COLUMBIA LIBRARIES OFFSITE 
 
 HEALTH SCIENCES STANDARD 
 
 HX64111962 
 RA965 .L96 1 876 Dispensaries : their 
 
 RECAP 
 
 LUD] 
 
 T3NSARI - LEIR ORIGIN 
 
MW 
 
 L<?6 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/dispensariestheiOOIudl 
 
1b,S 
 
 DISPENSARIES 
 
 THEIR 
 
 Origin, Progress and Efficiency 
 
 BY 
 
 WM. «. LTJDLUM, M. D. 
 
 MEMBER OP THE N. Y. ACADEMY OF MEDICINE, MEMBER OP N. Y. COUNTY 
 MEDICAL SOCIETY AND AMERICAN OTOLOGICAL SOCIETY, ATTENDING 
 PHYSICIAN AT DEMILT DISPENSARY, DEPT. OP THE EYE AND 
 EAR, AURAL SURGEON N. Y. EYE AND EAR INFIR- 
 MARY, MEMBER OF THE N. Y. MEDICAL JOUR- 
 NAL ASSOCIATION, ETC., ETC 
 
 \ 
 
 NEW YORK: 
 G P. PUTNAM'S SONS, 
 
 1S2 FIFTH AVENUE 
 
<Xaa_0-oo OulJ 
 
DISPENSARIES 
 
 ORIGIN, PROGRESS AND EFFICIENCY. 
 
 Read before the New York Medical Journal Association, on 
 Friday Evening, April 2lst, 1876. 
 
 "Me. President and Members of the Association: 
 
 "Your attention is first invited to a partial consideration of 
 the latter portion of my subject, viz., 'The Efficiency of Dis- 
 pensaries.' I shall begin with the re-publication of a certain 
 anonymous volunteer contribution of my own, which appeared 
 in the New York Daily Tim.es. I was aroused to write this 
 article on account of the previous appearance in the same 
 journal of an inflammatory account of the case of an English 
 woman named Ann Tipple, who was brought before the 
 magistrates in the City of London for violation of the require- 
 ments of the Vaccination Act. This article of mine contains 
 quotations from that inflammatory account, and gives certain 
 dispensary statistics and personal experience connected with 
 vaccination, in which department of medical service Dis- 
 pensaries have done peculiarly effective work. And one 
 object which I have in view in re-publishing it on the present 
 occasion is to correct certain typographical errors which were 
 
overlooked by the proof-reader. Sere follows the article in 
 question : 
 
 " Toth Editor of the New York Times; k Is Vaccination 
 Dangerous? ' This question was propounded in the New 
 York Times on Monday, August 30 (1869), and with it an 
 invitation for the doctors to come forward with reasons for 
 their faith in vaccination. But the burden of proof naturally 
 lies with those who doubt the efficacy of vaccination. Those 
 who make the general statement that vaccination is danger- 
 ous, might be very properly called upon to establish the 
 genera] fact, and the appeal can be made to general experi- 
 ence. If the general verdict of the world is against vaccina- 
 tion, the fact would be beyond the range of either faith or 
 discussion. Waiving, however, the right usually conceded to 
 the defence with regard to the burden of proof, this much 
 may be said now, viz., that Ann Tipple's experience amounts 
 to nothing ; and if it were multiplied fifty-fold, it would make 
 but slight difference among the almost infinite number of 
 cases where vaccination has not been followed by deleterious 
 results. Exceptions to the general rule do not militate 
 against it. 
 
 "Ann Tipple, it appears, was so unfortunate as to lose one 
 of her children three days after it was vaccinated, but how 
 many children, in the course of time, died in consequence of 
 taking the small-pox from the other four who were not vac- 
 cinated ? and how many other children were exposed to danger 
 by such neglect ? If in this woman's experience is summed up 
 the indictment against Jenner's discovery, let us have all the 
 facts, in order that we may form an intelligent and Logical 
 conclusion respecting this narrow aspect of the case, as it is 
 given to us. Let us grant, for the sake of argument, lei us 
 grant that death was the consequence of vaccination in the case 
 of one of Ann Tipple's children. Even then vaccination, with 
 
all its dangers (if it have any danger in itself), would be prefer- 
 able to allowing the general mass of children to incur the risks 
 they are naturally liable to if not protected by vaccination. 
 If one child in ten were actually lost in consequence of vac- 
 cination, the general good would be promoted in giving the 
 other nine the benefits of vaccination. Anomalous cases are, 
 after all that may be said, of very little account. 
 
 " As a general rule, vaccination is of great benefit, and the 
 fact is established by the strongest testimony that man can 
 have, viz., the testimony of his own senses. That vaccina- 
 tion is beneficial is not a matter of faith or belief now, but a 
 matter of fact. Repeated trials, conducted through a long 
 series of years, have settled the question whether vaccination 
 is beneficial in the long run or not. And how is it beneficial? 
 In two ways. First, it is beneficial as a preventive. Under 
 its protection the vaccinated have gone fearlessly among pa- 
 tients sick with small-pox, and, as a general rule, escape con- 
 tagion ; whereas, as a general rule, the unprotected thus 
 exposed, become infected. This has been tested time and 
 again all over the world, and the general verdict of mankind 
 is that a reasonable reliance may be placed upon vaccination 
 as a protection against the virulence and dangers of small-pox. 
 
 " ' But,' you say, ' Vaccination is not a certain preventive 
 in every case.' Granted. There are exceptions to most 
 rules, perhaps to every rule, as far as our knowledge extends. 
 But vaccination is known to be capable of modifying the 
 course of the disease in those persons who happen to have 
 small-pox subsequently. According to general experience, 
 that is a well-established fact. And this is the second way in 
 which vaccination proves to be beneficial. 
 
 " Small-pox, as a rule, is a protection against itself, but 
 that rule is liable to exceptions. Lf small-pox itself is no 
 absolute protection against recurrence of the disease, it is no 
 
6 
 
 very great wonder that vaccination in some individuals, under 
 certain conditions, tails to protect them. But such exceptions 
 do not militate against the general rule. 
 
