Blockley days; memories and impressions of a resident physician, 1883-1884

BLOCKLEY DAYS

ARTHUR AMES BLISS

THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA

LOS ANGELES

Blockley Days

Memories and Impressions of a
Resident Physician

1883. 1884

Arthur Ames Bliss, A.M., M.D,

Printed for private circulation
MCMXVI

Copyright, 1916,
By Laura N. Bliss.

INTRODUCTION

It was in the winter of 1913, that my husband came upon his
"Memoirs of Blockley." He decided at once to rewrite and
revise them for publication. Every spare moment during these
winter months, in spite of not having been in his usual health.
Doctor Bliss spent in preparing this work. It seemed to give
him so much pleasure, that I repressed my feelings of anxiety
lest he might overtax his strength.

His professional duties had been especially hard during this
winter, and he gave himself unsparingly to the many who called
for help. These "Memoirs" had been just finished and been
typewritten, when God called him to his Heavenly reward.

The life of Doctor Bliss was an example of unselfish devotion
for the good of others, and of rare nobility of purpose.

To publish these pages is my greatest privilege.

Laura Neuhaus Buss.

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PREFACE

Humanity has been observed from many points of view.
The rich and great and fortunate of Earth have had their en-
trances and exits on the stage of Hterature. Great authors have
told of the lives of the lowly and depraved. Paradise has been
described; and classic writers have drawn and redrawn the
sunless world of Hades and of Purgatory. Even Hell need have
few surprises for any one who reads.

In the pages of this little book there is a candid, almost
photographic, account of life in a community of paupers, where
the members conduct themselves without any fear that fate or
the authorities can put them in any lower place than that in
which they have placed themselves. It is not the life of a
reformatory or of a prison. The almshouse is merely a receptacle
of the miserable and helpless, and, in Blockley, there are added
hospitals for the physically and mentally ill.

The book tells something of the life and habits of these
submerged citizens, and of the experiences and impressions
gained by one who went in and out very freely among them
in the peculiar and intimate relations of a resident physician.
It is a plain, direct statement of things that actually happened,
without any attempt to enlarge upon them or to soften the
blunt realism. And, between the lines, can be noted the effect
of this life and contact upon the journalist.

It is a grim story, not without some touches of a sad humor.
But it all happened ; and something like unto it has been worked
into the life of many a resident physician not alone of Old
Blockley, but of any great Cit}^ Hospital. So the little journal
is a small bit of actual history.

Arthur Ames Buss.
Philadelphia, April 20th, 1913.

Blockley Days

The life of a physician who has pursued his calHng within
the confines and surrounding country of a great city is so filled
with the incidents and details peculiar to his profession, that he
has little opportunity to review his career. He lives so entirely
in the present, that there are no spare moments in which to
look back and trace for footsteps in the sands of time. Such
sands are shifting. The footprints are shallow and faint, and
little would be gained by a search backward through the forgotten
years. But it happens, sometimes, that a narrow bit of trail
may have survived, and certain landmarks remained unchanged
by its way. There came a chance moment in the busy life of
a doctor now advancing into middle life, when the need for
certain notes of cases, in relation to a study of an obscure disease,
led him to hunt within old boxes and chests in a lumber room.
The reader would have little interest in all that such delving
amid relics revealed, except, perhaps, for the discovery of one
plainly bound notebook. When the Doctor unearthed this
small volume, a flood of memories seemed to spring into being,
and, for a moment, he was floated away upon a tide of time
that set him somewhat adrift from the real object of his search.
In his own handwriting, on the corner of this book, he read
the title, "Blockley Days. A Journal, September 1st, 1883 —
August 31st, 1884. 'So it's over the hill to the poorhouse.'"
It was indeed a forgotten trail; and the discovery of the foot-
prints recalled to the physician's recollection that he had been
an interne in Blockley Hospital, and that he had essayed to
keep a sort of diary, and that here was the very record of his
good or evil deeds unexpectedly facing him out of the dusty
corner of an old packing box. Blockley has undergone such

8

changes in the course of recent years, that these records of an
official life, passed there almost thirty years ago, must not
be applied to the institution as it exists to-day. The diary
has some historical value, as it describes the episodes in the
life of a resident physician of that period, in a hospital con-
ducted much on the general lines that obtained then in all
large city hospitals. But the inmates of that day might be
the inmates of the modernized and improved institution that
succeeded it; for human nature is the same as in the days
of Babylon. The tramp, the degenerate, the unfortunate,
the weakly good and aggressively bad are simply clad in the
rags and tatters of their especial time and place. Blockley's
guests are much as they were then and ever have been. The
administration, the methods of control and medical attention
have revolutionized the place so greatly, that none of the refer-
ences in this diary that relate to nursing and hospital details
can be applied to the institution as it is conducted to-day.
The very name has changed. No one spoke of the institution
otherwise than as Blockley. This name of reproach is now
lost in the modern title of the reformed and re-organized insti-
tution, "The Philadelphia General Hospital." The Almshouse
of Philadelphia, after having occupied several different localities,
was finally established on an extensive tract of farm land on a
narrow lane below Spruce Street, bordered on the east by 34th
Street, and extending to the Philadelphia, Wilmington and
Baltimore Railroad tracks along the Schuylkill River. Its
western limit was another picturesque narrow lane which
separated it from a bit of wooded ravine that formed a part
of Woodlands Cemetery. In old times all this district
had been a part of the extensive estate of Blockley, and thus
the large community of City Hospital, Hospital for the
Insane, and Almshouse derived the name by which it was
known, and to which a certain sinister meaning was attached,
on account of the maladministration in all departments.

and the general misery and wretchedness that became
a part of the lives of all who passed within its gates.
The buildings formed a vast parallelogram following the main
lines of the property and enclosing a large central courtyard.
Through the centre of this great open space a line of irregularly
built shops and storehouses extended, dividing it into two
great halves with a single, dark, gloomy passageway between,
while at either end of the yard arose lofty stone walls, with
two arched gateways and heavy gates in either- wall for com-
munication with the great north and south halves of the central
open courtyard. Thus divided, the northern half of the institu-
tion was for the accommodation of women, and the southern
half for men. The high wall to the eastv/ard separated the
yard from the buildings and ground of the City Hospital, while
beyond that to the westward were the extensive buildings
and grounds of the Asylum for the Insane. The lines of build-
ings between these eastern and western divisions, and the
great court itself, formed the Almshouse of the City of Phila-
delphia. Thus it will be seen that the Almshouse dominated
and overshadowed the City Hospital, which should have been
free from the associations which belong to this home for the
destitute and inefficient. So close, however, was the relation-
ship of the various departments at Blockley, that it was often
with extreme difl&culty that a poor but respectable man or
woman, when sick, could be induced to enter the City Hospital.
"Oh, Doctor! Don't send me to the Poorhouse!" It is indeed
a shame and disgrace that a hospital which should have been
regarded as a proper and honorable place of retreat for the
sick poor of Philadelphia should have been so burdened by
mismanagement and evil associations that no sick man or
woman sought its walls willingly. It was the last resort for
those who could not gain admission to other hospitals, or who
were absolutely friendless and penniless.

The great buildings of Blockley were of uniform construction,

10

having mastic covered walls of a dull grey color, three stories
in height, with a low, sloping roof. The main entrance, facing
towards an open stretch of fields that represented the farm
of the Almshouse, was a rather imposing portico of Greek design,
standing high above a lower story, in which the offices of the
institution were housed. One gained this upper terrace by
a flight of steps, passed beneath the arcade of columns, and
entered the main hallway, on one side of which the Superin-
tendent had his office, while a door on the other side led to the
assembly room of the Board of Guardians of the Poor, the
rulers of the institution and the various activities associated
with it.

This large and important governing board consisted of
many members who were elected to their office by the City
Councils. Each district of the City was represented among
the members of the board. For many years it had been con-
nected with the less open and honorable field of local politics.
Few citizens of sterling character or important standing in
the community cared to serve in its ranks, or could have gained
an election even if their candidacy had been proposed. The
board had a bad name. Somewhat caricaturing its manage-
ment and reputation was the oft-heard epithet which gave
it the title, "The Board of Buzzards." Among the earliest
efforts to reconstruct and improve the City was a determined
effort by a small group of able and honest members of the
City Council to elect better men on the Board of Guardians
of the Poor. A few men of worth and prominence in the social
and financial affairs of the City were persuaded to stand as
candidates for election. It was a hard and bitter contest in
the Councils, but the better elements of those bodies combined,
and filled a few vacancies on the Board of Guardians with
these gentlemen of good character. Many improvements to
the institution were effected by the work of these new members
assisted by their friends in the City Councils. One change

11

of importance was the appointment of resident physicians for
Blockley by a fairly conducted competitive examination, in place
of the old system of appointment through personal influence.

It was a dark, sultry day, the first of September, 1883,
when a certain young, inexperienced, and somewhat anxious
youth, who had gained the degree of Doctor Medicinae, and
had won his right to an interneship in Blockley by the first
competitive examination held for this position, took his way
over the Chestnut Street Bridge across the Schuylkill River
and turned into the pleasant shaded lane that extended in
front of Blockley.

The farm fields sloped gently down towards the river from
the left side of this road. The trunks of the trees that bordered
the lane were covered with whitewash. The sidewalk was
of wood, and gave such a hollow reverberation to the youth's
feet, that there arose a disturbing notion in his agitated mind
that all Blockley must hear his coming, and every prospective
patient be called to the long rows of windows to observe his
approach. Far away over the river was a nondescript mass
of old factories, railroad tracks and bridges, and the green
foliage about the buildings of the Naval Asylum. The City
had a sort of tag-end appearance from this view of its more
southern portion. A break in the long line of grey buildings
was closed by a high wall through which was a wide-arched
gateway. Above this, in black letters on a band of white, was
painted the title, "Philadelphia Hospital." In the hospital
ambulance the young doctor was to pass in and out of that
entrance very often in the months to come, at all hours of the
daj' and night, going forth for or bringing back paupers, sick
people, and sometimes unfortunate victims of mental disease in
every degree of delusional wealth or misery.

Knowing nothing of what lay before him, the young medicus
reverently ascended the entrance steps as to the shrine of
iEsculapius, passed beneath the somber portals of Blockley, and

12

became one of the denizens of that strange community that,
in a sort of microcosmos, represented the misery and goodness,
the meanness, the brave endurance, the cheap deceits, the
vileness and degradation of the whole great world.

