WffftMHURHT HX64167143 RA982.P38P38 Addresses! RECAP Addresses Delivered at tlie Opening of the Walter Garrett Memorial Building of the Pennsylvania Hospital April 23, 1897 & ■ Columbia Wlntotvsiitp iniljt&itpot&etogork Colkge of Mpsitian* anb burgeons Reference JLibmvp i>e/ t^/i ^uz^e/cJ ^MMJ^/wtfrrwa/ <_/Cc&f?st w^Zsesrt&n^z Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/addressesdeliverOOpenn Addresses Delivered at the Opening of the Walter Garrett Memorial Building of the Pennsylvania Hospital April 23, 1897 J^HLv^ ^JL* Dr. Thomas G. Morton's Address Mr. Benjamin H. Shoemaker, the President of the Board of Managers, introduced Dr. Morton, the Senior Surgeon on the Medical Staff. Dr. Morton said : Ladies and Gentlemen, Managers, and Contributors to the Pennsylvania Hospital : We are here assembled to celebrate with appropriate ceremony the opening of the latest addition to the resources of the Pennsylvania Hospital, the " Walter Garrett Memo- rial," designed to be occupied as a Reception Pavilion, a Clinical, Operative and Lecture Hall, and a Surgical Ward for Children. The Managers of the Hospital, who are ever mindful of the best interests of the institution under their care, having decided that increased facilities must be provided in order to keep pace with the modern rapid strides of improvements in surgery, one year ago authorized the construction of this building. Under the supervision and direction of Mr. Addison Hutton, and Doctor Thomas S. K. Morton, this Memorial building has been planned and constructed. No pains or expense have been spared in the effort to make this equal, if not superior, to any other structure of its description in the world. I may add that it has been erected through the generosity of a member of a family of philanthropists, to whom the Hospital is already greatly indebted for very generous gifts. Permit me briefly to invite your attention to the admirable internal arrangements of this building. All the sick and injured brought to the Hospital, either by our Ambulance, the Police Patrol, or otherwise, are admitted at the southern entrance of the Main Hall, on the first floor, w r here all details connected with the patient are imme- diately recorded. Male patients are taken into the large reception ward on the right of the Hall, and female patients and children into a similar ward on the left. Patients with diseases or injuries which do not require their admission into the general wards, will here receive appropriate temporary treatment, after which they will be dismissed and directed to return to the Out-Patient Department on Spruce Street. Patients who are to remain in the Hospital for treat- ment, are transferred from the Reception Ward to the large room beyond, where they will be bathed, and otherwise put in proper condition, before being taken to the main wards in the Hospital appropriate to their disease or injury. Should an important surgical operation be required, after the same preliminaries, as far as possible, the patient will be brought by the elevator up to this Hall. On the first floor, conveniently situated, there are also baths and lavatories, flushing sinks, a steam closet, where bedding and clothing may be warmed or dried rapidly, and rooms for ticketing, bagging and storing clothing. One small room contains a steam sterilizing oven, in which infected clothing can be thoroughly cleansed, and germs and vermin destroyed. At the northern end of the corridor is a well appointed diet kitchen. In the centre of the building, on the eastern side, is located a capacious elevator, of most approved pattern ; it is surrounded by a beautiful, broad, marble stairway. From the first floor there is direct communication with the base- ment of the Hospital by an enclosed corridor, thus afford- ing ready access to all the various wards. This building, it will be seen, therefore becomes the centre of distribution of patients to the entire Hospital. All patients admitted to the Hospital between sunset and morning will be temporarily accommodated in this building, so that there need not be any disturbance during the night in the general wards, which heretofore has often been unavoidable. On the second floor, upon which we are at present, the complete series of rooms and arrangements to facilitate modern surgical purposes are not equalled by those of any other Hospital in the world. Large double doors lead from the landing or stairway into this commodious Clinical, or Main Operating Hall. Situated to either side of the corri- dor and in communication with this Clinical Hall, are rooms where patients can be etherized before being brought into this room for operation. This Hall has excellent acoustic properties ; and it is brilliantly lighted by the ample glazed dome, during the day, and by Welsbach and electric lights at night. Students or spectators will enter by a special gate upon Eighth Street, near the corner of Spruce, and on approaching this Hall, will find, on the landing half way up, a coat and toilet room. The seats, which as you notice are seven tiers, numbering in all two hundred, are so arranged that there is no obstruction to observation from any portion of the room. On either side of this operating space, as you may have observed, are sinks, flushing tanks, wash-basins and pipes for applying steam for sterilizing purposes. There are also two large water sterilizers, the largest ever made ; and here, too, are steam closets for heating blankets, etc., racks for supporting glass reservoirs holding antiseptic solutions ; here are also movable glass tables for the dress- ings and instruments. Behind, and to one side of this operating space, there are doors which open to the dressing- rooms for nurses, utilizing for this purpose the space be- neath the seats. Nurses who are to assist in the operations, here prepare themselves, their hands and clothing, with the same scrupulous care as the surgeons. On the other side, are rooms in which the sterilized dressings for the entire Hospital will be manufactured in accordance with the requirements of antisepsis, with the aid of four high pressure steam sterilizers. Retiring rooms for patients recovering from the effects of anaesthetics are also suitably and conveniently arranged. A novel feature on this floor is a room where operations may be performed on patients having virulent and dangerous diseases ; after which everything in the room will be subjected to the antiseptic action of live steam, thus destroying all germs and overcoming, in great measure, the danger of commu- nicating contagious disease. The small operating rooms, also situated on this floor, are most convenient and complete. An enclosed corridor connects with the main floor of the Surgical Pavilions of the Hospital, so that patients may be transported by the 8 most direct route to the other parts of the building, or from thence to this Hall. On the third floor is a spacious children's ward, capable of accommodating twenty-five beds, with all the conven- iences for the little patients and their nurses, including a bright play-room and sun parlor. I would call your attention particularly