 "The benefits of vaccination consist, then, either in pre- 
 venting the disease altogether, or in so modifying the consti- 
 tution that the disease runs a milder course. 'But vaccination, 
 in certain cases, has been followed by unexpected and la- 
 mentable results.' Granted. Untoward results sometime* 
 follow the application of vaccine matter, even of the purest 
 kind. For example, ten children are vaccinated with the very 
 same matter, ground up into a paste of uniform consistency 
 and character throughout; the arm of one of those ten chil- 
 dren inflames greatly, perhaps ; gangrenous erysipelas sets in 
 and the child dies ; but no such result obtains in case of the 
 other nine, vaccinated with the selfsame matter and applied 
 by the same vaccinator with the self-same instrument. In 
 the nine the vaccine pustule, undisturbed, runs a natural and 
 easy course. Now, what is the reason for this difference ? It 
 is clearly not traceable to the matter employed in the vac- 
 cination. The untoward result in the one case is simply 
 associated with the vaccination on account of certain indefinite 
 and perhaps unknown contingencies. Other circumstances 
 must be ascertained and taken into account, and these cir- 
 cumstances vary with each particular case. 
 
 "From constitutional and other causes, untoward results 
 occasionally follow very simple surgical operations, but the 
 means employed are good in themselves, and they should be 
 employed, notwithstanding all the risks ; for by avoiding such 
 operations, you do not escape danger, but on the contrary, 
 become liable to greater dangers. This is especially the case 
 in regard to vaccination, as a precaution against danger. It 
 can not prudently be neglected. It is as illogical as it is 
 unwise to single out individual cases and give them undue 
 
importance. The proper mode of studying out this question 
 
 is to consider its bearings on communities. Then it will be 
 learned that small-pox is more prevalent and more widely 
 fatal among those who systematically neglect vaccination ; but 
 the disease is less common and less dangerous among com- 
 munities where vaccination is systematically encouraged, and 
 especially when it is enforced by regulation or law. 
 
 " Among sanitary laws and regulations, those relating to 
 vaccination are among the most salutary and least trouble- 
 some of any that have ever been devised. Those now stand- 
 ing on the statute books of various European countries (1869) 
 have proved to be the best bulwark against a loathsome and 
 terrible scourge. 
 
 " The comparatively low rate of mortality from small-pox 
 at present (1869) is owing to the fact that the advantages to 
 be gained from vaccination have been so extensively embraced. 
 
 " If such sanitary regulations were persistently disregarded, 
 the neglect would undoubtedly be followed in a few genera- 
 tions by the appearance of small-pox in its old-fashioned 
 vigor, to decimate communities now comparatively free from 
 the ravages of the disease. 
 
 "In answer, then, to the question, 'Is vaccination danger- 
 ous, per sef I for one answer, ' No ! ' and appeal to facts in 
 support of the answer. 
 
 " Isolated facts furnish a very insecure and fallacious 
 foundation for forming a correct opinion in any matter. Ex- 
 ceptional cases oftentimes furnish the most potent proofs of 
 the general rule which they seem to invalidate, when you 
 come to examine them thoroughly. The fullest account that 
 we have received of poor Ann Tipple's experience is very 
 meagre, to say the least of it. She had too much interest, 
 moreover, in making an unfavorable statement, in order to 
 avoid the penalty with which she w T as threatened. The testi- 
 
mony of a prisoner at the bar is worth very little, unless cor- 
 roborated. Bui Buppose her individual experience was truly 
 understood by herself as a witness, and truly reported with- 
 out exaggeration, the personal experience of the writer will 
 more than counterbalance it. 
 
 " The writer was vaccinated in infancy, as he is informed, 
 and hears the mark of it well impressed on his left arm, 
 without any disadvantage in consequence. With equal safety 
 lie was consciously vaccinated twice subsequently during 
 childhood and youth. As is commonly the case, the vaccina- 
 tions subsequent to the first one in infancy were attended with 
 less marked manifestations than those which accompanied the 
 first vaccination. 
 
 " Subsequently, during adult life, having professional duty 
 to discharge in a hospital devoted exclusively to small-pox 
 patients, as a matter of precaution I vaccinated myself (that 
 being the fourth vaccination in the course of my life), prior to 
 entering on daily duty, and spent many days among the pa- 
 tients under my care, visiting them at least twice a day. 
 
 "If any one was ever thoroughly exposed to the contagion 
 of small-pox, I was ; and if there be any protective power in 
 vaccination, my immunity from the disease is manifestly trace- 
 able back to the first vaccination ; for the subsequent trials 
 of the vaccine virus upon my person in childhood and youth 
 amounted to next to nothing, and the vaccination in adult life, 
 three days prior to entering on duty in the small-pox hospital, 
 did not take at all. From these facts one of two inferences 
 naturally follow, viz., either that effectual vaccination in in- 
 fancy wrought such a change in my constitution that I had 
 lost all susceptibility to the contagion of small-pox for the 
 time being, or else I was born without any susceptibility to 
 the disease. 
 
 " As tar as my own conclusions extend, I am inclined to 
 
9 
 
 believe that my immunity from small-pox for forty years (I 
 may now add for forty-seven years) is clearly owing to the 
 fact that I was well vaccinated in infancy. 
 
 "Relying on this safeguard, I would not hesitate in the 
 least about approaching a small-pox patient, as far as I am 
 personally concerned. To claim any special privilege above 
 the majority of my fellow men in regard to innate immunity 
 from the disease seems to me preposterous and absurd. But 
 your readers may draw their own conclusions and accept 
 either horn of the dilemma. Thus much with regard to 
 vaccination in my own person, with regard to vaccination in 
 others, I can say that in every case that has come within the 
 sphere of my observation, no such result as Ann Tipple says 
 that she experienced in one of her children occurred in a 
 single instance. 
 