It is surprising how quickly one finds his place in the order
and discipline of life in a great hospital. The very green young
doctor, in a state of anxiety and mental mix-up as to his ability
to meet the unknown that faced him in the wards, who doubted
that he might not sin from ignorance daily, and be an agent of
death instead of health, found very quickly that his errors were
unknown, unnoticed, or nonexistent. The faces that peer out
at him from the long rows of beds soon cease to shock him with
imagined expressions of distrust, contempt, or fear. His col-
leagues of the resident staff give him friendly hints and helpful
suggestions. The grave medical or surgical chief treats him
with a kind consideration that combines the manner of a father
and older brother. He feels the unconscious support of the
great organization of which he is one of the units, a soldier in
the little garrison. The events of each day confirm him more
and more in the methods of thought and the ethics of the splendid
guild that has received him as a member, and to which his
loyalty and enthusiastic devotion are due for all the years of
his life. The oath of Hippocrates, seldom pronounced in words,
is moulded into the young doctor's habits of thought by the
precept and example of his associates. For truly can it be said,
that among no class of men is the earnestness of their calling
more expressed in their lives and associations with one another
than among a community of physicians. There is a wholesome
boyishness in the mental make-up. There is no pretense that
they are models of piety. In the great army to which they belong
are deserters and camp followers, but those of the rank and file
are generally true to the responsibilities of their great trust.
Like Chaucer's clerks gladly will they learn and gladly teach.
With a modest acknowledgment of the vastness of the dark

13

unknown about them, physicians have hopefully looked forward,
through all the ages, for more light, more light. In a time when
idealisms are dulled in the greyness of a materialistic philosophy
of life, it is still the physician who rejoices to spend and be
spent in the pursuit of scientific truth, who values his life cheaply
in the struggle with ignorance and disease, whose compensa-
tion is more often found within his conscience than in bank
cheques or coin of the realm. In that glorious army of saints
and martyrs, sung by the Church; those who have borne
testimony to their faith and have been faithful unto death,
there are few physicians; but surely another group of martyrs,
they who have perished in the struggle against error and the
unknown, who have lost their lives in the conflict to tear the
veil of mystery from disease and let in the sunlight of knowledge,
the unhaloed army of martyrs for science, should have their
meed of praise.

Without any direct instruction in ethics, the young medicus
is involved in a social order that honors these traditions of the
past and the heroes from the history of his profession. Thus
the young and self-doubting interne, in the unconscious influences
of his surroundings, as well as the direct instruction of his
colleagues, begins to acquire confidence based on experience.
The medical instinct, that specialized combination of sense-
perception and the reasoning faculties in relation to the various
phenomena of disease, begins its development, and the young
medicus finds himself.

The Board of Guardians possessed a City office building on
South Seventh Street. It was an old and dilapidated dwelling
house, in no way rebuilt for office purposes, but simply made
available by the most limited supply of desks and chairs and
benches placed in parlor, dining room, and bedrooms. In what
had served as a parlor, on the ground floor, was housed the
bureau for arranging the proper payment and collection of
money in cases of illegitima^ie children, born at Blockley. It

14

may have had other duties, but complaints and inquiries in
connection with the consequences of infringement of the seventh
commandment were always in progress on the occasions of my
visits. Above, in what had served as the best bedroom in days
of family life, the "second story front," was the office for receiv-
ing and examining applicants for the Almshouse itself and for
the hospital. The medical examination was conducted by
a Blockley resident physician. One of our staff was in attendance
daily, for a few hours each morning. The examination in
regard to social conditions, destitution, and inability for support
was made by the Secretary of the Board of Guardians or by
the House Agent of Blockley. It must be confessed that the
young medical man was too often disposed to be sarcastic,
cynical, suspicious, and anxious to drive away every applicant
who did not bear in his or her body the symptoms of being an
interesting medical or surgical case. On the other hand, the
two lay officials, men long trained to their duties, were most
patient and reasonably sympathetic. I never heard either of
these men say an unkind word to the wretched, broken men and
women who applied for shelter within the walls of Blockley.
Not infrequently when I had dismissed an applicant with a con-
temptuous statement that the poor man or woman was "not
sick enough" to be admitted to the hospital, the Secretary or
House Agent, whichever one happened to be officiating at the
desk, would find some excuse for admitting the subject to the
Outwards — the Almshouse Department, — or would mildly set
aside my verdict and make out a pass for the hospital. Having
obtained such a pass, the miserable citizen of the underworld
would start on the long journey across the City and over the
Schuylkill by one of the bridges to the haven of rest for the
poor and sick. So a thin stream of outcasts took its way daily,
through the cold, the snow or melting slush of winter, or the
summer's torrid heat, among the busy shoppers of Market or
Chestnut Street, past the great stores and amid the rushing

15

traffic, each with the precious bit of paper that meant shelter
and somewhat of a home. Many of the sick must have spent
long, bitter moments on the way, with frequent rests on door-
steps or against railings or on the curbstones of the street. It
would have been a vision for an artist to have depicted this
long, struggling line, as wherever in this sad world of ours the
weary and heavy laden have journeyed, led by the Man of
Sorrows, with His patient face of infinite compassion, bearing
His cross and going on before. The lowest of the earth are in
that line, outcasts and beggars and weaklings; nothing noble
is there, nothing heroic; only sickness and hunger and longing
for some place of refuge.

It is in this very Seventh Street Office that the scenes of the
diary have their beginning, for the first report in that old book
is entitled —

"A Gentleman Gone to Seed.

October 23, 1883.

"At the Seventh Street Office, a few days ago, I came across
a queer example of whiskey- wreckage. The last applicant for
admission was an unsteady, red-nosed, dejected-faced, white-
haired old man who slunk into the first chair near the door.
I asked him what his trouble might be this morning, when to
my surprise he answered in the refined tone of voice of an
educated Englishman. He wanted shelter; was afflicted with
a variety of complaints all of which narrowed themselves into
the syndromes of drunkenness and poverty. During the
citations of what he was and what he wished for, he quoted from
several Latin authors. I learned that he was a graduate from
Eton, that he had taught in the Cathedral School of Exeter,
and that he had been a teacher in this country. His weakness
for drink caused him to lose every position he had held, and
now an outcast he dragged himself from the gutter and begged
for admission to the Almshouse. We decided 'to send him out,'
which means, he obtained his pass of entrance. The Warden

16

took pity on him and allowed him to spend the days in his
office doing some nominal work, for the old fellow is lazy.
Although he will talk for hours about his necessity to find some
occupation, so as to fill his mind and keep out sad memories,
still, when any real work is supplied, he seems to prefer the
memories. He is a real old Micawber. A few days ago he
told me in a most independent manner, as though his coming
hither had been a matter of pure option on his part, that, 'A
few more days will decide me whether to remain here longer
or go elsewhere. My mind must be occupied. I find it very
hard to put up with the profanity of this place. My dear sir!
There is nothing for which I have such a violent aversion as
for the hoi polloi! I wish much to ask you a question. Can
you inform me as to the necessary steps for me to take in order
to obtain a piece of castile soap?' He had already asked me
for a copy of Thucydides. He spends much of his time in
composing ingenious sentences in Greek and Latin which give
the same meaning when read backward or forward. He is
the saddest object on earth, a gentleman gone to the devil.
He has the intellect, sensitiveness, and the exclusive traits of
a scholar, and yet with these he has the slavery to drink which
has brought him to the level of its other victims here, most of
whom are of the opposite social scale to which he belongs. What
a place of decay and death this is! It reminds me of the Ox
Bow in the Connecticut River. The broad, deep river flows
on, but into this back stream drift the deadwood, scum, withered
leaves, floating corruption; and there they drift together swirl-
ing around in the sluggish current, sinking to its muddy, oozy
bottom, never again floating out into the open stream. Hope
gone! Ambition gone! Yes, the very sense of shame van-
ished!"

"Arrogant Guests.

October 24, 1883.
"What I am unable to understand, or rather what con-

17

stantly surprises me, is the degree of arrogance which the
inmates of this place develop during their sojourn. I have seen
men who have come here as a last resort, actually picked up
out of the streets, who after a few weeks' stay develop all the
selfishness and overbearing manners of one born to every luxury
that wealth supplies. They order the nurses about as one
might speak to slaves. They complain of the slightest dis-
comfort. They anathematize the food and cooking, both of
which are far superior to any they have known for years. The
only individual of whom they stand in awe is the doctor, for
he has the keys of a heaven or hell, and can allow them to rest
in sheltered ease or send them forth to experience winter and
cold weather in the streets. And I must confess that it is
almost a pleasure to me to 'come down heavily' on such men
as these. In some cases there must be a limit to long-suffering."

"Cadaverous Charlie.

October 31, 1883.
"There is a man here named Charlie. He has charge of
the green-room or green-house, both of which are the local
terms for the post-mortem laboratory, or dead-house. Charlie's
entire time is devoted to work upon the dead. He is present
at the autopsies, sews up the incisions after examinations, and
takes measures to preserve in glass the various specimens which
are to be kept in a sort of alcoholic immortality. He is a well-
built, broad-shouldered, and cheerful-tempered German, and
is quite an anatomist. He never estimates a man, either living
or dead, by his face or reputation, but judges of his worth by
considering what kind of a skeleton he would make, if the
fortunate opportunit)'^ offered. A stranger at once excites his
notice, and he exclaims, 'Mein Gott! Vhat a vine skeleton dat
man vould make!' Or, it may be that the whole ensemble was
below standard, and that the skeleton would be a frank failure
and unsatisfactory. He has fitted up a neatly made bracket

18

on one \vall of the post-mortem room, and here the severed
head of an insane negro rests, which Charhe had embalmed
and prepared with tender care. In its way it is a work of art.
The ghastly ornament has painted eyes, made from paper and
fitted between the eyelids, giving quite a satisfied and friendly
expression to the face. A pair of femurs are crossed behind
the head, and the whole makes a most horrible ornament for
this place of death, but evidently brings much satisfaction to
the cadaverous mind of Charlie.

"v. has gone off in the ambulance to-night to bring back an
insane woman to the hospital. I was to have gone also, but, as
Donovan's arm was amputated to-day, the Warden thought
it best that I should be on hand in case of trouble. So M. has
gone in my place. They will have a rather moving experience,
as the woman is so violent that her husband dares not enter
the house."

It would be difficult to-day for any one to conceive of hospital
work without the efficient services of the trained nurse. Every
institution has its school for nurses, in which young women of
good character and a very fair degree of general education are
instructed, employed in the service of the hospital, and grad-
uated after having pursued the full course and passed the pre-
scribed examinations. So valuable and essential are the services
of these nurses that no satisfactory result in medicine or surgery
could be obtained without their aid.

The Blockley of 1883 had no trained nurses. Each depart-
ment had an official called the Head Nurse. These officers
were men or women appointed by the Board of Guardians and,
in most cases, prot^g^s of some one member of that board.
Their skill in the art of nursing was not so much considered as
the influences that placed them for nomination and their ability
to keep order in their departments after appointment. The
acting nurses for all wards were simply convalescent patients

19

who evinced some aptitude in carrying out orders, and who
received a small compensation in money for their imperfectly
done work. Among such convalescents there would develop,
from time to time, some man or woman who seemed to have
a natural instinct for the required work, and who dreaded a
plunge again out into the world beyond the high walls. Per-
haps without any valuable friends and with little ambition,
such individuals had acquired a species of "Blockley habit," and,
until they wearied of the place and work, were content to live
on and labor in its wards for mere bed and board and a nominal
wage. Among such as these were found the assistants to the
Head Nurses, sometimes rising even to the dignity of night
nurses.

It was a strange, irregular, untrained force, the members
of which not infrequently fell from grace by returning drunk
after a day off in the City, or who wandered back to their old
associations and ways of life. In the office we had a very
intelligent gentleman who had been a volunteer clerk for several
years, because within the walls he was able to remain sober,
but, once outside, would mean drink, drunkenness, and delirium
tremens. Of course our main officials, the Superintendent,
Chief Clerks, and members of the administrative staff, were
men of character and efficiency.