to the most approved system of heating and ventilation, to the cemented floors, to the lighting, which is either by gas or electricity, and to the absolutely fire-proof character of the building. At this time you may very properly inquire the neces- sity for this outlay, and for all the costly appliances to which your attention has just been directed. To properly reply will require a very brief exposition of the facts and theories upon which the modern system of antiseptic sur- gery rests. If a ray of sunlight be permitted to enter a dark room, innumerable particles of so-called "dust" are seen floating in the pencil of light. These moving atoms have been ascertained by the late Professor Tyndall, to be principally living germs, microscopic in size, and believed to be of vegetable origin and character. Many of these germs are- harmless, others cause serious or fatal disease. Therefore we aim to exclude from wounds all living micro- organisms, thus preventing blood poisoning or septic infec- tion. Surgery to-day is so surrounded by precautions that absolute antisepsis can be secured. The various apparatus and appliances to which your attention has been directed, have been found to be capable of destroying disease-gener- ating germs, and the means taken to attain this object, form collectively in surgery what has been termed the antiseptic treatment of wounds. Sterilization of dressings, or of instruments, is the complete destruction of all living micro-organisms present and the prevention of the growth of others. Water is usually sterilized by boiling, surgical dressings and instru- ments by moist or dry heat, and wounds during operation are kept free from germs by the use of germicide or aseptic solutions. The importance and necessity of antisepsis in surgical manipulation has, as you know, only been recog- nized within a comparatively recent period. The method, however, of purifying water by the use of heat has been known and practised by the Chinese for many centuries, both for household purposes and for wash- ing wounds. It is also a curious and interesting fact that the precaution was adopted by Cyrus the Great twenty-four hundred years ago. Herodotus, the Father of History, in referring to the expedition of Cyrus against the Assyrians, says : " The great King, in his warlike expeditions is pro- vided from home with cattle and all other necessaries for his table. There is also carried with him water of the river Choaspes, which flows near Susa, for the King drinks of no other; wherever he goes he is attended by a number of four-wheeled carriages, drawn by mules, in which the water of Choaspes, being first boiled, is disposed in vessels ot silver." The consideration of the very complete appointments of this Surgical Building, leads me to remark that the great development and present position of usefulness of the Pennsylvania Hospital is the result of an evolution due not entirely to its management which has ever been prudent, efficient and successful, and as such has elicited universal commendation, but in simple justice to those who have TO passed away, it may be said that the reputation of the Penn- sylvania Hospital is in great measure due to the character of its medical staff. Let me briefly direct your attention to the remarkable personnel of the members of the Medical Staff who served this Hospital in its early days, the men who contributed so much to the reputation of the institution which they so faithfully served. I find that between the opening of the Hospital and the close of the century, from 1752 to 1799, inclusive, there were twenty physicians all told who served on the staff and devoted themselves to the care of the insane, the sick and injured. They were all men of exceptionally high character — eminent not only in their own vocation, but having acquire- ments and accomplishments which made them leaders in the community, and active and influential in all its social affairs. They held positions of great responsibility and honor in public life ; they had great literary ability and were classical scholars. Most of them had traveled and had been graduated abroad, and they were always received with marked attention in the medical centres at London, Oxford, Edinburgh, Bonn, Berlin, Vienna, and in Italy. They were pre-eminently men of affairs, and were con- stantly being called upon to take an active part in the administration of government. It will, I think, be a matter of surprise to you, as it was to me, upon looking into the lives of those medical men who served before the opening of this century, to find how important were the public services which they had rendered, -apart from their arduous daily professional work. Thomas Bond, was the originator of the Hospital. At the outbreak of the Revolutionary War, when past his sixtieth year, he entered the military service of his country and rendered distinguished service by organizing the Medi- cal Department of the Army. He was the founder of the Humane Society of Pennsylvania and its first Presi- dent. Thomas Graeme, was a Judge of the Supreme Court of the Province of Pennsylvania ; he had previously been a member of the Provincial Council and subsequently was Collector of the Port of Philadelphia and also Naval Officer. John Redman, was the first President of the College of Physicians of Philadelphia ; he was one of the most active of the eminent men who organized that honorable society and was a member of the Common Council of Philadelphia. Thomas Cadwalader, was a member of the Provin- cial Council of Pennsylvania and Medical Director of the Army Hospitals. William Shippen, was twice elected by the Assembly of Pennsylvania a member of the Continental Congress. John Morgan, held a Lieutenant's Commission in the Army at the time of the war between Great Britain and her Colonies and France, but he acted chiefly as Field Surgeon. During the Revolution he was appointed by Congress, Director-General and Physician-in-Chief to the General Hospitals of the American Army. William Shippen, Jr., was Physician-in-Chief to the Flying Camp, and Congress elected him Director-General of all Military Hospitals of the Armies of the United States. Preston Moore, was Provincial Treasurer of Penn- sylvania and Trustee of the General Loan Office. James Hutchinson, when on his way home from France, was entrusted with dispatches from Franklin, then American Minister. His vessel, when off the American coast, was chased by a British ship of war, and being determined to save his dispatches, he left in an open boat, and, landing under the fire of the enemy, succeeded in his mission ; but the vessel was captured and everything he had brought with him, including his valuable medical library, which he had carefully collected in England and France, was lost. He became Surgeon-General of Pennsylvania, subse- quently Senior Surgeon to the Flying Camp ; was a mem- ber of the Committee of Safety, and he was frequently con- sulted by Washington on matters relative to the Medical Department of the Army. John Jones, served in the Colonial Army in 1775, against the French. He was the intimate friend and phy- sician of Benjamin Franklin and physician to President Washington. He was President of the Humane Society of Pennsylvania. Foulke was President of the Executive Council of Pennsylvania. Caspar Wistar, was present at the battle of German- town, but unable on account of religious principles to carry arms, he sought the wounded and was active among those who were administering relief; while Doctor Physick, on account of his valuable services to medical literature and medicine, bears the honorable title of " Father of American Surgery." 