 "In the year 1865, when there Was considerable anxiety 
 among the community in the city of New York with regard 
 to small-pox, and mothers came in great numbers to one of 
 the dispensaries of this city (viz., the Northern Dispensary to 
 which I was then attached) to have their children vaccinated, 
 some difference was noticeable among the children after vacci- 
 nation, but such difference had no direct connection either with 
 the virus employed, or the mode of its application. During 
 the months of January, February and March (in 1865 at the 
 Northern Dispensary) 8,741 children were vaccinated (by Dr. E. 
 B. Warner, myself, and others who took part in the work), and 
 there was not a fatal case among the whole number. Among 
 such a large number there was, of course, a difference of mani- 
 festations connected with the course of the vaccine pustule, 
 but this difference invariably arose out of circumstances con- 
 nected with the previous condition, surroundings, and origi- 
 nal constitution of the child in whom the difference was 
 
 exhibited. 
 2 
 
10 
 
 " Even healthy children are not all alike in respect to irri- 
 tability of temperament, and the course of the vaccine pus- 
 tule will be governed accordingly, but once in a great while 
 perhaps one child out of a vast multitude might have a highly 
 inflamed arm subsequent to the insertion of the vaccine virus, 
 and in consequence of neglect, or mismanagement, mortifica- 
 tion and death ensue, as in the case of poor ' Ann Tipple's 
 child.' But such an extraordinary case is an anomaly. The 
 occurrrence of exceptional cases may be very sad to contem- 
 plate but their importance should not be unduly magnified. 
 (Some careless feeders have choked themselves to death in 
 eating roast-beef even of the very best quality.) 
 
 " The great practical object to be aimed at is to secure the 
 greatest amount of good to the greatest number of persons 
 (in vaccination and other matters.) As a preventive measure 
 against the spread and virulence of small-pox, vaccination is 
 practically the best method. That is the general verdict of 
 all who have had anything like extensive acquaintance with re- 
 gard to vaccination and small-pox. It is a very fallacious line 
 of argument that is based upon exceptional cases. 
 
 " There are contingencies which are beyond the science and 
 art of men to control, and such contingencies unfortunately 
 exist in every department of (life as well as in) medicine and 
 surgery. If such contingencies and the failures in guarding 
 against them in medical art and surgical practice are to be 
 unduly magnified, we might as well abandon all remedial mea- 
 sures, for the best remedial measures have never yet been inva- 
 riably successful (in all cases.) As science advances we may, 
 perhaps, be able at a later day to confine the dangers arising 
 out of obscure contingencies within (still) narrower limits 
 (than at present.) As far as small-pox is concerned, the path 
 of safety lies not in discouraging but in encouraging universal 
 dependence in vaccination as practically the best known pre- 
 
11 
 
 ventive and modifier of such a terrible disease (arid the mana- 
 gers of the public prints will be doing good service if they 
 avoid publishing accounts of extraordinary cases, as sensa- 
 tional matter, even if true.) 
 
 "According to the bills of mortality in the City of London 
 from 1700 to 1800, before the introduction of vaccination, the 
 average annual mortality from small-pox was 1,780, in a pop- 
 ulation of 261,233, that is, one in 147. From 1800 to 1855, 
 after the introduction of vaccination, the average annual num- 
 ber of deaths (from small-pox) was reduced (by vaccination) 
 to 821, with a population of 2,250,000, that is, one in 2,740. 
 
 "According to the record kept at the Royal Military 
 Asylum, it appears that out of every thousand boys admitted, 
 who had been vaccinated effectually, only 7 too were subse- 
 quently attacked by small-pox, and not one fatal case oc- 
 curred among those affected with modified variola. 
 
 " From the records kept at the London Small-pox Hospital, 
 where patients of all ages are to be found, the mortality among 
 those who had been effectually vaccinated was less than 1^ 
 per cent., while the mortality among those who had not been 
 vaccinated averaged 27^ per cent. The facts with regard to 
 vaccination and small-pox have been thoroughly studied out 
 in England, and the statistics of that country can be 
 relied on. 
 
 "The Act of Parliament which Ann Tipple violated, was 
 passed in 1853, and under its provisions parents and guardians 
 are obliged to have every infant vaccinated within four months 
 from birth, unless the state of the child's health renders it 
 necessary to postpone the operation. It is one of the best 
 legislative acts ever passed. It is not based on theory or faith 
 in a result to be expected, but it is the fruit of practical 
 observation, extending as far back as the year 1795. For 
 more than half a century evidence has been accumulating that 
 
12 
 
 vaccination, as a general rule, is of great practical benefit. 
 There are, and there perchance always will be, occasional 
 exceptions to the uniformity of the results. But, sum up all 
 the unfortunate cases to be discovered and credit them to the 
 various accounts to which they properly belong, as for example, 
 'gross carelessness,' 'unskilfulness,' 'mismanagement,' or 
 ' unavoidable contingencies,' and still the maxim holds good 
 that it is better for the community at large to rely on vaccin- 
 ation than to do without it." * * * * 
 — JV % Y. Daily Times, Sep. 5. 1869. 
 
 So much for this article, as revised, corrected, and slightly 
 amplified by the author. I have introduced it here in order 
 not to break the continuity of thought in other matter, by 
 another hand, relating to the same subject, which I will 
 reach subsequently. 
 
 At this point I may now, however, introduce one of the 
 most recent opinions delivered by an English authority in 
 respect to the efficiency of methods employed for preventing 
 the spread of small-pox. In this country we have largely con- 
 tributed to that end by means of dispensaries. From the 
 opinion expressed by Wm. Squire, M. D., M. R. C. P., Phy- 
 sician to St. George's Dispensary, Hon. Secretary 'of the 
 Epidemiological Society, &c, &c, in a paper entitled "On 
 Sanitary precautions against the Infectious Eruptive Diseases," 
 read before the last meeting of the "National Association for 
 the Promotion of Social Science," in the Public Health Section, 
 as reported in the "London Practitioner' 1 '' for February, 1876, 
 pp. 163 and 164, we may learn what dangers appear 
 to threaten the English people from remissness in this 
 direction. Mr. Squire says, among other things, " Until quite 
 of late we have retrograded in the matter of providing against 
 infectious eruptive diseases, and the old buildings, once com- 
 
13 
 
 monly known in England as the 'pest houses,' have disappeared, 
 without being replaced. * * * 
 
 Vaccination so far suppressed small-pox that those refuges 
 became vacant; less accommodation of this kind is now 
 needed, or more rarely required, but it is not safe or right to 
 do away with this prime necessity in dealing with infectious 
 diseases; unless the first unit of disease be controlled, we 
 cannot be sure how far it will extend ; circumstances might at 
 any time arise which would make it spread ; cold, want, war, 
 famine, or even the temporary predominance of the social 
 errors, which find expression in anti-sanitarian societies, might 
 admit pestilence. What this last element may do in again 
 disclosing to us the ravages of small-pox I will illustrate by 
 some facts from that greatest of modern medical observers, 
 Wunderlich of Leipzig. In 1868, he tells us that the number 
 of children vaccinated in Leipzig — a town then of 106,000 
 inhabitants — was 3,443 ; in 1869, the number vaccinated was 
 1,970, and in 1870 it had fallen to 1,340. 
 