Among our comparatively untrained head nurses were men
and women of line instincts and good judgment. Although
most of them belonged to a class of individuals fitted for domestic
service rather than for the management of hospital wards,
we had some who won and held the affection and respect of
every resident physician of that day and generation. Mr.
Smith, the white-haired, clean-shaven, and fine-featured old
man who was chief nurse of one of the departments of the
surgical wards for men, was a splendid character. This really
fine old gentleman would receive the wild, raw, young internes,
in his neatly kept office, with an air of kindly deference and

20

quiet dignity that commanded respect. Doubtless his long
experience in practical work had given him a better knowledge
of the needs of our patients than the interne had gained from
his college training. Everybody loved Nurse Owens, the
amiable, patient, and cheery head nurse of the medical wards
for men. A rather fiery and energetic character, well fitted
to be first mate on a sailing clipper, ruled the surgical wards
for men. He had lost one leg, and the slightest disturbance
in any of those wards would be attended by a rapid and energetic
stumping through the corridors, as the leg and stump came
swinging in hurried rhythm, and rebellion was hushed by a
quick sharp command. There was an impression given that
all our hospital officials had been through more or less interesting
history, that there were backgrounds in their lives. The women
nurses were not so able or of such decided character as were
the men; and yet, considering the methods of appointment
and the imperfect training for the responsible positions, it
is much to be wondered at that the general work and the order
of the wards were so well maintained. This absence of trained
nurses threw much more responsibility upon the internes than
is now the case in any hospital. We did all the surgical dressings,
and were forced to oversee very closely the details of the nursing
itself. Of course there must have been terrible negligence
and oversight. During the long hours of night duty there was
no one to superintend the work of the untrained, unintelligent,
and far from zealous workers. The books for night orders
miight be most carefully written by the interne, with dosage
and hours detailed for medicine and feeding, yet who could
tell that the attendants did not eat the food and drink the
stimulants themselves? The patients may possibly have
received the medicine. It was a time when much reliance was
placed upon alcohol, in all exhausting fevers. Our patients
were of a class that knew whiskey and valued it highly. They
were apt to know when it was ordered for the night, and their

21

insistence on receiving their doses, and fear that they would
report to the doctor any failure in this attention, probably
deterred the night attendants from consuming all the supply
that was ordered for distribution. But the patients recovered
in very fair proportion, and it must be acknowledged that
the rank and file of our poorly trained helpers took interest
and even pride in their share of credit for the good results.

"A Martinet,

November 13, 1883.

"Nurse H. is a remarkable character. He ought to have
command of a crew of pirates. His abilities are really lost
in this relatively law abiding community. He is of large size,
possesses the strength and gentleness of a blacksmith, and,
although thoroughly good-hearted, is obsessed with the idea
that all patients are prisoners and are to be treated accordingly.
Conscientiously faithful in duty, he believes in maintaining
a high ideal of dignity. I am sure that he is annoyed that I
do not assert myself as Allah, and then he could figure as my
prophet. When I appear at the door of the ward, Nurse H.
always stops his work, strides to the middle of the room, glares
about him with an expression of great threatening, and calls
out in a powerful voice, — 'Silence. The Doctor's in the ward!'
This is a nice direct way of giving a timid medicus a due sense
of his importance. To-day he interspersed strictly professional
notes with accounts of our patients' misdoings. 'Bed No. 5
over there's been at it again; hidin' chunks of steak under
his mattress and eatin' of 'em at night. Bed No. lO's took off
his dressin's. Bed 14 tried to rub his wound sore.' This
latter performance is not infrequent when a convalescent patient
fears that his recovery means a few days of work or immediate
discharge from the hospital."

In the days of the diary surgical cleanliness or antisepsis
was unknown. The operating room was the wooden-floored

22

arena of the great lecture amphitheatre. The operating table
was of wood. The entire furnishings of this great room were
of the same material. No sterilization of instruments or dress-
ings was attempted. The surgeons and all the assistants wore
their ordinary street or house costume. The residents were
clad in their uniforms of blue and brass and gold bands and
stars, which were supposed to be a copy of the uniform of a
surgeon in the Navy of the United States. Usually, one suit
of uniform sufficed for the entire year of service, so that it was
far from surgically clean. If an instrument chanced to fall
on the wooden floor, it might be quickly wiped with an ordinary
towel and immediately put to further use. The dressings
were of an ancient system of surgery, bearing no resemblance
to those in use to-day. One of the visiting staff who had just
returned from London, where he had seen something of the
work of the great Lister and his assistants, attempted an imita-
tion of the rather complicated dressings used by that great
man, but his colleagues smiled forbearingly and continued the
old wet and open treatment and had a horror of a dry wound.
Nothing healed by first intention unless the intention of the
operator was thwarted by a kind providence, and good luck
won in spite of our efiforts. Strange as it may seem, however,
most of our cases recovered after a long, slow process of healing.
The operative work was of a simple character, as the wonders
of modern surgery could not have been dreamed of under the
methods in vogue in those days. The most important public
clinics were held on Saturday morning, and the medical and
surgical chiefs selected their cases for demonstration with
reference to that great day. There is a reference made to
such a clinic under a note in the diary entitled

"Anderson, the Bum.

November 19, 1883.
"'This,' said Nurse H. stopping before a cot on which a

23

new patient lay, 'is Anderson, the Bum.' Anderson, surnamed
the Bum, opened his grey eyes and looked at Nurse H. with a
glance plainly indicating malice, but which changed almost
immediately to a look of lazy indifference. Upon the face of
Mr. Anderson, life had clearly printed the hieroglyphics of
laziness, courage, humor, and cruelty. It was battered, weather-
beaten, and seamed with ugly scars; and yet the head was
well-shaped, with a broad, almost intellectual forehead. There
was a strange mingling of gentlemanly refinement and brute
coarseness. The man's figure was massive, with broad shoulders,
large chest, and good length of limbs. Anderson's advent
in the ward occurred several days ago, and I have had an oppor-
tunity to develop considerable interest in the man socially as
well as professionally. He has been an inmate of the ward
before, and is well known to several of our other guests, whose
glee was manifest, as they anticipated that the ennui of the
ward was to be relieved by the appearance of this jolly devil.
As our newly arrived bum, however, has an abscess of the
liver, and is in a very weak condition, his social qualities will
not appear to their best advantage and add happiness to the
ward. Dr. P., our chief surgeon, selected him as a case for
operation at to-day's clinic. As Anderson watched me yesterday
in my attempts to adjust his mattress, so as to make him less
uncomfortable, he remarked in his slow, lazy voice, 'Say, Doctor !
You're taking a deal of trouble for nothing. I don't feel a
bit grateful for it all; and say, you know, I'd a deal rather
be let alone!' I told him, in reply, that the expression of grati-
tude would be so entirely beyond the line of our hospital
experience, that its exhibit would come almost as an unpleasant
surprise.

"The man must have an interesting background. I can
learn absolutely nothing about him, except that he has been
an inmate of this hospital on several occasions, when he has
made considerable trouble in the ward.

24

"He was v/heeled into the operating room this morning.
In the great amphitheatre, the circling rows of seats were crowded
with students, tier above tier, until, to one standing down in
the deep arena, the very air above seemed filled with eager
faces. The patient lay on a high, revolving, wooden table
in the centre of the arena, and was clearly displayed in the
light which streamed from the skylight in the lofty roof. Close
by stood Dr. P., knife in hand, lecturing to the students in
his rather stagely manner. On either side, each in his proper
place, were grouped the resident physicians. I face Dr. P.
on the opposite side of Anderson, as the chief assistant, and
in the background stand a few nurses. Everything is calm,
systematic, almost druidical. There is a breathless hush and
the light, sweet, sickening odor of ether fills the air. 'Gentle-
men, the next case v/liich we now bring before you,' says Dr. P.,
'I have explained already, and the operation will now proceed.'

"Well, so it is here on the clinic day! But the students
vanish. Dr. P. goes home, or to patients, or to another operation,
or to the opera, or to a banquet, and we poor devils are left to
fight out the after-treatment, which is a good deal more of a
work than the drama of the knife."

"The Story of a Night Watch.

November 27, 1883.
"Edmunds was operated upon last Saturday for excision of
the right hip joint. He is a strange combination of meanness,
wickedness, low cunning, and moral cussedness inherited or
acquired. His father was a criminal; his mother not much
better. He has been in two different prisons for long terms
of confinement. The unfortunate being certainly has suffered
horribly, and would arouse every one's sympathy did he not
also call up feelings of utter disgust for his character. His
last day on earth came very near to being that of the operation.
It was in the clinic room. We commenced at about half after

25

eleven o'clock. It was almost four in the afternoon before he
was placed and finally fixed in Bruce's splint. Dr. P. thought
that he was dying, but we managed to move him into an empty
ward and there, after long working with whiskey, ammonia,
strychnia, and, later, beef tea and milk, he was at last brought
into a sort of working order. I spent the night with him, as
it was out of the question to trust to the tender mercies of a
mere watchman.

"It was a strange and long to be remembered night. I
had been busy in the ward from half after eight o'clock that
morning, and had failed to get any dinner on account of the
unusually long clinic. Edmunds had been moved into a large,
barren, square room with board walls without plaster and
worn or stained to a dark mahogany color. My patient, propped
up with pillows, lay on the operating table from which he had
been too weak to be removed. Above his head, high up, a
single gas jet threw down a feeble light on his pale, emaciated,
pain-marked face. A storm had arisen, and all night the wind
moaned about the buildings, rattling the window sashes with
sudden gusts. There was a bright fire in the stove, the only
cheerful object in the room. Around the walls and placed
above spaces once occupied by beds, were many tin frames
containing cards which noted the bed numbers and the names,
ages, and diseases of patients who had long since gone back to
life and work, or perhaps, instead, to the Potter's Field or
dissecting table. They looked to me like memorial tablets,
raised to the departed. The ward had been unused for some
time, and numerous rats had established a colony in its walls.
Here I sat until almost four o'clock in the morning. Slowly
the hours passed by, marked by the solemn tones of the hospital
clock. Edmunds would awaken occasionally from a troubled
sleep, groan, make some incoherent exclamation, take what
was administered, and again drop ofi" into a semi-conscious
state. Otherwise, everything was very still, except when the

26

wind blew in gusts against the windows, or the rats scuttled
about in the walls or flooring or squeaked in the wainscoting.
Suddenly came a visit strange and unexpected. It must have
been near midnight. Edmunds had been restless but was
sleeping quietly. I sat before the fire thinking of the room's
history. How much pain and agony those walls had enclosed!
How much suffering each poor wretch drifted hither on the
tide of life represented, even outside and beyond himself, the
suffering he had caused to and received from others. A sound
seemed to creep into my train of thinking; a sound distinct and
real, yet vague and far away; a rushing, whirling sound as of
something flying, hastening on rapid feet that caused no footfall
but the rush and gliding shadow of a sound. The door of the
deserted ward opened into a long, dark entry. Into the upper
end of this passage the sound seemed to enter. It was louder
now and growing nearer, the pattering of hurrying feet that
scarcely seemed to touch the floor. Suddenly a piercing shriek
arose, loud, wild, and full of utter woe, a shriek that seemed to
embody the suffering of a lifetime and of an eternity beyond.
The cry rang out shrill and clear, and a something fell violently
against my door. Then the night was still again. Edmunds
had not awakened, so I went to the door, opened it, and beheld
in the thick darkness of the entry, as it were sunken in the
darkness itself, two glaring, fiery eyes. Edmunds had frequently
remarked to me, that, when his time came to be carried to the
dead house, whither he had seen so many borne during his
long illness, that the Devil would at once take his soul to the
underworld or shadows. Had the Evil One come to claim
his own? I threw a piece of coal at the Evil One and the fiery
eyes vanished ; but a light, galloping sound, as of a cat in extreme
haste, was apparent and grew fainter into the remote distance.
I closed the door and sat down again by the fire, but I was
soon conscious that something was in the room that had not
been there before. Seated by the stove and looking up into

27

my face was a small grey and black streaked cat. Evidently
it had been in company with that evil thing which had flown
away up the entry. With me it was in better company, and
I was glad to have its society for the rest of the dreary night.
At one o'clock in the morning a watchman arrived with my
lunch, which consisted of a very large bowl of coffee, Irish stew,
and bread and butter. The cat and I agreed that it was a
pretty good lunch and timely. At length half after three
o'clock was reached, and the watchman whom I had chosen
put in an appearance. It was sweet to get to bed; but oh,
how short and sweet! For soon Sam's horrible voice announced
at the door, 'Half past seven, Doctors; half past seven; half
past!' The work of another day was begun."