13 And what shall I say of the immortal Benjamin Rush, the Physician of the Port of Philadelphia, Fleet Surgeon of the Pennsylvania Navy, Physician-General of the Military Hospitals of the Middle Department of the American Arm}-, Treasurer of the United States Mint, a member of the Convention of Pennsylvania for the adop- tion of the Federal Constitution, a member of the Con- tinental Congress, a Signer of the Declaration of Indepen- dence, and now recognized by all as the American Sydenham. Thirteen of the twenty medical officers referred to were active in organizing the American Philosophical Society, several were founders of the College of Physicians of Philadelphia, and also of the College of Philadelphia, which afterwards became the University of Pennsylvania, while ten became Professors in the latter institution ; several were honored abroad by election to membership in the Academy of France, the Royal Society of London and other foreign Associations. Is it any wonder that the repu- tation of this Hospital advanced so wonderfully with such brilliant men in its service ? Volumes could be written to record their merits and embalm their memories ; but all may be condensed in the single statement : that with them education never militated against personal goodness, for whether in peace or war, in pestilence or plague, in poverty or wealth, they worked nobly " for the good of their fellow beings and the glory of God." If Franklin, who was the first Secretary and afterwards President of the Board of Managers, could to-day revisit this Hospital which he was so largely instrumental in establishing, he would find that wonderful changes had 14 taken place. To begin with, at the time of his death, in 1790, only the East wing was built, for the Centre and West wing were only commenced and finished about the close of the last and early part of this century. He would now find nothing remaining of the Hospital, as he knew it, save the walls of the East wing, while the original plan as after- wards completed has, within the last year or so, been sub- jected to an entire internal remodeling, and other buildings than those originally planned have been erected upon the grounds. He would even find the electric fluid, which he successfully conducted along the string of his kite, now successfully employed in the institution whose corner-stone he laid, as the customary means of sending the human voice to each portion of the entire range of buildings, and also of illuminating the halls and wards. In conclusion I wish to direct attention to the im- portant educational services rendered by this institution. The Pennsylvania Hospital may properly be styled the Mother of American Hospitals from the fact that it was the first hospital in this country ; but its reputation, which extends through the length and breadth of our land, has been gained not alone because of the tens of thousands of sick and injured charitably cared for, but also from the fact that medical instruction, bedside and clinical, has been a prominent feature from 1752 to this present time, and has been the means of disseminating the best medical thought and practice all over our country. The Hospital, during its earlier days, stood forth as the sole representative insti- tution for medical education, offering the only means for systematic instruction in medicine and surgery on this side of the Atlantic ocean, and this instruction which ha? '5 continued for nearly a century and a half, was permitted to suffer only a temporary interruption, inseparable from the social disturbances accompanying the War of Indepen- dence, when the Hospital was occupied by Colonial and British troops for their sick and wounded. The number of students attending the Hospital lectures became so great towards the close of the last century that the Managers, instead of crowning the centre building with a dome, according to the original plan, decided to utilize the space by converting it into a clinical lecture room, and it was so used until 1868, when the present, but now abandoned, octagon clinical hall was opened. Thirty years have now elapsed, and the building then considered the best for the purpose which could be planned, has now been found unsuitable, and has been superseded by this structure. What a like term of years in the near future may bring forth in Hospital construction it would be presump- tuous to even consider ; but it really seems as if perfection has been attained and all possible surgical requirements met, by the erection of this magnificent building, which is this afternoon formally presented to the Contributors of the Hospital. 16 Dr. J. M. Da Costa's Address The President then introduced Dr. Da Costa, the Senior Physician on the Medical Staff. Dr. Da Costa said : The excellent discourse to which we have just listened leaves little to say to one who is to address you on the same subject. You have been told in detail, and you see before you, what a clinic and operating room is, conceived and perfected in the spirit of modern thought, and can under- stand at once to what useful purposes it will be put. But there are a few points which my distinguished colleague has necessarily omitted, or only touched upon, that I ask to present to you. It is difficult for any one intimately con- nected with an institution so old and renowned as the Pennsylvania Hospital to estimate fully the influence on thought and action of its very antiquity and renown. From the room that preceded the one we inaugurate, from the old rotunda, from the newer building in which until now successive generations of eager students assembled, have gone forth lessons that stamped themselves into the professional mind ; lessons of readiness, of expertness, of cool determination in the surgeon ; of profound analysis, of keen detection, of skill in meeting untoward symptoms, in the physician. In the rooms that were anterior to this, have stood and taught those who were not unworthy successors to Rush, who for thirty years was the most conspicuous medical figure in this Hospital, as, indeed, by his learning, captivating eloquence and ardent zeal he was the most con- spicuous figure in the profession in the United States ; and to Physick, the dignified surgeon, who, bringing with him into our century the appearance and manner of another time, stood before his class with his hair powdered and clubbed, their idol, as in his cultivated voice he gave admirable illustrations of the conservative surgery of which he was the great exponent. In those rooms taught John K. Mitchell, the versatile and gifted, with the