 " An ti- vaccination leagues, clubs, and papers, had so pre- 
 vailed, that one half of the children born at this time were 
 unvaccinated. One reason of this was, that for twenty years 
 small-pox was almost unknown in Leipzig. But now came 
 the war with France ; prisoners were received in Leipzig, and 
 with the French prisoners came in small-pox ; in little more 
 than a year from the end of 1S70, one thousand and twenty 
 persons died of small pox in Leipzig, or one per cent, of the 
 entire population ; of the deaths 312 were adults, and 715 
 children, instead of the number of deaths being greater in 
 those over 15 years of age as in protected communities. 
 Imagine such a state of things to be arrived at in London, and 
 thirty thousand children would be swept off in one year, 
 * * * by a form of death from which the adults, who 
 allow it are exempted by the very means of safety which they 
 
14 
 
 deny to these helpless victims." I pass now to the iirst topic 
 of mv paper, viz., the Origin of Dispensaries, and in regard to 
 this matter I shall borrow liberally from another, and give his 
 own words entirely. 
 
 Among other remarks made at the 36th annual meeting of 
 the subscribers of the Northern Dispensary, held at the In- 
 stitution January 9th, 1863, Judge Charles P. Daly spoke as 
 follows : * 
 
 " In contrast with hospitals, dispensaries are of compara- 
 tively recent establishment ; and it is curious that so little has 
 been collected in relation to their origin and history. We 
 would naturally suppose that an institution so useful and so 
 widely disseminated would, ere this, have found a chronicler ; 
 that it would be necessary only to look into the encyclopaedias, 
 those books of universal reference, to find a condensed ac- 
 count of all that was known respecting them; but it may 
 surprise my hearers to learn that these works are almost 
 barren of information upon the subject, and the remark applies 
 not only to those in our own language, but to the more 
 elaborate works of this kind in France and Germany. Even 
 in the very last of these productions, the American Cyclo- 
 paedia, from which, having the advantage of all that preceded 
 it, we should expect to find a greater variety of subjects em- 
 braced ; the word Dispensary does not even occur. As I 
 happen to have gathered, in discursive reading, some informa- 
 tion upon this subject which is not very easily obtained, as it 
 is scattered over many works differing widely in character 
 from each other, it may prove interesting on an occasion like 
 this to communicate it. 
 
 "It appears strange to us that among nations so refined 
 and cultivated as the Eomans and the Greeks, no hospital or 
 
 • 36th Annual Report of the Board of Trustees of the Northern Dispensary, 1802.— N. Y., 
 1863, p. 7, et seq. 
 
15 
 
 institution, where the sick could be taken charge of and cured, 
 was established. 
 
 "The first hospital, at least, of which we have any knowl- 
 edge, was founded by a benevolent bishop, named Nonus, at 
 Edessa, in Mesopotamia, A. D. 460, a place then famous for 
 its school of theology ; and the first institution of the kind 
 in Europe was built in the same century, at Eome, by 
 Fabiola, a Eoman lady, a friend of St, Jerome. Tn the sense, 
 however, in which we understand it, an institution devoted 
 exclusively to the reception and care of the sick, the hospital 
 cannot be said to have existed until the eleventh century, as 
 the establishments in use before that time were not designed 
 alone for the sick, but also for the reception and refreshment 
 of travelers and pilgrims. 
 
 "By the statutes of nearly every monastery, the tenth of 
 its proceeds or revenues was devoted to the poor ; and to 
 carry out this charitable design, a stone building was erected, 
 generally- close to the church, called the ' Almonry J from 
 which we get our modern word ' Almshouse.' 1 In connection 
 with the building was a very active officer called the ' almoner J 
 who had the management of this establishment, and who, 
 among many other benevolent duties, was required to find out 
 the sick and infirm poor, and to administer to their wants and 
 necessities. 
 
 "There was also attached to every monastery a large 
 garden, devoted to the rearing of esculent plants and medical 
 herbs. * * * * There was also au officer called an 
 ' infirmarerf whose especial duty it was to take charge of 
 everything designed for the sick, and in some of the monasteries 
 an apothecary shop was kept, which was under his direction. 
 To the almonry the sick-poor flocked from all quarters, and 
 when it was necessary, the almoner visited them at their place 
 of abode. This officer necessarily prosessed some little knowl- 
 
n; 
 
 edge of medicine, especially of the healing properties of 
 plants, but it was very limited. The art. of medicine had 
 their made but little progress; bleeding was the remedy 
 almost universally resorted to, with the application of plants 
 to the healing of wounds, and probably the most effective 
 service which the almoner rendered, was in supplying what is 
 so necessary in sickness, nourishing food and drink. In that 
 age, however, he was of inestimable value to the poor, 
 uniting, as he generally did, the many offices of alms-giver, 
 physician, apothecary, religious consoler and friend. 
 
 "As the knowledge of medicine advanced, physicians, pur- 
 suing the art as a calling, began to practice in the cities ; and 
 in Zurich and in many of the German cities there was what 
 was called the dadt-arzt, or city physician, usually a man of 
 eminence, on whom the duty was especially imposed of pre- 
 scribing for and attending upon the poor of the city, he 
 receiving from the city annually, in honorable recognition of 
 his services, certain household benefits, such as his yearly 
 firewood, a pipe of wine, or something of that kind, in addi- 
 tion to which he was repaid for the medicines which he sup- 
 plied to the poor. 
 