"By the Way.

December 2, 1883.
"V. has departed homeward, having received a letter that
gave news of his father's sickness. The attack seems to be a
severe one of quinsy, and my energetic roommate has hastened
home with his mind filled with ideas to meet any eventuality.
I thought that he had discovered every possible method of
treatment needed for any complication, but I came upon him
suddenly, at the last moment when he should have been well
on his way to the railroad station, reading up the subject of
Feeding by the Rectum. The medical talent of the town will
be startled when Dr. V. comes on the scene in his present state
of mind, and with the armamentarium that he is prepared to
set into action. To-day was Sunday, a busy one, and as little
like my old-time Sundays as day is like night. Sunday has
been a variable day in my experience. The time has not long
passed since it was the cloud and bugbear of my infant life.
Dreaded from one week's end to the next, the fact of its existence
and regular coming hung like a pall over my youthful hilarity.
The day became less trying as years advanced. To be sure, I

28

had to read 'Barnes' Notes,' on Sunday afternoons, and the
Notes of Barnes and those Sunday afternoons were painfully
long. But then, barring Barnes and his Notes, the day was
not wholly unpleasant, for it was judged that I could go out-
side the door of the house into the open and yet not sin. At
Princeton the day was the pleasantest one of the week. It
was after the long walks of Saturday afternoon. We had no
work, and we did have a fair dinner, followed by a supper rather
more choice than usual. During medical student days the
great day became truly a Godsend, for it brought the only
rest of mind afforded an overworked candidate for the degree.
During its passage we could throw physics to the dogs and
have some freedom of thought and action. And now the
busy life here reduces the day to the standard of work required
for all other days. But there is yet a difference, though I know
not what it is. Something in the air, in the sky, in all instincts
and memories, unconsciously and subconsciously at work,
announces that this is Sunday; and from far away beyond the
walls of the Almshouse comes the sound of ringing bells."

"Work in the Dead House.

December 10, 1883.
"Edmunds died last Tuesday. An autopsy was held on
his body last Thursday afternoon. I did the cutting. Dr. P.
had sent out word that he wished the entire pelvis and the
diseased femur removed and sent to him for his college museum.
So, after the post, I commenced the operation of excision of
the pelvis. It is quite an undertaking, and the day was well
advanced into the late afternoon. Daylight is short now.
There is no means of lighting the dead house except by candle
or lantern. Finally Dutch Charlie, the last helper available,
went off to his supper and I was left alone. At the upper end
of the long table lay all the recognizable parts of my former
patient. His face, deeply marked with lines of pain, was quiet

29

with the rest which had come at last. His eyes, wide open,
had the far-away blank gaze of death. It is an indescribable
stare, as though the dead man saw far off something for which
he had long been searching, and was satisfied. And in the
face of this poor crime-possessed pauper there was a touch, a
shade of expression, which seemed reflected from some former
time when he was a child and innocent. I could see this, because
I had worked over him and watched so long. Yet one who
had been present that afternoon had exclaimed, — 'What a
villainous face!' What would he have said if he had seen
Edmunds at his worst! It was getting dark. I could hardly
see to place my knife. In one corner of the room, leaning
against the wall, was a roughly made, unplaned coffin with
shavings for a pillow. In this the mangled remains of what
had been humanity was to be carried to the Pit or Potter's
Field, and there hidden away under the ground.

"Along the walls of the room on shelves were large glass
jars containing impossible babies or specimens of various organs
gone wrong by disease, and, from a nail fastened into the side
of a grey-painted, greasy cupboard, hung a dangling mass of
leather and metal charms, tarnished, stained with filth and
wear, that had been taken from many bodies posted in this
clearing house. I say clearing house advisedly, because here
the truth comes to light. A learned professor may have
diagnosed a disease while the patient was still under treatment.
He may lecture learnedly and eloquently upon his diagnosis
to crowds of wondering and note-taking students; yet the
observations held in this room may prove that the professor's
bad organs were good organs, and that the good were all bad,
and that there was no more health in the diagnosis than in the
patient. Through an open door that admitted to an outer
room, placed on rudely made trestles, could dimly be seen a
row of coffins, many of which were already filled while others
were yet waiting for their occupants. Such is the dead house.

30

and here I labored in the moonlight aided by two candles, until
the unpleasant work was finished. Then Charlie arrived
with additional candles, in time to place the removed bones
in water and clear the debris. I had intentionally left the
body in such a condition that the parts could have been replaced,
skin and flaps sewed up, and the whole would not have presented
such a very bad appearance. But there was no need of this
care for Edmunds' clay; his friends long ago lost to him; his
family, criminals themselves, indifferent as to his fate; not
even a dumb animal to care for him or mourn his loss! All
that remained was soon accomplished, and he has found rest
at last, after his twenty-five years of tossing and stumbling
and suffering through his vagrant and criminal life, in the ash
heap of the Potter's Field."

"Some Good Ones.

December 20, 1883.

"A pleasant change from Edmunds is Daniel C, a boy of
sixteen years of age, who came to Ward No. 3, Men's Surgical,
about nine days ago. He is from a rough country, Schuylkill
County, a mining district, where his occupation was to drive
mules in connection with the mining operations. In spite
of the ruggedness of his surroundings, his disposition developed
into a combination of gentleness, patience, and sweet reason-
ableness that is rarely to be met in this house. Every one in
the ward likes the boy, even the roughest and toughest, and
all are willing to help him in such way as is possible. I have
not yet had a patient in whom I have felt so mmch personal
interest. But the poor fellow has no prospect of recovery. He
has a tumor almost as large as his head, which is growing from
the back of his neck, infiltrating the surrounding tissues and
extending into the carotid region of both sides. It is a small
round cell sarcoma of exceptionally rapid growth. * * *

"The boy never complains. He is perfectly satisfied with

31

everything about him and is always cheerful and brave. Some
of his relatives who live in Philadelphia come to see him occasion-
ally, and, this evening, it was my unpleasant duty to tell one
of his family that there was little hope that the boy could live,
except for a very short period. It is a rare picture and a very
pleasant one to me, this little glimpse that I have had of what
was evidently a very pleasant home life. The people were
all poor and compelled to work. My patient was the oldest
son and did much towards the support of the family in which
each member was doing his or her part. He was able to earn
about thirty-five dollars each month. Always at home after
his work was finished, he spent the evenings reading books that
would give him some start at an education. He was entirely
different from the men and boys of his mining town, but is free
from all priggishness or the peculiarities that we associate
with the victims of *early false piety.'

Another good patient for whom I feel much interest is
Henry G. During Edmunds' last days G. watched by him
constantly, enduring with patience his complaints, curses, blows,
and bites, and did all in his power for the patient's comfort.
He has a thin, dark, sad face which itself speaks of a history,
but of this I know nothing except that he has served in the
United States Navy and is a native of Salem, Mass. I did
not learn that he was a fellow Yankee until a few evenings
ago, and naturally my interest in him was increased. He
makes a good assistant in the ward, does his work faithfully,
and is always anxious to be of help. C. and G. and a few
others are as rare gems amid the mass of human rubbish
which lies in and about this place. It is a pleasure to work
for such as these, and to try to give them relief. One
feels that sympathy is not thrown away. Of course we work
for all alike, but it is hard to worry and toil over a man who
would pick your pocket, if he had the chance, or who might
break your head if there was any cash in the undertaking, or

who rewards your efforts with false and servile flattery that
has no true-heartedness in it and cannot be taken seriously."

"New Year's Eve.

December 31, 1883.

"New Year's Eve to-night, and to-morrow is 1884! Now
for turning over new leaves, making resolutions, signing pledges,
taking vows! With me the greatest change that the New
Year brings is the fact that I 'go off the surgical' and 'go on the
nervous.' This will be a relief. Too much night work now.
I was up all of last night until three o'clock in the morning,
and am to be called at three o'clock to-morrow morning, New
Year's Day, to relieve my colleague V., who is now watching
by my man of last night. I ought to be expressing fitting
sentiments for the 'ringing out' business, but will go to bed and
sleep through the change of years."

"A Night Ride on the Ambulance.

January 7, 1884.

"The night of January 6th was bitter cold. Outside, an
icy feeling was in the air. One's breath froze as it left the
face. A splendid fire burned in our stove and the room had
an unusually cheerful and at-home appearance, in contrast
to the manifest discomforts that existed beyond the walls.
A knock came at the door. 'Dr. Bliss. Ambulance, Sir!' There
was no escape. The only thing to do was to bundle up as
warmly as possible and go forth into the cold, cold night. It
was bright moonlight, and the stars shone like vivid dots of
fire snapping in the clear, open, purplish-black sky; a typical
clear winter night, when the snow creaks under one's feet and
one can almost see, as well as feel, the cold. Passing through
the front offices I found the ambulance waiting for me by the

33

entrance. 'Where to?' I asked, 'and on whose order?' 'Oh,
it's from the Central Station! We've got to go to 4 N. Front
St.' Small comfort the driver's reply gave me, but we climbed
in, and away. It was a long ride, down Chestnut Street, lighted
by its electric lights. The pavements, usually so crowded, are
bleak and deserted on this cold Sunday night. We have the
track pretty much to ourselves, except when the rapid pace
of our horse brings us up behind a street car. Bong! Bong!
goes our bell. The car stops. We turn off the track and
jolt heavily over the stone paving covered with icy mounds of
snow. Heavily again we roll on to the track, and once more
away, flying onward as fast as the strong, fast horse can drag
the rather light wagon. Policemen run to the corners. Bong!
Bong! 'Off the track there in front!' On we rush past well-
known stores and theatres and street crossings. On, on in a
wild whirl of speed. The horse slips, sparks flash from beneath
his feet, but he is steady again and doing his best. How strange
the familiar streets look on this bitter cold January night!
And for what are we going? Is it some crazy, mad creature, to
be seized, bound, and handcuffed, and carried back shrieking
to the Madhouse? Is it the result of some drunken brawl?
A crowd of men; a blood-covered and bleeding figure on the
floor; sounds of cursing and broken sobs and the low muttering
of hushed voices! We know not what the errand may be,
but still onward flying through the cold and darkness. We
have left the lighted thoroughfares and have turned up Second
Street, dimly illuminated by far-apart gas lamps. We approach
a part of the City which is new to me. It is one of the worst
neighborhoods in Philadelphia, Callowhill Street near the Dela-
ware River. We enter a space wider than the ordinary streets.
Houses of irregular size and shape stand farther back, giving
a more open appearance to the roadway. Gaunt outlines of
factories tower aloft, their sides and chimneys silvered with
moonlight, while dark shadows lurk in angles and corners and

