CD 13 3 0) fa 1 co" CD 13 CO B CD fa 1 CO 03 13 s cd fa CO 13 2 CO B CD fa CO 13 CO s CD fa ___ 5 2 4 [ 4 2 1 1 1 1 ) 5 4 3 1 3 4 o 3 1 1 2 1 r 3 3 1 1 1 ] 13 6 2 2 2 1 2 1 3 1 ) 14 4 3 3 4 2 3 ) 14 11 2 2 2 3 2 1 3 1 1 L 14 9 6 3 2 4 4 3 1 2 I 20 12 7 3 3 2 1 1 3 3 1 1 20 11 5 1 5 5 3 5 1 6 1 1 37 12 9 3 8 3 2 5 3 5 23 11 13 5 7 4 3 3 1 1 16 7 9 3 2 2 2 2 5 7 18 6 8 4 5 3 4 3 1 B 24 10 7 1 4 3 5 3 3 1 9 21 3 4 4 3 1 3 2 5 6 2 D 33 14 12 5 2 1 7 1 3 4 1 1 17 14 10 4 1 1 1 5 3 4 1 2 22 14 10 5 4 1 3 2 1 2 8 4 3 27 18 7 6 9 5 2 3 4 2 2 5 4 38 14 9 2 8 6 6 1 2 2 3 5 22 7 16 6 4 3 3 1 3 1 10 4 6 21 7 7 5 3 1 4 2 2 12 1 7 24 12 9 3 4 3 3 7 6 8 7 6 2 2 5 1 1 2 2 2 4 9 8 4 4 5 1 1 1 1 4 (37 ) Admit- Reliev- , Removed [ t ted. Cured. ed by friends. Eloped. Died. 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Cured. ed. by friends. Eloped. Died. CO CD CO CD CO CD CO CD CO CD CO CD CO a ed s CD fa m CD 13 ed S CD fa CO 13 es s CD fa CO CD 13 £ CD fa CO CD 13 3 ed S CD CD 13 12 cd s CD fa 1813 68 29 34 11 13 5 9 6 8 1814 45 15 16 7 6 1 18 6 2 1 6 1 1815 40 33 13 12 5 3 10 7 1 1 10 1816 60 29 11 6 11 7 16 10 5 7 4 1817 69 31 23 7 6 4 25 15 5 1 11 1818 51 23 19 6 6 6 23 11 3 8 1 1819 59 23 19 4 9 6 20 6 2 o 6 1820 45 19 16 4 9 2 5 11 2 8 3 1821 51 14 16 4 17 5 18 5 1 2 1 1822 45 21 22 5 13 7 11 4 4 2 2 1823 38 21 18 9 6 2 6 5 2 2 8 3 1824 38 21 11 4 6 5 13 5 1 2 6 2 1825 26 13 7 3 2 3 9 5 4 3 1 1826! 37 20 6 3 1 16 10 2 2 7 18271 46 24 19 6 9 2 15 6 5 3 2 1828 44 29 19 10 7 5 8 9 1 2 2 1829 64 33 15 11 25 9 22 8 1 5 2 1830 47 43 12 12 13 10 15 10 3 2 1 ToDec. 1st. 35 22 10 868 4 3611 7 482 11 279[ 6 7 187 42 4 346 3 2429 1152 480 249 166 Total 35E 1 12 29 761 7'< 19 25 >9 512 Remaining in the house December 1st, 1830,—Males 66, Females 55, total 1.21. (39) Duration of Confinement. The patients remaining in the house on the first instant, have been confined as follows: , .. ..£' 'r 40 years \ 3.0 to 3& jear3 • 25 to 30 " 20 to 25 " 15 to 20 " 10 to 15 " 5 to 10 « 3 to 5 " 2 to 3 " 1 to 2 " Admitted in 1830 ,;. l Males.' Females Total. 1*:.* 1 3 *' , 4 2 2 4 6 1 4 7 6 5 11 4 6 10 12 11 23 4 4 8 4 6 10 6 4 10 19 14 33 66 55 121 Age of Insane Patients. Of 121 patients remaining in the Hospital, Deciember 1st, 1880, were,-*-aged From 20 to 25 years 25 to 30 " 30 to 35 " 35 to 40 " 40 to 45 " 45 to 50 " 50 to 60 " 60 to 70 ," ' 70 to 80 " Males. Females. Total. 6 9"> 11 10 2 ' 12 •1,3 7 6 6 22 13 & 11 16 5 4 9 ' 9 12 21 'V ( 6 8 14 1 i ; 2 1 3 66 55 121 (40) In 265 consecutive admissions, the age of the parties was as follows: Aged 15 and under 20 years 20 d 25 u 25 u 30 tt 30 u 35 a 35 It 40 (< 40 (( 45 (C 45 (( 50 it 50 (< 55 a 55 t( 60 u 60 (( 65 a 65 (( 70 a 70 a 75 a 75 a 80 u Males. Females. Total. 7 9 16 24 9 33 29 13 42 41 H.14 55 14 14 28 17 19 36 13 7 20 4 5 9 8 3 11 4 3 7 1 2 3 2 1 3 1 1 * 2 165 100 | 265 Social relations of persons attacked by Insanity. Of 213 males admitted into the Pennsylvania Hospital, there were- Unmarried 126 Married - 74 Widowers 13 213 Of 144 Females, there were— Unmarried Married - . ■ Widows - 45 71 28 144 (41 ) MANIA A POTU or DELIRIUiM TREMENS. Neither of these terms found its way into the Hospital reports prior to the year 1822. The cases of-this disease admitted before that period are included among those of Insanity ; and although a few of these cases might be recognised under the designations " Drunken madness," and " Lunacy from intemperance," which occasionally appear on the records, yet the general application of the term Insanity to all cases of mental aberration would render it useless to attempt any separation of them from an earlier period. This disease has been of frequent occurrenee in the surgical ,~wards, consequent on accidental injury of the persons of hard »,drinkers, and death, from this cause, has frequently followed ac- :.'' cMents which would scarcely have jeopardized the life of a sober man. Of such cases, however, until lately, no record has been flrejerved. In the reports of Hospital practice, death has invariably been charged to the cause of admission. Cases of Mania a Potu or Delirium Tremens, admitted from the year 1822. •>* Admit-ted. Removed Cured. Relieved. by friends. Eloped. Died. f ■ In the year * CO .2 CO CD 13 s CO CD CO CD 13 E 13 GO 13 E CO CD 13 CO CD 13 £ CO CD 13 CO .2 .£ to CD ► 'a CO CD a CD ending Ap. 26 n fa S fa s fa s fa s fa £ fa 1823 6 2 1 2 .>; 1824 17 2 8 1 4 1 1 2 1825 31 4 12 2 2 1 3 2 9 1 1826 26 1 11 1 5 2 1 'I 1827 30 4 24 4 1 1 9 1828 29 4 25 3 1 3 1 1829 30 1 18 1 1 11 6 1830 41 1 33 1 To Dec. 1. 32 242 3 20 22 155 1 14 1 14 1 3 B1'' 5 — 8 55 1 t 12 1 3 21 52 11 39 1 [5 1 3* , 5 8 Remaining December 1st, 1830—1 Male and 1 Female* F o o B £ ri ■ o. o CD <0 T3Q H .2 o £ -*J * W y o S a co H T3 a oS CD •- ^><1 •a c , Ph a o ed jc co .2 CD >-2 w a CO _£2 cd ed HH w CO O © Q) fc *3 ,n 1—H >H ^ *1 u* a .. 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