 "After the dissolution of monasteries, the duty of visiting 
 the sick poor at their abodes, and supplying them with gratui- 
 tous medical aid and assistance, was very much neglected. 
 * A want was felt, and this led to the origin of 
 the modern dispensary, the first step towards which occurred 
 in the middle of the sixteenth century, and for which the 
 world is indebted to a woman. Sattler tells us, in his 
 ' History of Wiirtemberg,' that in A. D. 1559, a noble-minded 
 and benevolent woman, the wife of Duke Christopher, then 
 the reigning Duke of what is now the kingdom of Wiirtemberg, 
 caused an apothecary's shop to be erected in the ducal palace 
 at Stutgardt, for the purpose of supplying medicines to the 
 
17 
 
 poor, which she maintained at her own expense. In 1560 
 her example was followed by the wife of Philip I.]., of Gruben- 
 haugen, a princess of Brunswick, who supported, at her court, 
 an apothecary's shop and still-room for the benefit of the poor ; 
 and it would, perhaps, be interesting to quote the language 
 of the old writer by whom the fact is recorded. It is from 
 Lettzner's Chronicle, 1596. 'By her apothecary's shop and 
 still-room,' he says, ' we may discern what real compassion 
 this Christian-like Electress showed towards the poor who 
 were sick and infirm; for, by having medicines prepared, and 
 by causing all kinds of waters to be distilled, she did not 
 mean to assist only her own people and those belonging to 
 her own court, but the poor in general, whether natives or 
 foreigners, and not for the sake of advantage or gain, but gratis, 
 and for the love of God,' 
 
 "Professor Spittler, in his 'History of Hanover,' informs 
 us that in 1568 the wife of the reigning Duke of Brunswick 
 kept, for the use of the poor, an expensive apothecary's shop 
 in her palace ; and Beckman, by whom this information is 
 collected, mentions another instance, that of the Electress 
 Ann, a Danish princess, who, in 1581, established an apothe- 
 cary's shop at the Court of Dresden, which, in 1609, was re- 
 newed by another woman, Hedwig, the widow of the Elector 
 Christian II., and which, I believe, is still in existence. 
 
 " We are thus indebted not only to a woman for the estab- 
 lishment of the first hospital that w r as founded in Europe, 
 but we owe to five women the first attempts to meet a want 
 which the modern dispensary supplies. In Germany, the 
 dispensary, as a distinct and separate institution, does not 
 exist; its place being supplied by the admirable hospital 
 arrangement which prevails there. ****** The 
 dispensary and the hospital are wisely combined under one 
 general system of management (in that country.) 
 
18 
 
 "The dispensary as a separah institution, had its rise in 
 England; and, as the history of its origin is curious I will 
 narrate it. Before the close of the 17th century, the apothe- 
 caries of London had very generally adopted the habit of 
 giving medical advice gratis, charging only for the medicines. 
 The incorporated physicians denounced the practice as a device 
 resorted to by men wholly uneducated in the healing art, solely 
 from an interested motive, that they might increase thereby 
 the sale of their medicines ; while the apothecaries, on their 
 part, declared that the miserable state of the sick poor, and the 
 inability of that class to employ a regular doctor, rendered the 
 giving of gratuitous medical advice, in connection with the sale 
 of medicine, an act of necessity and charity. To remove this 
 ground of complaint, the College of Physicians and Surgeons, 
 in 1687, resolved by public act, that all its members should 
 attend the neighboring poor without charge ; and the apothe- 
 caries, who saw in this movement a serious diminution of their 
 profits, managed to frustrate it, chiefly by fomenting dissen- 
 sion in the college, and, being an active body cemented 
 together by mutual interest, they succeeded in arraying in 
 their behalf a considerable amount of public support, and in 
 keeping up a controversy which extended over a space of 
 16 years. 
 
 " Failing in their first effort, the doctors resorted to another 
 measure. They turned the laboratory of their college, in 
 Warwick Lane, into an apartment for the making up of medi- 
 cines, which they disposed of, in a room adjoining, to all who 
 applied at first cost. To the apartment they gave the name 
 of the Dispensary, a term formed from two Latin words, dis 
 and pendere, meaning to take from a weight or mass and dis- 
 tribute ; and which was derived from a well-known word in 
 use in the middle ages, dispe?isatorium, afterward corrupted 
 into 'dispensatory,' signifying in the early hospitals, the place 
 
19 
 
 where the substances used in the preparation of medicine were 
 kept, and from which they were distributed, and which term 
 was also used as the title or distinguishing name of the 
 first books which were published upon the natural history of 
 the substances which enter into the composition of medicine. 
 All the efforts of the apothecaries were now directed toward 
 the breaking down this establishment of the doctors at their 
 college in Warwick Lane, against which it struggled for some 
 time with indifferent success. A paper war of unusual anima- 
 tion followed, a flood of pamphlets appeared, and the poets 
 mingled in the strife. Sir Samuel Garth, an eminent physi- 
 cian, published a mock-heroic poem in six cantos, called ' The 
 Dispensary,' which has taken its place in our literature, in 
 which the leading apothecaries were most unmercifully ridi- 
 culed, and which had great popularity in its time. Dryden 
 came to the support of his fellow-poet, in some stinging satir- 
 ical lines against the vendors of drugs, a couplet of which I 
 remember : 
 
 ' ' From random files a recipe they take, 
 
 And many deaths with one prescription make." 
 