eye of genius foreseeing the part minute organisms play in the production of disease ; George B. Wood, as methodical and accurate in his statements at the bedside as everywhere in his respected career ; William Pepper, clear in his descriptions and con- summate in unravelling obscure processes ; . William Ger- hard, take him for all in all, the greatest observer and clinician America has produced ; John F. Meigs, inheriting with his famous medical name an interest in this Hospital from the illustrious and inimitable teacher whom also it is our boast to have had on our list, and showing here the same skill and kindness that made him the most sought- after physician in the community. In the old rooms also has been heard the voice of Barton, the pride of his colleagues, whose ability and ingenuity remained a tradi- tion for long years, joined to regret for the early retirement from a profession in which, still young, he attained the first rank ; of Norris, the truthful, honest, conscientious gentle- man and teacher ; of Joseph Pancoast, the brilliant surgical artist, devising processes that seemed to be the result of intuition, and practising, long before it was taught, a kind 22 of antiseptic surgery, of which he himself did not recognize the importance or wider application ; and of Agnew, the most esteemed man of our day in the American profession, cool, skilful, daring, yet of the soundest judgment, and a clear, concise, admirable teacher. Thus from the days, one hundred and thirty years ago, when Bond enthusiastically, with the full approbation of the Managers, introduced clinical teaching into the Penn- sylvania Hospital, and therefore on this continent, — for it was in this Hospital that the first bedside instruction in Medicine was given, — up to our time, there has been a succession of men bestowing publicly their best thought and experience without reward, or idea of reward, on those who were to come after them. It is scarcely possible for one who has been long associated with this Hospital, and watched its workings with the eye of affection, to abstain from mentioning the present and his colleagues. But if I may not speak of the living, I know and feel the influence they exert ; I am aware of the love they bear this ancient and famed institution ; I see and hear in many ways how worthily they strive to emulate and equal its best records, and to let the teachings of the Pennsylvania Hospital be distinguished, as in the past, for truthful exposition, sound practice, for enlightened, not blind, conservatism, for earnest wish and endeavour to contribute to medical progress. The traits of the many distinguished teachers that have been connected with the Hospital, and the influence of the character of the Hospital itself, have made indeed, a great school of both Practical Medicine and Surgery, developing on rational lines. The men have formed part 23 of the Hospital, the Hospital has formed part of the men. Nor is it only by oral teaching that the Pennsylvania Hospital has been helping to mould and guide the genera- tions that have come here for instruction. It has also clone its part in addressing the wider audiences to be reached through writings. It has given many an enduring gift to the profession at large. From this Hospital have emanated, or been chiefly promulgated, the simplest, most direct and most successful treatment of fractures recognized and commended the world over ; the method of manipula- tion in the reduction of dislocations ; the use of animal ligatures in surgery ; the distinction of typhoid fever as a separate form of fever in America, and as pre-eminently the fever of this country ; some of the earliest, and to this day the best, descriptions of remittent fever and its conse- quences ; the connection of joint affections with spinal diseases ; the now universally adopted treatment of sun- stroke by ice, and other forms of treatment that have become standard. To this — and it is but a partial list — may be added the description of many new operative pro- cesses by such masters in. the art as Barton, Pancoast, Agnew, Levis ; essays and clinical lectures innumerable by observers like Gerhard, Stewardson, Pepper and Hutchin- son. And all have the same stamp of directness, truthful- ness, careful observation and practical value. It is greatly to be regretted that so much of this literature is scattered, and has not been collected in the way Guy's Hospital and other great hospitals bring together the work of their men. Some years ago the attempt was made, and two volumes were issued ; but the undertaking had to be abandoned with reluctance on account of the expense, with all the 24 greater reluctance because the volumes were most warmly received and lauded. But to return to the clinical teaching of the Hospital. It has taken a profound hold on the medical mind of the country, more profound, perhaps, than we who live in large centres realize. If I may be pardoned for speaking of what has happened to me personally, and of what is, I know, equally the experience of my colleagues, I have often, when summoned out of town into a remote region, met a physician who, as soon as the immediate cause of our conference had been attended to, would ask me about some person whose malady he had heard expounded ten, fifteen, or twenty years before at the Pennsylvania Hos- pital ; or quote, in support of his view of the disorder before us, a case there seen, and describe it so vividly that it seemed as if it had been but yesterday met with. And once, in the wilds of Colorado, encountering a middle- aged man who introduced himself to me, he asked, almost as his first remark, " Did the patient brought before us at aclinic," the date of which he mentioned, "recover?" "What were the subsequent symptoms?" "And did all turn out as supposed? " I am ashamed to say his memory of the circumstances was better than mine, and I could only give him a general answer, which, I fear, lowered me greatly in his estimation. This wide diffusion of knowledge, this living interest in the doings of a Hospital, is one of the advantages of clinical teaching, and it is certain that the Hospital that neglects it, neglects a great means of doing widespread good. Moreover, it shuts itself off from the world ; it has no ardent friends everywhere with its name on their 2 5 tongues ; it becomes purely local in its character and aims. It never takes rank with the first institutions of its kind, and must be content with a second or third-rate reputation. Establishments for the sick existed in the time of the Romans. Hospitals, as we understand the term, hare been founded since the fourth century. They were spoken of in the Council of Niccea in the year 325 as institutions well- known and deserving support and encouragement. The Hotel Dieu, with its motto, " Medicus et Hospes," began to receive the sick and destitute about the year 600. The Grand Hospital of Milan, with its several thousand patients, occupies the same building it did in 1456. But who has heard or knows anything of these Hospitals, unless from their walls has gone forth something that has taught and been made