34

about the lower stories. Doors of grogshops open stealthily.
Faces peer out into the night and vanish back again. We
are at the top of what looks like a steep descent. It was once,
in far-off days, the quiet river bank, where trees grew and
shaded mossy slopes; for the moonlight, flooding down, gleams
on a space of glancing whiteness where the river moves and
tosses broken masses of floating ice. A mere glimpse we have
of this, down a narrow way of blackness, descending tunnel-
like between the dark walls of lofty buildings. Turning into
Front Street the ambulance stops before a mass of ancient,
worn, and decaying houses. 'Where is No. 4 — ?' I take the
lantern and jump to the pavement. A man slouches across
the street out from some shadows. 'There's the place!' He
points to an archway leading apparently into nowhere, if one
can judge from the blank darkness of the passage of which it
forms the entrance. I ascend the steps of the adjoining house
and try the door. It is locked. A series of loud knocks appears
to make little effect on the stony hearts within. There is a
sort of glass-covered slide in the door, a small space but large
enough to enable one within to glance out into the street. This
slide is now cautiously opened, and a villainous-looking face
gazes out; low forehead over which a mass of tawny, matted
hair hangs stiffly; a thick unkempt beard; eyes which search
and search, as though hunting for crime or escape from its
consequences. These eyes look quickly at my face. They
see a uniform cap and brass buttons. The slide closes quickly
and decidedly and with an air of finality. There is nothing to
be done but to enter the dark passage. Here I am soon sur-
rounded by strange, half-clad savages, mostly young girls and
women, although a few men slouch about here and there. 'Yes!
This is the place! Come along! We'll show you the way!"
Up, up I go, with these strange guides, the bedraggled looking
outcasts hidden away in this resort of vice and crime and poverty.
The stairs are worn and old. Filth is everywhere, and the

35

cold, damp air is heavy with foul odors. The walls and floor
are smeared with stains of many colors. In a little room,
high up, with no furniture, bare, bleak, and desolate, its one
window broken and admitting the winter's bitter cold, there
the patient lay. She was a little, thin, pinched, and withered
old woman, the very ideal of a hag. She lay upon the filth-
bestrewn floor almost naked, and with nothing to protect her
from the cold but an old, ragged, straw ticking. 'Don't go
near her! She's alive with them!' warned some one. Well
know I what this means! The old lady starts up and looks
interested. Yes, she will go along with us. Evidently this case
does not require immediate medicine. The usual questions are
asked and answered, and then they make her ready for her jour-
ney. Never before had I seen the charity of the poor for the
poor so well set forth. I was among the lowest of the low, people
so wretchedly poor, that, in Philadelphia, the city of cheap
homes, they housed, or rather kenneled, in this rotting tene-
ment. I don't suppose they knew much of the fine distinctions
between right and wrong. I don't imagine that their ideas of
morality were exact and nice. I strongly suspect that, like
beasts, they lived in promiscuous intercourse, but a wave of
emotionalism or, perhaps, divine pity, swept over them, and
between them all they dressed that lice-covered old woman
as best they could. One gave a pair of stockings. Another
brought out from some corner a skirt. A shawl was contributed.
And so they covered the candidate for Blockley with articles
of dress that must have left sad gaps in their wardrobes. And
they are making an event of it all! It is an excited, good-
natured, almost a joyous crowd, that gathers about the
ambulance in the street, little children, besotted men, and
miserable girls and women. It is really the event of the season.
Actually! These people are laughing and seem happy! Faith
they have, more humanity left than I had given them credit
for possessing in all their sadly tangled lives. 'Good-bye!

36

Good-bye!' We're off again. Bong! Bong! Off through the
deserted streets, whirling away. Rattle, rattle, rattle, we go
over the crossings; rumbling heavily over the bridge. 'How
are you now? All right? Warm enough?' 'All right,' comes
the reply from among the blankets. Bong! Bong! Off we
turn from the main streets and draw near the hospital. Home
at last! Half frozen! How good and warm the fire feels, and
how cozy the cheerful lighted room! And she who was freezing
to death in the rotting tenement is washed, clad in warm, clean
clothes, and tucked into bed in the first decent resting place
her old bones have lain upon for these many months. Another
piece of driftwood tossed hither on the tides of life! Here is
peace. But the tenement, there, is still full. There still live
crime and misery. 'The poor ye have always with you!' Yes,
the poor and the vile. What hope for them? The busy life
of trade, of pleasure, of gain, goes briskly on. It is not for
them. Youth is beautiful and has so much of happiness. It
is not for them. For them is a blank existence of indefinite
days with misery always; now and then some gleam of what
joy might be. For them is a dreary, dull, monotony of want,
hunger, misery, cold, and heat; brief gladness, most always in
relation with wrongdoing. And all the year, below them,
tossing in winter the broken ice, floating dead driftwood in
summer, runs the River, and to many of them it gives peace.

" ' Who will miss them there to-morrow.

Waifs which drift to the shade or sun?
Gone away with their songs and sorrow,
Only the river still flows on.' "

In the days of the diary the resident physicians were served
by two men, who were called the "Doctors' runners," and by a
middle-aged, kindly, almost m.otherly woman who looked

37

after the laundry and had general oversight of the care of the
rooms. Our men were Sam and Billy. It was a behef, accepted
without an}^ exact data, that both these men had found their
way into the institution through the door of the Seventh Street
Ofl&ce. Everybody except the higher officials appeared to have
gained entrance to Blockley by that way, rising in the social
grade of the Almshouse community to a position that cor-
responded with their abilities. A large number of the attendants
also were friends or hangers-on of members of the Board of
Guardians, and were placed in office by such influence. Sam
was a nervous, quick-moving, shallow-brained, but most willing
servant. Billy, who had but one active eye, was older than
Sam, was slow, deliberate, somewhat pessimistic in his views
on men and life, disposed to have sentiments of profound depth
without the verbal ability to express them clearly. He had
seen many generations of resident staffs come and go, during
his term of service, and knew somewhat of the general char-
acter of the average young medicus. There is a reference to
Billy in the diary that is somewhat characteristic.

"By the Way.

January 16, 1884.
"No one can deny that Blockley residents are not kept actively
busy. I think that we earn our salt. Billy came into our
room, the other evening, to light the gas. The burner leaks
out a little of this volatile substance which we try to imagine
gives some illumination, but it does not. In regard to this
matter we labor under an unsystematized delusion. But gas
is expensive, more or less, and the Board of 'Guardeens' is bent
upon economy. Well, the antiquated and slow-moving Billy
came shuffling into the room. I remarked to him something
about the rapid flight of time here, especially when one had much
work. Billy stood on a wooden chair, his arms stretched at
full length above his head, endeavoring with unsteady hand

38

to insert a lighted match under a globe of the chandelier, and
squinting dreadfully with the earnestness of his efforts. Pop!
went the flame. Billy slowly turned around, and still on the
chair, but in imminent peril of falling off, delivered himself
thus, with much force on each word and impressive pauses
between: 'Of all the men I've seen in life, I have never, at any
tim.e, here, seen a class of men so worked as the present resident
stafi"!' He stepped to the floor, and, suddenly rousing himself,
demanded, 'Why don't you strike?' Being told that this was
useless, a look of deep melancholy settled in his one remaining
eye, and he left the room, sadly remarking in the depth of his
sympathy, that it was 'all a great shame.'

"We cannot very well strike, but certainly there is much
to be done. Here is a report of to-day's work: Out of bed at
half after seven o'clock; breakfast at eight. Then at work in
the wards until twelve, making my rounds and applying the
large battery. I am snatched by a runner for the ambulance.
Off to the Seventh Street Oflfice, and then away uptown to
North Second Street near Columbia Avenue; then back to
Seventh Street and out to the Hospital. Arrive here at half
after two, and have what dinner I can obtain at that late hour.
Go to my room and begin writing up histories of cases for Dr.
M. Again comes the runner with another ambulance call which
proves to be a false alarm. So back to the crazy histories
again. Finish these by five o'clock. Then another ambulance
call which, again, proves false. Very fortunate, this, for other-
wise I should have had the pleasure of a visit to Bandbox Row,
away up in the slums of Richmond. I now go to the wards
and, while making my evening rounds, Dr. M. appears. Five
students are with him, and he lectures to his class until almost
seven o'clock. As a result, I nearly lose my supper. After
this, I make my rounds in the Erysipelas v/ards and then go to
my room. Here I try to read, but fall asleep over the book;
so that now, about the hour of ten, I am full ready for bed.

39

There are easier stations in life than that occupied by a resident
physician in Blockley."

The wards for patients suffering from diseases of the nervous
system were the most primitive in their equipment of any
department at Blockley. They consisted of two groups of
long, one-storied, wooden pavilions, separated by a wide road-
way that led in from Thirty-fourth Street. The pavilions on
the north of this roadway were for women and, on the southern
side, for men. These thin-walled structures were raised about
three feet above the ground and were lighted by long narrow
windows. The students, visiting the public clinics in large
numbers on Wednesdays and Saturdays, entered the grounds
by the gate on Thirty-fourth Street and passed along the
avenue between the groups of pavilions to the door leading to
the clinic amphitheatre. These cheerless, ill-equipped, wooden
structures, hardly better than shacks, had been erected for the
nervous patients, because no space remained available within
the walls of the main hospital buildings. It is probable that
these pavilions were never intended as permanent buildings,
but must have been designed to meet an urgent need, at a time
when the Guardians were economical or stingy. Every phase
of chronic disease of the nervous system was represented in
these wards, and the acute cases were numerous and interest-
ing. No finer school could have been found for the study of
this class of patients, especially as the most able neurologists
of the City had terms of service in this department of the
Hospital. One pavilion in each group was reserved for patients
suffering from epilepsy. The attendants were few in number
and chosen, as throughout the hospital, from available con-
valescent patients, or were temporary helpers who might leave
us at any time. The Head Nurses corresponded with the
same class as in the other wards of the Hospital. Among the
patients, especially in the wards for epileptics, were many

40

who were on the border line between eccentricity and insanity.
It was not an infrequent occurrence to transfer an uncertain
case to the Department for the Insane, after systematized
delusions had developed, and there was need for more secure
and better organized means of restraint than we could supply.
The epileptic patients required careful oversight; and yet the
poor victims themselves were most willing to aid one another
when seizures occurred. The diary has a reference to some of
the peculiar denizens of the nervous wards, under the title and
date

"False Lives.

February 17, 1884.
"Sunday morning. Rain and darkness. A dull, heavy
day filled with suggestions of erysipelas, malaria, and numerous
lung affections; filled too with far from cheerful thoughts of
the unattainable. To disperse these we need only a few con-
secutive days, or even hours, of sunshine. Two weeks of dark
and dismal days have favored the growth of gloom. All my
patients have numerous new and unaccountable aches and
pains. In my ward are several half insane persons of a greater
or less degree of crankiness. One gentleman, Henry C — s, is
badly deranged upon the subject of religion. His ideas are
crude, but much resemble many of the primitive beliefs of
several old races, as well as some of the ancient schools of
philosophy. He thinks that men should so live as to worship
the Great Cause, whose name he seldom mentions, speaking
of God in a roundabout manner. He generally refers to the
Deity in a long sentence which I have heard him repeat so
often that the formula is stamped in my memory. I asked
him to describe his idea of the Great Cause, and he answered
thus, 'The truest, purest, surest, most holiest and most power-
fulest power of all powers. The principal power of all powers.
The beginner and maker of all and of everything, visible and
invisible, known and unknown, to all and to every one; whose

41

name we don't know, but I hope will know some day, as we
meet on the way.'