 "And Pope espoused the cause of the doctors with some of 
 his most trenchant verse. As the controversy progressed, the 
 doctors gathered strength. In 1694, the college, by a positive 
 edict, enjoined upon all its members the duty of attending the 
 sick-poor gratis, and to maintain the Dispensary, fifty-three 
 physicians, in 1696, entered into a liberal subscription of ten 
 pounds each, after which measures the establishment became 
 a complete success, as the poor very naturally resorted to a 
 place where they could get their medicine at one-third less 
 than the apothecaries charged, and where they had, in addi- 
 tion, the benefit of the very best medical advice gratis. The 
 apothecaries now resolved upon a bolder course, that of 
 visiting patients at their own houses, and prescribing for 
 
20 
 
 them gratuitously. This, in the judgment of the physicians, 
 was practising physic, and they waited but for a convenient 
 opportunity to bring down upon their adversaries all the 
 vengeance of the law. It soon occurred. A butcher named 
 Scale tell sick oi a. distemper, and sent for a neighboring 
 apothecary, called Rose. The latter went to the butcher's 
 house, ascertained the nature of the disease, and prescribed 
 for the patient, charging only for the medicines. The college 
 immediately brought an action against the apothecary, in the 
 Court of King's bench, for practising physic without a license. 
 The prosecution of this action became a matter of great public 
 interest, and the point involved was considered so doubtful, 
 that the case was argued three times — a very unusual circum- 
 stance. Finally, the court decided unanimously, that practi- 
 sing physic was judging of the nature of the disease, and pre- 
 scribing the proper remedy, which they held to be a physi- 
 cian's vocation ; and that the business of an apothecary was 
 to make and prepare prescriptions under the direction of a 
 doctor. They accordingly gave judgment against Rose. An 
 appeal, however, was taken to the House of Lords, and, by 
 what has been regarded as a very questionable decision, the 
 judgment of the Court of King's bench was reversed, to the 
 great joy of the apothecaries. It is to this controversy that 
 we owe the successful establishment of the Dispensary, for 
 although the Royal General Dispensary of London, now the 
 oiliest existing institution that distributes medicine gratui- 
 tously, was not established until 1770,* it had its origin in the 
 circumstances which I have narrated. * * * * 
 [So much for the establishment of the Dispensary in England.]! 
 "The Dispensary, as a permanent institution, was not es- 
 tablished in France until 1803. About the middle of the 
 
 • Daly, in 30th Annual Report Northern Dispensary, in 1802 N. Y., 1863, p. 12. 
 
 t Ludium. 
 
21 
 
 previous century, however, Chamouset, the son of a distin- 
 guished judge, and who was himself advocated for the magis- 
 tracy, having his attention drawn to the wretched state of the 
 sick poor in Paris, from the want of medical attendance, 
 studied medicine and devoted the remainder of his life, with 
 the most untiring zeal and assiduity, to practising gratuitously 
 as a physician among the poor. He not only did this, but 
 devoted the whole of his fortune to the same noble object. 
 He turned his house into a hospital for the reception of poor 
 patients, whom he maintained at his own charge, and from 
 which medicines and medical advice were furnished upon 
 application, gratis ; and at all hours of the day or night he 
 was ready, at any summons, to visit the bed-side of the sick 
 and wretched. This remarkable man was not simply a mere 
 benevolent enthusiast, he was a man of great good sense, of 
 acute observation, thoroughly acquainted with human nature, 
 and of a practical and original turn of mind. 
 
 "He was the originator of the penny-post and of insurance 
 against fires in cities ; and, among other valuable suggestions, 
 he devised and published a plan for the organization of an ex- 
 tensive association in Paris among the poor and working 
 classes, by which every man, by the payment of a small sum 
 of money, at fixed periods, might insure his being well taken 
 care of, with the best medical treatment, in case of sickness. 
 The suggestion was not lost, though nothing came of it until 
 1803, when the Philanthropic Society of Paris established five 
 dispensaries for the relief of the sick poor. The beneficial 
 effect became at once apparent, and similar institutions were 
 almost immediately established in I/yons, Besancan, Nantes, 
 Caen, Montpelier and Marseilles."* 
 
 Now I turn to General Mather's account of dispensaries, as 
 given in the last annual report of the Demilt Dispensary in 
 
 *Daly, lb. p. 13. 
 
22 
 
 the City of New York, for the year ending December 81st, 
 1875. 
 
 Frederick E. Mather, Esq., the President of that Institution, 
 lias given a very elaborate account of dispensaries existing 
 among those who speak the English language and its associate 
 dialects. This account I will condense. He speaks first of 
 the "Royal General Dispensary" above mentioned hy Judge 
 Daly, as the first institution of the kind in England.* 
 
 Then he passes to the results of the establishment of that 
 dispensary, and says, " that within the next twenty years, 
 nine other dispensaries were organized in London," and they 
 all are still in existence. Then General Mather passes to 
 dispensaries in Ireland. In that part of the British dominions 
 an act was passed by Parliament as early as 1805, providing 
 for the establishment of dispensaries throughout all Ireland, 
 as well for the most sparsely settled parts as for the cities and 
 populous towns. It was a defective plan, but in 1836 there 
 were 494 dispensaries organized and in operation under it. 
 The defects of this plan of dispensary service were particularly 
 prominent in 1846 when famine, pestilence and death ravaged 
 Ireland. But in 1851 Parliament made a radical change for 
 the better, and the result was shown in this wise, viz. : that 
 instead of there being 58,006 deaths from small-pox as from 
 1841 to 1851, there were only 12,727 deaths by the same 
 disease from 1851 to 1861. 
 
 In the year 1863 vaccination was made compulsory, and as 
 a consequence there were only 187 deaths from small-pox in 
 Ireland in that year, and in 1867 there were only 20 deaths 
 from the same cause, and in 1868 only 23. 
 
 At this date (1868) the sanitary provisions and the medical 
 arrangements for the sick poor in England, Wales and Scot- 
 land were substantially the same, but a general dispensary 
 
 * 25th Ann. Rep. Demi It Die p. p. 8. 
 
23 
 
 system had not been established. By the act of 1851 the 
 general dispensary system was established, and by the act of 
 1872 provision was made for rendering the dispensary districts 
 symmetrical and compact. But there is room, in General 
 Mather's judgment, yet for improvement across the water in 
 regard to dispensaries, and he expresses the opinion that we in 
 this country have improved upon the lessons taught us from 
 1770 downwards. It appears that the city of Philadelphia 
 has the honor of being the first to establish a dispensary on 
 this continent, viz. : " The Philadelphia Dispensary," which 
 was established in April, 1786, and incorporated in the year 
 1796. The city of New York followed next in order by 
 establishing " The New York Dispensary," in 1791, and it 
 was incorporated in 1795. This dispensary was suggested by 
 the Rev. Dr. John Rodgers. It first occupied an humble 
 building on the northwesterly corner of Beekman and Nassau 
 streets, i. e. to say it was in the southeasterly corner of the 
 " Brick Churchyard," but finally it was located on the north- 
 westerly corner of White and Centre streets, where it now 
 stands. 
 