of use to others ; something that, in the minds of regardful men, has become identified with the progress of investigation and of ideas ; something that thrown on the billows of thought has been carried far onward in the ocean of knowledge ? Clinical teaching, rightly conducted, is a benefit to the sick. There is an opinion that it is only of use to the medical profession, and especially to those about to enter it. To them, indeed, it is invaluable, and through them to whole communities. But it is valuable, too, to the patients themselves. The very publicity, the hundreds of critical eyes with which it is observed, ensure that the best thought is given to the helpless and the sick. There must be accuracy, there must be the most strenuous effort for relief, where there are many keen watchers ; and the influence of all this is that the habit thus acquired is transferred to ward work, which in its turn becomes more exact. There is very 26 rarely any objection on the part of the patient to having his case publicly investigated. On the contrary he likes it ; he regards it as a mark of interest. To most teachers it has happened to see offended women bursting into tears, because, owing to inability to do so in the time allotted, they had not been taken to the clinic room after being spoken to about it ; they were provoked at the favoritism thought to have been shown. Then it must be always remembered that the very ill, or any whom it might possibly injure, are not brought before the class. No one with a spark of humanity thinks of such a thing. Certainly in this Hos- pital the claims of patients have never been subordinated to bedside teaching, and, judging by the past and the record to which we hold, never will be. We recognize, indeed, that we bring to this new room much from the time gone by. We are sensible that the old memories, the old tradi- tions, the old spirit, are moving with us into this admirably arranged edifice. We feel their power, and no member of this ancient Hospital can be unmindful of the strength of their hold on his fullest exertions and truest sympathies. But the splendid room in which we are assembled has other uses than merely those connected with teaching. It is but a part of this Garrett Memorial Building, which will be alike a lasting monument to the generous philanthropist that endowed it, and to the forethought, the sagacity, the advanced knowledge of those that planned it. Here is seen in a completeness nowhere, I believe, as yet equalled, an operating Pavilion in which to make modern surgical treat- ment, with its marvellous antiseptic results, even more than ordinarily successful. The most minute details are attended to ; years of professional experience have contributed to 27 their elaboration. It is the perfection of mechanical ingenuity, the apotheosis of cleanliness, and with its numerous attractive appliances, its movable tables, its large brass instruments, its adjacent tiled and marbled dressing rooms, would be fascinating, if one could only prevent a thought of the grim purpose of all this beauty from enter- ing the mind. Then, in this building with its combination of means, other most valuable arrangements are manifest. There is a room devoted exclusively to operations upon those with infectious diseases that can be filled with live steam at a slight pressure ; a room for the employ of the X-rays ; there is electric apparatus for resuscitation and treatment ; there are rooms for etherization. In other parts of the building — for it is more than a mere structure for lecturing and operating purposes — are rooms with every facility for immediate treatment of those brought here too ill or too severely injured to be moved further ; there are "quiet" or recovery wards for those whom noise might hurt, or who have passed the worst stages ; and receiving wards for the reception and distribution to the appropriate places of all patients who can be at once assigned to the main Medical or Surgical Hospital. Here then is a build- ing of wide intent and beneficent purpose, planned to meet what years of thought and experience have shown to be most desirable, and executed in a manner that makes it not only a credit to the Pennsylvania Hospital, but to the city and the country. This building, too, is only one of the improvements that the present Board of Managers has gradually effected. They have, step by step, transformed the Hospital. An admirable School for Nurses, with a separate building, 28 erected by the generosity of the Misses Blanchard ; a Surgical Hospital, due to the munificence of the family of their former President, Wistar Morris, whose memory it worthily celebrates; an endowed Outdoor Department, with every facility, the gift of William E. Garrett, Jr., one of the same family that gives this Memorial Building ; the reconstruction of the old building in a manner that makes it the equal of any modern hospital ; now this thoroughly adapted structure,- — surely all this shows careful thought, far-sighted action. The community which believes in them has, little by little, occasionally in large sums, supplied them with the means, and, as it is seen how they are used, the springs of benevolence are expanding into broad streams. But they never oan be too broad ; the need is still great. This Hospital, once to a considerable extent supported by those who entered it, is now almost entirely a free Hospital, open at all times to those of every nation- ality and every creed. It still spends more than its income in their support ; but, owing to the feeling of attachment and pride which the community has for it, and the reliance on- a management which one of my former colleagues in an address has described as an active, intelligent body, which never wastes, never misappropriates, it meets all demands and increases steadily. It instinctively attracts to it, both in its Managers and warm friends, those who love their fellow-men, who have a genius for philanthropy, and calls forth the large bequests that, in virtue of the affection and trust it has inspired, have alone made possible the changes in the Hospital, which are so splendidly transforming it. If it continue to grow on these broad lines, it will not be long before, in addition to its antiquity and renown, it will 29 be cited as being one of the foremost developments of the hospital idea in its best form among the modern hospitals anywhere. How all this would have delighted the benevo- lent souls who founded it ! How gladly Bond would be with us to-day, viewing the growth of what his humanity suggested ; and if, at the first meeting of the Managers, in December, 1756, to inspect the new wards before the sick were admitted, they could have foreseen to what the Hospital would attain, what would have been their gratifi- cation ! Perhaps the then President of the Board — the great American, Benjamin Franklin — did ; and we can see in the pleasure in his benign face, in the light in his large gray eyes, that there has come to him the vision of what, through the natural sciences, so dear to him, through the intelligent care of successors as worthy and as true to their