"This morning he came to me as I was leaving the ward,
having made my rounds, and said: 'You asked w^iere the
principal power of all powers lives. This morning while eating
it came to my mind that he lives in the whole world, for you
find life everywhere— the smallest ants and creeping things in
the ground; and I don't think men ought to kill them for food
— as killing sheep and bullocks — or for other reasons, for they
are made by the principal power of all powers, that is Jesus
Christ. I believe every man ought to have a wife. My father
meant me for the priesthood, but I refused to be a priest for
they don't marry.' He informed me, the other day, that his
thoughtful and far-seeing parent 'had me cut for stone, so as
to keep me from doing wrong when I got old.' I fear that
this operation, whatever it may have been, has not been success-
ful. Henry's religious and ethical sentiments are as noble as
those of an Indian Buddhist, and his habits of life quite dis-
gusting and depraved. When not prevented, he eats and drinks
substances that are fit only for the drains and sewer. When
asked why he does this, and when threatened with punishment,
he replies that he does it for the honor of the principal power
of all powers; that he made such substances, and that, there-
fore, they are not unclean.

"An old colored woman who resides in one corner of Ward
II, Women's Pavilions, is very talkative. She says that she
has always lived with the 'quality,' and refers v/ith much scorn
to certain 'colored gals and fat black women' with whom she
must now associate, and who are always telling lies about her.
Religious topics arouse her into a high state of hysterical excite-
ment. The poor old lady is extravagantly fond of ginger
cakes, and, the other morning, after asking me for a supply of
these crisp and snappy delicacies, she cried aloud, 'I'm ready
to go from Earth to Glory for they don't give me enough to eat!'

42

"Directly across the ward from this woman resides a white-
haired, hollow-eyed, wild and cadaverous looking old Scotch
lady who is very noisy and violent and uses the vilest language
imaginable. She must be a relative of Rob Roy's wife. Many
trains of thought follow one another without rhyme or reason
through her brain. I spent a dreary afternoon noting down
her mutterings for Dr. M. If he can make any head or tail
out of her talk, that will be of value to the science of medicine,
it will be a rem.arkable feat of the imagination. For mere
intellectual amusement I would recommend him to try a picture-
puzzle, instead. Unfortunately the dear old lady was not in
a profane mood last evening, and the reported monologue was
quite commonplace and decent. I copied down a few of her
interesting remarks, — 'He was born this side of Glasher and
baptized at Douglass' (mumble, mumble, mumble). 'Father
McElhone asked me why I didn't sleep. I don't sleep any
because a priest and a bishop put their hands on my head at
night.' 'He asked what was the prettiest place in Scotland,
and I said, said I' (mumble, mumble, mumble). 'I don't see,
says he, how any woman could have picked up so much. She
couldn't have it, says I, if she hadn't it to pick up.' Deep and
dangerous talk this! Almost as clear as Browning! This
morning an old colored man, having only one eye, the other
having been destroyed by some disease, came to me and an-
nounced that his name was William I — m, and that he was seventy
years of age and born in Maryland. 'I am the greatest grain-
measurer in the City of Philadelphia,' said he; 'well known to
all the prominent merchants years ago; have known all for the
last thirty-five years. They have died and gone now, and their
children coming up.' According to his statement, I — m has
a serpent lodged in the left iliac and hypogastric region. He
slaps his abdomen, and the creature crawls and curls about.
It has spun a v/eb, he reports, which extends down along both
legs to his feet and also up into his brain. It covers his whole

43

body. 'I'm webbed entirely in,' he says. 'I don't know whether
I'll live through an operation, but I'll have it taken out. When
I walk the web spins out and is just like a chain-ball. It won't
let me go.' This snake eats all the man's food. 'He gits his
share and that keeps him quiet. Whether I took it in drinking
Vv-ater, or how it got in, God knows, or why. People are so bad
in this world!'

"So these people and many others, some better, some worse,
live on in their fancies and false lives; one with his bosom
serpent; one with her dream of ginger cakes and glory; one
with his dark deceiver ever at hand to catch him off his guard;
another with her mixed recollections, talking and muttering
of things past, of old memories mingled together without order
or reason, and the whole dreamy fabric of words mortared
together with cursing and blasphemy."

"An Afternoon Walk.

February 23, 1884.
"This month has contained thus far nineteen days of rain.
One almost forgets that a shadow was ever cast, and the sun
is becoming a mere thing of past history. However, yesterday
afternoon the old illuminator did appear and forced a few
feeble rays of light through the lead-colored clouds. V. and
I took a walk out Darby Road. The day really was delightful,
all the pleasanter for the long series of clouds and storms v/hich
had gone before. There was a gentle and suggestive sense of
coming Springtime in the air, while everywhere the grass was
bright green, and every road was wet and soft with the melting
frost. Anywhere, but in the depressing neighborhood of
Blockley and the lower reaches of the Schuylkill, the voice of
the turtle would have been heard distinctly had one been about
and possessed of vocal powers. Yet, in spite of the feeble
February sunshine, it was rather a grey day and a grey land
through which we walked. Our way took us past several

44

Church Homes, and finally turned down a long lane, near the
Theological Seminary of the Episcopal Church, towards the
River, which we soon reached. It was a dreary spot. The
clouds had gathered again, and under a dead, heavy grey sky,
the landscape itself seemed grey of many varying dull shades,
with no bright bits of coloring to relieve the monotony. Here
the river is almost on a level with its banks, and on either side
of the stream extend long stretches of marsh land, white at
this time of the year and covered with scant, tall, dried grass
over which a moist, chilly wind was blowing from the southward.
Along our side of the water stood huge oil tanks, and close by
were the low, unsightly sheds and furnaces of several refineries.
For a broad space about them the ground was saturated
black and dank with crude oil. The river itself, bordered by
low, scrubby willow trees, was of a greyish yellow tint flecked
with whitecaps over its wind-ruffled surface. Across the
wide river low-lying marsh lands stretched away, from the flat
level of which tall chimneys of oil works rose here and there,
and, at a distance, two huge grain elevators loomed aloft, their
slate-grey roofs and sides standing out clearly against the lighter
grey of the lowering sky. Far off across the marshes could be
seen the tall, bare masts and yardarms of several bark-rigged
ships lying at anchor in the Delaware. Near by, moored to
a wharf, were two large vessels being loaded with blue-colored
barrels of petroleum. We walked on, going down a railroad
track towards the City. On our right we passed a large, hand-
some mansion, built in English-manor style, which stood on
a knoll above the river and its marshes, and was almost sur-
rounded by trees. Through these we caught glimpses of the
building as we passed. Its windows were all closed and boarded
up. In many places plastering had fallen from the stuccoed
walls. Evidently the place had been shut up and deserted long
ago, for young trees had sprouted up thickly in what had once
been a well-kept grove, which was now dense with tall under-

45

brush and tangled thickets. As if the ghostly and uninviting
aspect of the place were not sufficient to warn off visitors, a
large sign had been placed facing the railroad, which threatened
all the law's penalties upon any one who ventured within the
high, briar-covered stone walls enclosing the estate. We
trespassed not, but I fancy that within the house were large
empty rooms; perhaps in some the remains of old furniture,
rolls of worn-out carpeting, broken china, all the debris left
behind in a place which had once been a home. Even old
Blockley wore a cheerful aspect, when I returned to it with
a vision of this deserted mansion in my mind.

"I — m, the man who imagines that a serpent is within him,
told me this morning that I might as well stop giving him
medicine; for although he confessed to feeling better, he said
of the snake: 'It is something which neither you nor your
forefathers ever saw. It was put on me by God, and I would
not have it taken away. Barnum, Sir!' he said, striking his
chest, while he straightened up and glared wildly with his one
and only eye, 'Barnum, to-day, would give a thousand dollars
for my exhibition in a show!' Poor William is fast working
himself into a candidate for admission to our associated institu-
tion across the great courtyard, where the insane have their
habitation."

"Relaxation.

March 2, 1884.

"The other evening. Dr. R. came into the room. I had
out my fiddle, and V. and he endeavored to sing while I picked
out an accompaniment. As a performance, although satis-
factory to us, it was not entirely a success, and was most un-
favorably received by our colleagues in the adjoining billiard
room. Later in the evening we joined the billiard players in
the great entry, together with others of the staff just back from
hospital duty, and improvised a stag ball. I stood on a chair
and fiddled waltzes while R. and V. and M. and the others

46

gallivanted around over the floor, sometimes in couples, or each
one singly embracing a chair for a partner. These dances were
followed by a grand quadrille, in which, as the fiddler took
part, we had no more effective music than the rhythm of our
heavy tread. Action was strong and the figures mixed, while
a general din of shouting kept up the enthusiasm. This soon
resolved itself into a game of leapfrog. Up and down the long
hall we went. It was no joke to go over the backs of the six-
footers, but it was still less of one when they went over your
own. Leapfrog suggested a contest in running and jumping.
Two piles of tables and chairs were placed, one on either side
of the entry. The narrow strip of carpeting that adorns the
centre of our entry was taken up and stretched across the hall
between the piles of furniture. This was the line, and was
cleared by a running jump, after which it would be placed
higher and the contest continued. Tiring of this, we chose
sides for a rope-pull, using the dear old carpet for a rope; and
so the evening ended with two rounds of a tug-of-war, in which,
of course, victory was claimed by both sides. It is this sort
of gentle, intellectual amusement that excites the suspicions
of our new Superintendent, Mr. S. A more wholesome and
yet sober group of young fellows never served on a Blockley
resident staff, but Mr. S. is sure that the noise that occasionally
disturbs the evening hours and is wafted across the great court-
yard to the Front, where he and his family reside, is the din
that attends an orgy, and he doubts the morality of suffering
it longer,"

In the days of the diary the resident staff of Blockley con-
sisted of eleven men and one woman. The Staff of 1883-4
was quite independent in respect to obligations associated
with appointment, as all of its members had won their places
by the highest averages in a competitive examination. As
a result of this method of choice the Hospital had obtained an

47

unusually efficient and conscientious group of young men.
The one lonely woman was a graduate of the Women's Medical
College of Philadelphia, and was held in great respect by her
male colleagues. As she was excused from certain depart-
ments of the hospital work, in which it would have been quite
unfit for a woman to serve, a slight excess of labor was thrown
on the eleven men of the Staff. They took themselves and
their work quite seriously, but had that buoyancy of disposi-
tion common to the American college man. The writer could
not have found a more congenial, self-respecting, and well-
mannered group of associates than were his colleagues on the
staff of his term. Our quarters were in the central building
of the Women's Outwards, the Department of the Almshouse
for Women. We occupied rooms opening on a wide hall, on
the third story of this building, and were assigned rooms in
couples. The woman physician had a little room at the ex-
treme end of our hall, and must have been rather astonished
and somewhat annoyed at the noise made by her professional
brothers, when this hall served as a football field or space for
track athletics or boxing. One room of the series was unoc-
cupied, and in this we had a billiard table which was rented
and paid for by subscription collected from the members of the
staff. The rooms were spacious, with very high ceilings and
each room had one large window so high above the floor that
a platform was built, a sort of dais, beneath it, so that the
occupants of the room could be seated and yet look out upon
the external world. Here the writer and his genial roommate.
Dr. v., lived on terms of cordial intimacy. Dr. V. was a tall,
well-built, soldierly-looking man, rather impulsive, not always
well-balanced in his moods and tenses of self-control, but warm-
hearted and loyal to his friends. One afternoon, the writer
returned to his room, after some duty in the wards, and saw
his roommate standing erect at the window, his broad straight
back presented to the interior of the apartment, and his face

48

to the rather dreary outlook over weed-covered fields and
vacant lots. It was not apparent what train of thought passed
through Dr. V.'s mind; perhaps longings for the Springtime,
when he was to go forth into the wide, wide world, free to
establish a private practice. At all events, with hands thrust
deep in the wide pockets of his uniform coat, head erect, and
face to the world, he was singing in a thoughtful but most
expressive manner this song, —

"I'm old and helpless and feeble.