 The next dispensary was "the Boston Dispensary," organ- 
 ized in the city of Boston in 1796, and incorporated in 1801. 
 This made the third dispensary in America. In course of 
 time other dispensaries came into being, and there were, 
 according to State Board of Charities' Report in 1874, in the 
 State of New York, 49 dispensaries, and 29 of these are in the 
 city of New York, and they are very good samples of dis- 
 pensaries to say the least, but General Mather says that our 
 dispensaries are better than those across the water, and I for 
 one am very willing to believe that. But I will not waste time 
 in glorifying our nation, and will pass at once to the last topic 
 of my paper, viz. : the efficiency of dispensaries. According 
 to one authority, " a dispensary is a place where you get 
 
24 
 
 medicine in your own bottles, 1 ' But the late Charles Dickens, 
 Esq., was always inclined to be jocular in his descriptions and 
 definitions. Still he spoke the exact truth. This same truth, 
 however, is very tersely and with all gravity set forth in the 
 words of Theodore Roosevelt, Esq.,* our own countn man, as 
 follows: " Dispensaries may be called preventive institutions, 
 offering, as they do, free relief to the sick at the inception of 
 disease, an item which is very important in the successful 
 issue of many diseases; hence the poor need not delay on ac- 
 count of expense or poverty, for at the furthest in this city — 
 New York — they have but a comparatively short distance to 
 go to embrace the proffered benefit of an institution incorpo- 
 rated and maintained expressly for them." 
 
 " From careful observation of the workings of the system, 
 it is but proper to state that patients are better treated and 
 obtain more real benefit from it than any other '."f 
 
 " Through the efficient aid rendered by the officials many 
 useful citizens are saved from protracted sickness and fre- 
 quently from death, while their dependents and families are 
 kept from becoming applicants for private or public charity. 
 Family ties are not weakened or broken by the absence of a 
 member in hospital ; only those who cannot be properly 
 treated at their houses need go into an hospital. The value 
 of such service in promoting public health, and removing or 
 preventing the necessity for protracted charity cannot be over- 
 estimated."i * * * * 
 
 "The medical and surgical staff (he goes on to say), are 
 selected usually from a large number of applicants from the 
 ranks of the younger members of the profession, and those 
 who are appointed are of a high grade as to attainments, per- 
 
 • Extract from 9th Add. Rep. of State Boaid ot Charities of the State oi X. Y., relatiDg 
 to the present dispensary system of New York, transmitted to the Legislature, Juue 14, 
 1876. Albany, 187G. 
 
 t Italics, mine. t Italics mine. 
 
25 
 
 sonal character and fitness for their respective duties. The 
 members of the medical staff, excepting the house and visiting 
 physicians, receive no pecuniary remuneration."* Let that be 
 noted I say, for a contrary opinion is oftentimes encountered 
 by the unpaid medical and surgical staff of every dispensary 
 and every institution of a similar character in this city — 
 "and the salary of the visiting physicians," i. e., those who 
 go from house to house, " are usually very meagre." To 
 which I may add that the salaries of the house physicians 
 and surgeons do not correspond with the labor and skill with 
 which those offices are usually filled. "Diseases of every 
 variety are treated." " Free vaccination is offered to all." 
 "Dentistry in the most important of its varied branches, under 
 the direction of competent men, has also its value in connec- 
 tion with the administration of dispensary charity." " The 
 doors are closed to none, of whatever nationality, creed or 
 color; all receive alike," [and in the order of application, 
 first come, first served, whether white or black, brown or 
 yellow, j] "all receive alike the same care and attention."! The 
 subjects of Queen Victoria, from her American dominions, 
 are treated with courtesy as human beings needing help. 
 
 The natives of Alaska and of Iceland, and the inhabitants 
 of Cuba are not neglected when they apply for aid. Even 
 the red man, the Sandwich Islander, and the heathen Chinee 
 receive their due share of attention. Dispensaries are cos- 
 mopolitan. " Those whose illness will not allow them to attend 
 at the dispensary, are attended in their homes by the visiting 
 physician, and the medicines prescribed (by him), are fur- 
 nished at the dispensary,"§ free of charge, on presentation of 
 the written prescription presented by the messenger sent by 
 the patient or his friends.) I have ventured to add this 
 
 * Italics, mine. t Ludlum. t Ludlurn. 
 
 § Roosevelt, super, p. 5. 
 
26 
 
 latter -clause to .Mr. Roosevelt's very complimentary notice, 
 and I will venture -till further to make myself the self-elected 
 mouth-piece of all others engaged in this kind of Bervice like 
 myself, and say that we heartily thank him tor his careful 
 observation and kind words. From henceforth the ancient 
 reproach, 'he's nothing but a dispensary physician,' has lost 
 its sting. BVom henceforth, the dispensary physician may 
 proudly hold up his head and say, as did the colored man 
 down South, "I am no shoe-string nigger, hut 1 am a gentle- 
 man." 
 