trust as the friends that there surrounded him, have grown to be structures as complete as his imagination could have pictured, and as full of such appliances as his genius would have delighted in, and have surely added to. If there could come to us from that vision into the unseen world an expression of the appreciation it occasioned, warm words of approbation would surely reach those whose perfected efforts we are to-day inspecting. But in all the changes, you, the Directors of this great charity, are effecting, one appeal we still make to you for action in a matter we know you are contemplating, and the importance of which our daily work forces on us. Give us a laboratory, commensurate with the dignity and reputa- tion of this Hospital. It will be one more claim to grati- tude, not only of the profession, but of the ill and the injured, and, in its far-reaching results, of science and of 3° posterity. It is no longer possible, it is becoming scarcely conceivable, that physician or surgeon can recognize disease as completely, or treat it as well as it can be treated, without the aid of laboratory facilities. Good work he may still do ; but it will not be his best, and very far from the best that can be done. The time has passed for mere bedside labor, and in justice to the sick and helpless, in justice to those exposed to possible contagion, laboratory work must supplement or guide professional effort. Crown, then, your work with what is a recognized need of the day. Crown it with what will have the beginnings in it to develop with the wants of a portentous future. Crown it with a laboratory that now and in times to come will gladden those who look for guidance to this famed institution. But we know well that for the great plan of which the finished structure we are now in is but a part, neither means nor opportunity exist to accomplish everything at once. For all that has been done already there is true appreciation and gratitude. For the building which is formally opened to-day let us here express it. It stands as- a monument of generosity, of enlightenment, and of ideas carried to perfect conclusion. Noble was the thought that conceived it ; noble the thought in one who bore the name of a family that was already among the great benefactors- of this Hospital, to add to a large bequest all that was needed to make the ardently-desired beneficent plans a reality. In this Garrett Memorial Building, with an equip- ment in which nothing that the most advanced science can suggest is absent, pain is to be abolished, the best possible results ensured to the injured and distressed. From here- 31 lessons will go forth that will penetrate into every hamlet. Men now, men in years to come, will, during many an arduous struggle of a long career, turn to it with a sense of gratitude to the generous donor through whose aid many of their difficulties are smoothed by giving them an opportunity of witnessing how difficulties can be best over- come. And further, he who is brought to these emergency wards, stricken or so hurt that he cannot be moved another step without the gravest risk, the most destitute, the most wealth} - , will be treated with appliances and in a manner that not many years ago the most powerful of the earth could not have commanded, and will learn to give thanks reverently that there were noble-minded souls that so splendidly and thoughtfully provided for his dire necessi- ties. 32 5 2 Dr. J. B. Chapin's Address The President next introduced Dr. Chapin, Physician in charge of the Department for the Insane. Dr. Chapin said : It is recorded in the History of the Pennsylvania Hos- pital that "on the 28th of May, 1755, the President, Joshua Crosby, attended by all of the Managers, the physi- cians, and many contributors, marched in a body from the Hospital (then on Market Street), accompanied by a select concourse of citizens, and the children of the public schools who were of an age suitable to recollect the fact, to these grounds which had been acquired by purchase, and then laid the corner-stone of the Hospital building near which we are now assembled. On this stone is an inscription which ends with these words — " May the God of Mercies Bless the undertaking " — an invocation not to the unknown God, but to the living God then, now and forever. Although those who then assembled to perform this becoming cere- monial have been personally unknown to several gener- ations which have succeeded them, as we look upon them now they were pioneers, discoverers, founders of States, and a new order of social existence with all of its prob- lems. They well and truly laid the corner-stone, not only of a material structure which was to endure, but also of an organization on principles destined to perform its 37 offices of helpfulness, healing, and benevolence in the relief of human suffering, through all ages. On this corner- stone was to be erected a structure not as a memorial of their benevolence, but to be dedicated to the service of suffering humanity for generations, which were to follow after the founders had passed away. They asked the provincial authorities to legalize and perpetuate their organization which provided for the care of three classes — the sick, the injured, and the insane ; and it is a noteworthy fact that the organic law creating this institution described it as a hospital to be properly disposed and appointed for the care of all patients, " where, by the blessing of God on the endeavours of skilful physicians and surgeons, their diseases may be cured and relieved." This law was enacted in May, 1751, and distinctly recognizes insanity as a disease amenable to medical treatment and management. It was the pioneer movement of the kind in America, begun forty-one years before the reforms in the treatment of the insane without the imposition of cruel restraints proposed by William Tuke at York, England, in 1792, and Pinel, in France, in 1795. In January, 1836, a site was acquired west of the Schuylkill, for the purpose of erecting upon it a hospital structure to receive the insane then occupying the west wing of the Pine Street Hospital. This change had become imperative by reason of the limited space that could be devoted to out-of-door exercise ; the growth of the city ; and the inability to extend the accommodations for the insane. On the 22d of June, 1836, a large assemblage of friends of the Hospital was present to witness the laying of the corner-stone, and listen to an address by Dr. Benjamin 38 H. Coates. Full of hopefulness, and impressed with the enlarged usefulness which the new department promised, he predicted that "we may reasonably hope for a long service of progressive improvements and refinements. Here, never, certainly, shall be heard the lash or the chain. We may hope that here the violent and ferocious shall be restrained from mischief or protected from injury by methods the mildest and most humane — that the temporary ebullition of an inflamed brain shall be allowed to expend itself in harmless noise or motion — that the helpless shall enjoy relief for his wants, and preservation from indignity and