The days of my youth have gone by.
So it's over the hill to the Poorhouse;
I'll wander alone there to die."

The contrast between that big, well-built mass of human
energy and the song of despair was most amusing. And yet,
I think that we all of us felt a depression of mood, that came
as waves over our youthful spirits, during those twelve months
among the associations of old Blockley. From the central
building in which our rooms were placed, two long extensions
ran east and west. The lowest stories were occupied by the
old women paupers. In the upper story, or attic, the local
title for which was "Dandy Hall," were the women awaiting
confinement in the obstetrical wards, which also occupied
other portions of this same floor. In those days puerperal
fever was so common in Blockley, that we had a ward especially
devoted to the victims of this infection. Its beds were always
occupied. Asepsis was almost unknown. The writer remembers
that when it became his turn to serve in the obstetrical wards,
it was agreed between Dr. M., his colleague, and himself, that
during their term of this service they would discard their old
hospital uniforms, wear civilian dress that had never been
used about the hospital, remain away from the main hospital
itself as much as possible, and use the utmost cleanliness in all
operative work connected with their service. We had no

49

case of puerperal fever during our term of service. Yet this
was partly a coincidence or good luck; for the walls, floors,
and furniture of those old rooms must have been loaded with
streptococci, staphylococci, pneumococci, and all the noble
army of the bacillus gens. Our only efficient nurse was a
middle-aged woman who had large experience in midwifery.
She was a small, lightly-built, and most energetic individual,
quick in all her movements, prompt in decision and in action.
Her practical knowledge of her subject was superior to our
theoretical training, however much more scientific the latter
may have been. We could depend upon her to call us from
our sleep to active service not one moment sooner than the
necessities of the moment required, but when that call came
there was to be no delay. Her manner towards us was a quaint
combination of motherly interest, good-natured amusement,
and professional respect. It was fortunate for us, as well as
for the patients, that she was at hand, especially during the
early days of a change of service and the incoming of new and
inexperienced doctors. Most of our patients were primiparae,
women with their first children, young, ignorant, without any
self-control, sometimes with instincts and manners like savages.
Of course very few of them were married. In rare instances,
the mothers manifested a real and lasting interest in their chil-
dren, but usually the feeling was an evanescent, physiological,
maternal instinct, not as deep or as serious as a cat would feel
for its kittens, or a cow for its calf. Rarely would the mother
care to give a name to the unwelcome offspring. As some
name had to accompany our report of a birth made to the
Bureau of Health, the resident physicians gave such children
any names that a passing mood might suggest, and some of
these young citizens received as remarkable names as were ever
given to a human being. Fortunately such titles were not
legally binding, and a respectable name could be bestowed at
the time of the child's christening.

50

Below our quarters extended a series of rooms and wards
for the women paupers. Most of the wards were great square
rooms in which the beds were placed around the walls at in-
tervals, in corners, and through the center. A few favored
souls obtained "cubbies." These were cell-like spaces of a few-
feet square, large enough to contain a bed, a small table, and
a chair. The occupant of a "cubbie" was invariably a denizen
of the ward, who had proved her right to consideration by
genial manners, cleanly habits, and a cheerful observance of
all the rules and regulations of the house. Such women adorned
their small cells with ornaments and pictures chance or good
fortune might bring them, and took as much pride in their
narrow dwellings as a Queen in her castle.

The diary has a reference to the Insane Department. This
was distinct from the general hospital and had a medical staff
of its own. We were quite free, however, to visit its wards
and grounds whenever we desired.

"The Inferno.

March 4, 1884.
"I went with V., yesterday afternoon, through the Insane
side. It was something like a descent to Purgatory, if not
lower, after the Virgil-Dante fashion. There, in large, square,
bare, but sunny rooms, sitting on wooden benches about the
walls or wandering restlessly up and down, were the mad in-
mates. The months pass and seasons change but no change
comes to them. During the day, when not out of doors, they
are kept in large 'day rooms.' At night each has a room to
himself or herself, except the very quiet ones, who are kept
in general wards. Each one has his peculiar set of delusions
concerning which many will converse freely, but others are
very reticent. Each seems to retire into a little world of his
own, a false, dream-world, real only to himself. One man,
with hands firmly fastened in a muffler which confined his

51

arms, strode softly up and down one side of a room, every
movement filled with a suppressed energy. His restless eyes
saw everything, and glared with a baleful look. He seemed
to be waiting, waiting. When the release came, a very devil
would be loose; or, on the other hand, his evil spirit would
be tamed and in subjection. In several cells, into which we
looked through small circular windows, were raving maniacs,
some yelping like dogs, one apparently in a kind of wicked
ecstasy. The walls of these cells were padded. Scattered
throughout the various rooms and in the grounds, I saw many
of my old patients whom we had transferred from the nervous
wards. Michael R. was there. He seemed very glad to see
me. I — m, the snake man, was in the same room. He had
been there but a few days only, and expressed himself as con-
tented with his new quarters. He shook hands with me warmly,
and, having thanked me for my attention to him, proceeded
to bestow upon me a very formal blessing. He told me that
he was now a prophet, and that he controlled the winds with
his right hand and the earth's motions with his left foot. From
this it is evident that I — m is rising in social importance, getting
quite a little confidence in himself, and developing a sort of
universal influence. In another room I met Henry C — s. He
did not remember me, but was still willing to talk about the
principal power of all powers. At least three of my old
acquaintances were wandering about, and conversed with
me. It was a strange experience, like crossing over into another
world; for the inmates there are almost dead to this one. The
poor fellows I had known will never again be able to go beyond
the high walls. They live shut out from the great active present,
nursing their strange delusions. Like ghosts they seem, wander-
ing along the Stygian banks after crossing the dark waves in
Charon's boat. And it was odd to think while in these halls
and rooms, high- walled courtyards, or open plaza, that, just
over the Schuylkill River, men are working at their busy occu-

52

pations, little knowing that on this bank Julius Caesar still
lives; that Napoleon plots for universal conquest; Elizabeth
envies Mary Stuart; Washington still directs the affairs of
State; that a poor, deranged, long-haired and bearded individual
impersonates Jesus Christ. Comparatively few have assumed
these mighty personalities, but everywhere are busy and addled
brains filled with intense personal interest. That man is
awaiting a great fortune. He has been wronged, but the
property will yet be his. There is a man who has committed
some great crime. He will not talk of it, but he can never be
pardoned. That man is immensely rich. He owns the United
States Navy. His mouth is made of gold and all his teeth
are silver. One hundred mints cannot contain his wealth.
'Who gave you these things?' you ask. 'Upstairs,' he replies,
and points skywards. Here comes a man behind whom the
Prince of the Powers of the Air is gliding. Into his ear day
and night the Evil One is whispering, but the possessed man
will not tell what the demon says to him. That woman, over
there, talks with invisible spirits which tell her of celestial
things. Her soul is borne far above the earth and soars into
immeasurable regions of space.

"The evening shadows were falling over Blockley, as V.
and I passed out through the arched gateway in the high stone
wall that separates the insane side from the great central quad-
rangle. Across the courtyard, against the grey front of the
general hospital, a rosy glow was cast by the setting sun. But
the madhouse was in deep shade, except where the reddish
sunlight gleamed through windows opposite to others facing
westward. These were lighted up, like great eyes, with a
strange and lurid light, an emblem of the unhappy, false lives
that burned fitfully, wildly, fainth^ within the long grey walls."

During the course of that winter in Blockley, McL. and the
diary man, v/ith Dr. H. of the Insane Department, rendered

53

the music for the balls given for the insane patients. These
occurred very infrequently, but may have brightened up the
dull routine of life in that cheerless department of Blockley.
McL. was a finished performer on the violin. The diary man
could only fiddle. Dr. H. played the piano. And the poor,
crazy people danced! It was a weird spectacle, this festive
occasion, when the floor was occupied by the mentally deranged
men and women of Blockle}'. Most of the patients sat quietly
on the benches placed along the sides of the large hall. Others,
however, were quite eager to foot it merrily through the central
open space, in the glare of the lights, and to the music of our
making. Always at a definite hour, on these evenings, Dr. H.
started a doleful m.arch, and this was the signal for the close
of the ball and the retirement to wards or bedrooms. It was
always the same melancholy recessional that was rendered
on the piano. I do not know who was guilty of its composition.
It was fit for a funeral. V. was so fascinated with its gloomy
measures that he often asked me to play it to him on my fiddle,
and to this day there are times when bits and snatches of it
most unexpectedly recur to my mind, bringing a sense of sadness
that I cannot understand, until the associations of the music
call up voices from an almost forgotten past, and the lights and
shadows of other days.

"One More Unfortunate.

March 6, 1884.
"Yesterday afternoon I felt sleepy. There was nothing
unusual about this fact. The afternoons here, unless there
be ambulance work, receiving ward, photography, a bad case,
or clinical notes to write, are apt to be conducive to slumber.
But the peculiarity about this afternoon was that Susan, our
useful, middle-aged, calm and experienced woman servant,
with numerous gossips, was seated in her room adjoining mine.
The Irish voices of herself and guests, never very subdued,
seemed unusually loud.

54

"'Yis,' some one said, 'she was very unfort'nit. The young
feller hain't bin heard on agin.'

"'Well!' remarked Susan, 'she wasn't like to thim bould
things thet has more'n one child. The fust one don't so much
matter, — ' (a chorus here from the guests of 'Oh, no! Divil a
bit!'). 'It's a misfortune, or the likes,' continued Susan, 'but
after the woman knows what it means there's no excuse!'

"This sentiment met with warm and hearty approval. The
idea seemed to be that any woman, in the daily experiences
that make up life, might become the mother of her first and
illegitimate child. That was a 'misfortune ; nothing more.
Woe to the reputation of any woman, however, who repeated
the offense. For her there was no excuse. As I suspect that
most of the company present had been unfortunate in respect
to this 'misfortune,' their ideas of virtue were apt to rest on
a broad and charitable foundation. Yet the conversation
was interesting as an indication of the standard of morality
of the Blockley class. It is possible that it prevails, also, among
a large body of individuals who live in the rough and tumble
of uncultured and laborious lives.