 But His Honor Judge Daly, and General Mather, and 
 Commissioner Roosevelt, all three, are silent on one very im- 
 portant point, which they naturally could not appreciate as 
 well as the men actually engaged in dispensary service, viz. : 
 the efficiency of dispensaries as training schools for the 
 younger members of the profession, and as schools of instruc- 
 tion for students of every grade. This is a subject completely 
 out of the range of thought of even such distinguished laymen. 
 But we who have been for any length of time engaged in dis- 
 pensary service are tally conscious of the facts in the case. We 
 learn our proper business there, just like a clerk does in a 
 banking house where large and varied accounts are kept. 
 Dispensaries are not places for mere experimentation by a 
 fresh hand, for there is an established routine, and every new 
 man when he comes into the ranks must either stand in the 
 line or fall out. But I need not enlarge on this point, I 
 think that this plain statement will suffice. But there are 
 defects in the dispensary system, I think 1 hear some one say. 
 Very well. But can you point out any human institution 
 which is devoid of defects, or into which aberrations may 
 not intrude? Yes, there is at least one medical institution in 
 the United States so happily arranged as to be perfectly satis- 
 factory to all parties concerned — and that institution is in the 
 
27 
 
 city of Philadelphia, which city seems to be coming in for all 
 the honors just now — and if the expression of satisfaction by 
 Dr. A. D. Hall on the completion of the improvements recently 
 made in the "Wills Ophthalmic Hospital" in the city of Phila- 
 delphia is not exaggerated compliment to those who furnished 
 the means for the improvements, it must be just about perfect. 
 "As spokesman of my fellows," says Dr. Hall to the President 
 and gentlemen of the committee on Wills Hospital, " as 
 spokesman of my fellows, the surgeons of this house, I thank 
 you for the beautiful and convenient wards you have just en- 
 trusted to our professional care. For the first time in forty- 
 three years, we have wards built for the express purpose of 
 treating the diseases and injuries of the eye, with all the im- 
 provements in ventilation and heating, bathing and drainage, 
 that the latest science and experience can suggest. It is no 
 exaggeration when I say that no eye hospital, in all the 
 round world, has wards so well adapted to the business to be 
 carried on within them."* 
 
 There is then at least one " satisfied soul " among the doc- 
 tors, and Philadelphia has at last excelled New York city in 
 one respect, viz., as to Ophthalmic hospitals, and what is more, 
 the} 7 have struck out there an improvement in the dispensary 
 system, which improvement has been practically tested, as ap- 
 pears from the following extract from the medical report of 
 the eye and ear department of the Philadelphia dispensary, 
 for the year 1875. " The evening service (from 6 to 7 in the 
 evening), has been found a most valuable adjunct in provid- 
 ing for the laboring classes engaged during the day, and 
 who otherwise would have been compelled to forego all 
 treatment." Well, let Philadelphia have all her honors for 
 the time being. But New Yorkers wake up. Philadelphia 
 has caught you asleep this time in the matter of elymosynary 
 
 "Wills Ophthalmic Hospital Rep. for 1875, p. 14. 
 
28 
 
 institutions, for the relief of diseases of very important organs 
 in a commercial sense We want neither blind nor deaf clerks 
 and paupers. We need to keep our city clear of them, as well 
 as free from pestilence in another form, hi conclusion, it is 
 
 eminently gratifying to find three laymen in our midst who 
 have written concerning this subjecl with such evident relish 
 and acumen. The work we have done is appreciated by 
 some beyond all question. But some one says that the rate 
 of progress is not rapid enough for them. Well that is the 
 case with everything good. " Nihil per saltern," is nature's 
 law. You can not get up "rapid transit" 1 on that line. You 
 may salt the track as much as you please to get rid of the icy 
 obstructions, but the " nihil per saltern" still remains. This 
 fact has been more elegantly expressed by the poet, who says 
 
 *" The mills of God grind slowly, 
 But they grind exceeding fine." 
 
 There is more truth than poetry in these lines, and it he- 
 hooves us to remember the sentiment. That is indubitably 
 true, and what is true is good. 
 
 A few words more, and then 1 submit the matter to you. 
 
 The visiting physicians of the various dispensaries, who go 
 about from house to house, wherever called, among the poor, 
 go about the city in ordinary citizens' dress, and their dress is 
 oftentimes of the least expensive character — sometimes from 
 choice, sometimes from necessity; and but few persons realize 
 how important their mission is. The citizens of this and other 
 cities maintain police and lire departments for the safety of 
 their valuables and houses and tenements. They maintain 
 these departments well, and the well-dressed members of these 
 departments, in addition to the work they do, make <piite a 
 show on the streets. But the visiting physicians of the vari- 
 
 * TeunyeoD, with amendment?. 
 
29 
 
 ous dispensaries, silently and unobservantly for the most part, 
 guard you from enemies more insidious and deadly than either 
 fire or thieves. They guard you citizens of New York against 
 loss of those whom you hold dearer than your stocks and jew- 
 els, bonds, houses and tenements. They do their work, more- 
 over, at a most ridiculously small expense to you, and you 
 citizens allow the managers and trustees of dispensaries to go 
 about, always begging for the wherewithal to carry on the 
 work of dispensaries in all their departments, and when still 
 harder times come to these underpaid public benefactors, you 
 force the managers and trustees of dispensaries to cut down 
 the salaries to a disgustingly mean figure. Now, if you want 
 to see an old servant in the dispensary service, and at the 
 same time to see a specimen of old New York, go and look at 
 the Northern Dispensary. It reminds me of a sentry-box. 
 It is just about the dimensions of a good sized guard house, 
 in which its sanitary sentinels may assemble prior to going 
 out on their rounds. If you go into the building, after taking 
 a good look at the outside, you will find there a sanitary 
 officer who can give you over twenty-eight years history of 
 the place, and show you all its reports, and you can reckon 
 up all the work it has done and count the cost. But I warn 
 you not to occupy too much time at any one visit in such 
 investigations, so as to interfere with the business of the place. 
 The other dispensaries of the city have been considerably 
 altered and changed in appearance with the lapse of years, 
 but the Old Northern Dispensary will always continue not 
 much larger than a good sized sentry box, as long as it stands 
 on its present site, but if it is not much larger than a good 
 sized sentry box it is a very effectual sentry box in the matter 
 of guarding against the incursions of pestilence and death, 
 and the diseases which may attack the rich through their neglect 
 of the sanitary condition of .the poor. Citizens, as you value 
 
30 
 
 ymir household treasures, take good care <>f the outposts and 
 bulwarks, and then your habitations will be more safe than 
 they can be otherwise. 'Take very good care of these sanitary 
 outposts and bulwarks and then your domiciles will probably 
 be, so far forth, the abodes of cheerfulness and health. 
 

 Date 
 
 Due 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 $