disgust, unconscious of the kindness that protects him. Here shall the mind, enfeebled by long-continued disease, by the grinding inflictions of the world, or by the stormy struggles of unbridled passions, be permitted to waste in disease the remaining years of a shortened life. The bless- ing of the Author of nature shall hallow the scene, and the tortured soul shall enjoy the soothing quiet which is ever felt in contemplating the works of eternal beneficence." The projected Hospital was completed January i, 1 84 1, when ninety-three patients were transferred to the new department. To this date 4,360 insane persons had been treated in the Pine Street Hospital. Following the erection of the separate department for the insane, west of the Schuylkill, there was a rapid acces- sion to the number of patients. In 1853, the Managers, in their annual report, stated that the wards were often incon- veniently crowded, and that as many as fifty applications for admission had been refused during the year. The Managers were again confronted with the problem and embarrassments of over-crowded wards, and the necessity 39 of turning from the doors of the Hospital many worthy persons for whose needs no other institution or organization would probably come forward to supply. It was thereupon voted to erect a separate hospital building to be devoted exclusively for the reception of men. At the end of the year 1854, a Committee reported that 269 subscribers had offered to contribute $127,000 — a fact that was considered most honorable to the community and encouraging to the Managers. On the 3d of March, 1856, a Building Committee was appointed with authority to commence the construction of a new building. The corner-stone was laid October 1, 1856, by Richard Vaux, Mayor of Philadelphia, in the presence of a large company of the friends of the Hospital, when addresses were made by Dr. George B. Wood and others. The Department for Men was opened October 27, 1859, in the presence of a number of Contributors and Managers with appropriate ceremonies. The whole cost ot the Department for Men was $352,111.51, which sum was contributed by the benevolent citizens of Philadelphia. The cost of the Department for Women was $250,000, a sum realized mainly from the sale of lots adjacent to the Pennsylvania Hospital, and the wise administration of its capital'. Other additions, improve- ments, and betterments have been made from time to time from the avails of bequests and gifts. The one-story wards ; the two blocks, or wards, named for the benefactor, Joseph Fisher ; the Mary Shields' wards and the Isaiah V. William- son wards, respectively bearing the names of the eminent benefactors ; a detached cottage, house, or villa, affording liberal accommodations for a small number of women ; the 40 new wards completed in 1896, to furnish improved accom- modation and a better classification, have been added to the plant of the Women's Department, while at the Department for Men, a gymnastic pavilion, and a swimming pool con- nected with medical baths have been erected in recent years. The whole sum expended for lands in the first estab- lishment of the plant in West Philadelphia was $650,000, exclusive of buildings subsequently added. From 1841, to the end of the Hospital year, 1897, the aggregate sum received for board and treatment of patients amounts to $7,076,652.30 ; amount expended for maintenance of the Hos- pital, $7,160,961.55 — exceeding the receipts by $84,309.25. The amount expended on free patients, and for care of patients received at less than the cost of support, was $1,111,300. Of all of those sums not one dollar was asked or received from the public treasury. The inquirer might ask for an exhibit of the oper- ations of the Hospital from the opening in 175 1. It appears that the whole number of insane persons admitted to the present date is 14,898, of which 9,776 were dis- charged cured or improved, and the remainder, excepting the number now in the Department for the Insane, were discharged unimproved, or died. To turn to another side of our subject, it may now be properly recalled that from the time when Hannah Shines, being insane, was entered as a patient for treatment in the period of its humble beginnings made on Market Street, in 1752, to the present, is included the whole history of efforts made in America to ameliorate the condition of insanity, and the recognition of the study of insanity as a distinct department of medical science. 41 Dr. Andrew White (our new Ambassador to Germany) in his recent book, " On the Warfare of Science with The- ology," referring to the condition of the insane in England in the Sixteenth Century says, that " Shakespeare makes one of his characters speak of madness as deserving ' a dark house and a whip? At the end of the Sixteenth Cen- tury, Bethlem was reported loathsome for any man to enter ; in the Seventeenth Century, John Evelyn found it no better ; and in the Eighteenth Century, Hogarth's pictures show it to be what it had been in those previous centuries." Dr. White bears the following testimony that, " The first humane impulse of any considerable importance in this field seems to have been aroused in America. In the year 1751, certain members of the Society of Friends founded a small hospital for the insane on better principles in Pennsylvania. To use the language of its founders, " it was intended as a good work, acceptable to God." The improved and humane system of caring for the insane, now generally recognized in Christendom, has resulted largely from the recognition of insanity as a disease, and placing the insane under medical direction. In the accomplishment of this great work, which Andrew D. White pronounces " the final struggle and victory of science," the Pennsyl- vania Hospital must always justly hold the honored place as the pioneer. We know but little of the medical treatment of insanity during the first fifty years of its existence, for there was absolutely no guide or experience to direct. Insanity was not then regarded as a disease, but more generally recognized as a visitation, an infliction for sins, a demoniacal possession — a feeling which has strangely been 42 transmitted even to the present day, as seen in "child- fears," the awe and dread with which the insane are some- times regarded and a belief in demonism which sometimes shows itself. If the caricatures of Hogarth present truthful pictures of what he observed — whether made to excite pity or to excite indignation — they have a historic value, show- ing the condition of the insane in "Old Bethlem" in his day — so did the master, Benjamin West, reflect in his painting the sentiment of his day when he selected "a subject analagous to the situation" in 1800, the dawn of the present century. "It is the Redeemer of mankind extending His aid to the afflicted of all ranks and condi- tions." It must stand in all ages as an appeal to the highest emotions and sentiment ; awaken human sympathy ; and incite inspiration to consecrated acts. In 1806, came the first rational treatise on insanity by Dr. Thomas Arnold, followed by a similar work in 1808 by Dr. John Haslam. In 181 2, Dr. Benjamin Rush published a book entitled "Medical Inquiries and Observations upon the Diseases of the Mind," which was far in advance of the thought of his age. From this book we may infer that the practice of bleeding and general depletion, such as obtained in ordinary diseases, was applied to the treatment of insanity in his service, and so continued until near the close of the first centennial of this Hospital. During this long period there had been an accumulation of experience and observation leading to radical changes in the treatment and care of the insane in a directly opposite direction. For more than fifty years, depletion by bleeding and low diet have been abandoned. It is now recognized that sixty per cent, of our admissions have an origin in impaired 43 general health, and exhaustion of nervous force, to be best treated by a rapid restoration of the bodily health and the quality of the circulating blood to a normal state, with a result that the average duration of treatment and hospital residence of cured patients has been reduced ten weeks, with a tendency to a further decline. At a period when the researches of the laboratory have done so much to enrich every department of medical knowl- edge, it may be a pertinent thought to what extent this Hospital, with others, should enter a special field of inves- tigation, so fair, so promising of important benefits to man- kind, and yet unexplored. That the secret of the nature of vital force, and the complex operations of the human mind may be yielded by any exploration is perhaps beyond expectation, but the conditions under which these forces act, and may be best restored when impaired, are within the scope of proper scientific inquiry. That they are subject to some rules of action, or law, may be assumed by analogy, but the revelation of the hidden laws cannot be made mani- fest except through patient work on many lines, by investi- gations of the most technical character. It is not to be expected that any one centre of investigation will solve the intricate problems that are presented. It is the history of even' scientific advance and discovery that it is finally ren- dered possible only by reason of a great accumulation of knowledge — the result of the work of many observers. With the changes in the medical treatment of the insane other advances became possible. Mechanical restraints gradually disappeared. The doors of the Hos- pital swing easier in both directions. It is recognized that the insane have lost none of their legal or other rights, nor 44 are they less entitled to respectful and sympathetic consid- eration, by reason of their affliction. The directors of the hospitals are no longer wardens, but physicians ; the atten- dants upon the insane are not keepers, but nurses, and while at a period not remote in some places it was con- sidered necessary to employ men in women's wards, the white caps have found a place in the wards of men, there we trust to remain. On four occasions the friends of the Hospital have assembled to witness the placing of a corner-stone, and to show by their presence their approval of the proposed work. Now we are met to dedicate in a public manner to their several uses, not only this structure, but all of the buildings of the several departments of this Hospital which have been erected during this constructive and reconstructive era of the Hospital. We are here to commemorate the benevo- lent purposes of those, whether living or dead, through whose munificence it has been possible to erect and conse- crate these several structures to the use of the sick, injured, and the insane. We would at this time hold in precious remembrance the long line of friends and Managers of this Hospital, and those who in other relations have administered, guarded and advised about its material concerns as a sacred trust. If at times they have been confronted with financial prob- lems they could not at once solve, they have been rich in the faith that produces works, and have had the gift of persistence. I assume I do not make an inappropriate disclosure here in this assemblage of the friends of the Hospital, that a reference to the Minute Book of the Attending Managers shows no omission of the weekly visits 45 to the two Departments of the Insane since their establish- ment, and that in fifty-six years, 2,912 such visits and personal inspections were made — a written record of extra- ordinary fidelity to a trust. If it is an unwritten law that the living shall not be named, we can speak with gratitude of the special benefactions made to the department for the insane by Joseph Fisher, Mary Shields, and Isaiah V. Wil- liamson in past years, and the eminent professional services rendered to the insane of this and other lands by Rush and Kirkbride during a united service of seventy-three years. Following the memorable march of the procession that entered upon these grounds in May, 1755, to lay the foundation-stone, there began another procession of all creeds and nationalities, and of all social conditions, stricken with some one of the ills or calamities of life, and it continues to move thitherward with ever increasing numbers. To discharge in the present age, in a magnanimous manner, the responsibilities of a transmitted benevolence — which do not decrease, but from various causes increase with advancing years — is the problem constantly con- fronting the Managers of this Hospital. Let us strengthen their hands as we have heart and means in our day and generation, that this heritage may be preserved and handed down to those who follow us with a larger and better equipment for doing its appointed work. In this service, as in the past, men and women will come and go as the leaves of autumn, but may the God of our fathers, the "God of Mercies (continue) to bless the undertaking." 46 yd J UJ). HI " > r <_>.* j = Z- Or K &« J a' E i to V> z a i£ m m - 2-tQ° Ca 8 Q -5 » r .* .* a I 1-0=3 j r c a a *» «» «>- « o o * 4 n ps H 0. Construction of the Building. The architectural design of the " Garrett Memorial '"' is colonial, the details are classical and depend on mould- ings, from which sculpture is almost excluded. The building is 135 feet in length by 53 feet in breadth. The construction is mainly of bricks and iron. The amount of combustible, or easily destructible, material has been reduced to the minimum. The doors, sashes and some of the minor fittings are wood. The outer walls are double, with air space between the sections ; the partitions and floor construction are hollow bricks resting on steel beams, girders, and posts. The ward floor surfaces are hard wood ; the 1 lining of the stair well is enameled bricks, all other floor and wall surfaces are of hard plastic material, smooth surfaced and resistant of water and fire. The wall facings are of red bricks with door pieces and window trimmings of pink granite ; these apertures being disposed as symmetrically as possible. The visible roof is of light green slates, the cornice and a small cupola are of a copper color and match the stone courses. 47 TIMES PRINTING HOUSE PHILADELPHIA ■*%