"While I had charge of the Erysipelas wards, in which,
also, cases of any suspected contagious disease were kept, a
young woman was brought in who was suspected of having
scarlatina. This she did not have, but, as the patient was
wxak, feeble, anaemic, and very wretched, I kept her in the
ward and gradually built up her weakened condition with the
best food I could get, together with quinine and iron and atten-
tion to her general health. She was most anxious to get well,
on account of a poor, little, sickly baby which she had added
to the world's population only a few months before. At this
time, there was only one other patient in that ward. This
one was an old hag from the street. The young woman, although
poverty-stricken, was married and respectable. The old one
certainly had never stood before the marriage altar, and was

55

born disreputable. Such a congenital condition seems quite
possible from my observations here. One morning, I asked
the young woman how many children she had had. 'Six,'
she answered. The old hag, who had been listening, suddenly
groaned aloud, and exclaimed in tones of heartfelt indignation,
'Arrah, thin! and how can inny woman be so keerlessl'"

"Inconvenient Philanthropy.

March 9, 1884.

"While walking along the hospital front, on Vintage Avenue,
yesterday, I met two highly excited, elderly, widow-looking
women, who flew at me with the information that 'That man,'
pointing to a tall, rather well-dressed individual who was in
advance of me, that 'That man had a holt on a young baby
done up in brown paper!' Telling the ladies to calm them-
selves, and to feel no surprise whatever at a little thing like
that, as such objects might be picked up at any moment about
here, I went on to the House Agent's office. The tall gentle-
man had just entered. He bowed pleasantly to the assembled
officials and subalterns, and said in rather a chippy way, 'I
found this little object on a bridge near here; and, as it seemed
to have no owner, I thought I would bring it over.' He held
out the 'little object,' which was in reality an undeveloped and
evidently still-born child. Perfect silence reigned as he held
out the bundle, and every one looked at it critically. Finally
some one asked, 'Well, what are you going to do with it?' A
rather startled look broke over the man's face, and he said,
'Why, sir! Why, I thought I would leave it here! I think, —
I thought,— well, the fact is, — '

"'No, sir,' emphatically said the doorkeeper, 'we don't
take no dead ones in this place.'

"Now for the first time the dreadful possibilities of the situa-
tion seemed to dawn upon the unfortunate man. 'But, my dear
sir!' he sputtered, 'what in Heaven's name shall I do with

56

it? I 'saw a crowd of people looking at something. It turned
out to be this. So I picked it up and brought it along. No
one else/ he added, with a look of injured innocence, 'no one
else would touch it.'

'"It would a been a d — d sight more convenient for you if
you'd done like no one else,' coolly remarked the doorkeeper.

"'If I can't leave the thing here,' cried the now thoroughly
wretched man, 'where can I dispose of it? I can't walk in
the street with this. I can't throw it away, for fear of suspicions
being attached to me. I can't take it home. I don't dare to
go to a police station, lest unpleasant consequences result.'

"In his agitation he strode up and down the room gesticulat-
ing with one hand, while, in the other, he held the filthy bundle
stiffly off from his side.

"'This is a dreadful situation,' he muttered. 'Can't you
advise me?'

"'Don't know,' said the uncompromising doorkeeper.
'Better take it to the police. Can't do nothing for you here!'

"Once more into the street went the haunted man. Later
I heard that he met the Warden near the hospital, and tried.
as a last resort to persuade that ever amiable but diplomatic
man to hold the bundle 'just for a moment.' He was last seen
walking up Thirty-fourth Street with the 'little object' swinging
in time to his rapid steps. Who knows? Perhaps he is still
striding on; afraid to leave his burden; afraid to remain with
it ; fearing to take it home ; unable to rid himself of his dreadful
load, while every moment the horror is deepening and the
situation growing more desperate. It is to be hoped that
he fell into the hands of a sympathetic policeman, and is now-
free of his bundle and still possessed of his reason."

"On Duty at the Seventh Street Office.

March 22, 1884.
"It was a very rainy morning, and consequently we expected

57

a rather larger delegation of maimed, halt, and blind, than have
of late been presenting themselves as objects for our considera-
tion. The Board, composed of the House Agent and myself,
came to order at half past ten o'clock.

"Case 1. An old soldier; fought for his country; entitled
therefore to special notice; paralyzed; destitute condition;
poor but most respectable; never expected to come to this.
So much for his own story and opinion of himself. Now, in
fact, he turned out to be a case of old, long-standing fracture
of the thigh, a regular old bummer. Finding that the paralysis
dodge would not work, he assumes a very gentle manner, as
one using careful management over something that might go
off suddenly and throw him out, but which he purposes to
manipulate by tact. His manner was a kind of apologetic
superiority. With an air of profound secrecy he slides his
hand deep into an inside pocket of his long, greasy, dank, and
sodden overcoat. Eyeing me while thus, engaged, he says,
'I'll show you something.' He speaks almost tenderly. I'm
a wilful child. He will reason with my juvenile prejudice and,
incidentally, he will play his trump card. Having fumbled
about for a moment, he slowly draws out his hand as though
it held something almost sacred. It is out at last. With a
whispered, 'Look at that!' he presents to my gaze a six-ounce
bottle containing a very closely packed and uncomfortable-
looking tapeworm. In a husky voice he says, 'The head re-
mains!' But no! It is surely a pity to disappoint such in-
genuity, but the head will not at present be removed; at least
not at Blockley.

"Case 2. Some one is slowly stumping up the stairs.
Slowly, painfully, one foot dragged after the other. Gradually
a man's head emerges above the landing, and soon the whole
total wreck stands tottering before me.

"'What's the matter, are you sick?' 'Well (a long gasp),
if I ain't sick, there ain't nobody lives. I'm just knocking about.

58

I've no place, no place. I've lost my common senses and
I'm near a loony!' He speaks in a weak, low, spiritless tone,
and gives an unexpected emphatic drawl on certain words.
'I ain't bin so bad 'til last night,' he continues. 'Then I fell
on me back, and the spine of me back is broke.' Mr. B., the
House Agent, talks some time with him in regard to his means
of support. 'I didn't take a stitch of clothes off me, I may
say, since Christmas,' he announces in a sort of general and
indefinite way. In a final and overwhelming burst of despair,
the old man moans out, 'Ach, the spine of me back is gone
and I hain't got a tooth in me head!'

"I think that this last wail broke down our stony hearts,
for we gave the old fellow a ticket of admission. He had
nothing the matter with him worse than senile asthenia. How-
ever, when I catch that, perhaps I shall realize that the old
wanderer had sufficient reason for asking the City's charity.

"Case 3 is a youngish man, red-haired, with red, blood-
shot eyes, unsteady hand, flushed face, and all the other unmis-
takable signs of a long debauch. The whole affair seems a
great joke to him, quite amusing indeed. He has a brisk,
easy, genial air, and tells his tale as one would a first-class
story.

'"Well, Doctor,' says he, 'I'll just tell you! When I take
a breath a pain takes me right through the chest; and the
fact is. Doctor, I've got something else' (a sweet smile comes
over his face). 'Yes, I've been drinking, and my friends put
me out this morning. I've just raised Hell! The neighbors
all thought the very Devil was loose. My friends put me out,
and I want to get a little shelter. I've been in bed since Paddy's
Day.'

"I strongly intimate to Mr. B. that the gentleman is not
a very serious case. 'Yes, Doctor,' says the man reproachfully,
'I am sick and I've got a sore throat.' He receives an order
upon the district doctor. His disappointment is great, but he

59

finally yields gracefully and accepts the situation. At Seventh
Street we are ever mindful that our colleagues do not excuse
any errors that the man on duty may make in admitting unim-
portant and uninteresting cases. It is fully understood among
us that we should relegate such to the district physicians of
the City. These latter can always order that a patient be
admitted to the hospital, if they find that such necessity develops.
"Case 4 was a decent, respectable looking woman, but
with terribly dirty hands, who suffered from rheumatism.
'I got some horse liniment to rub with but it don't do no good.
I've been sick such a long time, I've run short of funds; can't
do no work. Here's a purscruption some one gave me. I
don't know if it would do any good?' I copied the 'purscrup-
tion' for the use of the profession in general.

10 cents worth of spiruts of juniper.
5 cents worth of oil of terpine (turpentine?).
10 cents wurth of spiruts of wine.

I told the woman that, to me, it appeared that she had
shown rare good judgment in restraining any impulse to invest
twenty-five cents worth of capital in this speculation. We
sent her to the hospital.

"Case 5. A tall, worn-out-looking woman with a child in
her arms. She wore an old black velvet hat with a discouraged-
looking, bedraggled ostrich feather hanging from the back.
A blue and black plaid shawl encased her thin shoulders. The
woman works out in situations where she can take the child
with her. She has no place in which to leave it. Her husband
went to sea, and has not been heard of for many months. She
stayed the previous night at the Almshouse among the 'Casuals.'
'I don't like to go there at all. Of course I have to go some-
where.' This is on account of the child, who is ill. 'Yes, I was
over there before. I was there when the child was four days

60

old. I had no home. No, I don't want to stay long.' The
two waifs, mother and child, receive their tickets of admission.

"Case 6. A sad-faced, desolate-looking vv'oman. Her story
is a short one. 'My husband gave me the Disease.' We
admit her.

"Case 7. A perfect, splendid tartar, a man-killer! Per-
haps, too, a loony, as the old man said of himself. Her dress
is covered and eclipsed beneath a fiery red shawl. A bonnet
perfectly sublime in its disregard of all arrangement and order
adorns her head, and she brandishes an explosive-looking cotton
umbrella. Her son is in the insane department, and surely
she should be keeping him company. She has merely dropped
into the office, this morning, to ease her mind and ventilate
her opinions. Her complaint is that her son is ill treated by
Dr. R., the chief physician of that department. Her language
is torrential, and her frankly insulting characterizations of the
dignified Dr. R. and the stately and courteous Chairman of
the Hospital Committee of the Board were amusing in their
absolute untruth, and want of proportion even as good lies.
The gesticulations with the dangerous umbrella were particularly
telling. 'That old bald-headed d — 1 R. ! goes around among
the women like an Irish rooster! Playing checkers when he
ought to be at his duty. D — d old fool! I'll make it hot for
him before Wednesday! Just look at my arm! Twisted all
about in the Poorhouse! Spittin' up blood? I've been spittin'
it up ever since. Pat Dailey's first cousin can tell the same
thing.' Mr. Patrick Dailey was one of the Guardians of the
Poor. 'G — d! I'd die before I'd go to the Poorhouse! They're
giving them soup in the Insane there on Fridays. Ha! Ha!
they've changed fish for flesh! I'm wishin' I'd meet Pat Dailey
here. I'd settle things. They're a dirty mean set, that com-
mittee with the old bloat H., the whiskey-head!'

"Other applicants came up, the usual round of real deserv-
ing sufferers and the shams; the latter often hard to recognize

61

from the worthy, even as the tares look like the wheat. Bitter
stories of want and sickness, we hear, in which the poor souls
struggle on a little longer that they may keep away from the
Almshouse. Old men, young weak women; stained, battered,
broken! Like ghosts they come from haunts of vice, filth,
disease; yet still clinging to the old landmarks, until, at last,
deserted, sick or dying, absolutely without hope in life, they
enter at our gate and join the nameless throng who pass through
this to find a pauper's home. To many of them it is indeed,
home, and its kind nurses are the truest friends of their wretched,
friendless lives. But with the tragic picture, there is much, too,
of comedy at the Seventh Street gate; and without doubt
one can hear more clever lying in two hours there, than at
a convention of promoters of the gold brick business."

"Down in the Slums.

March 30, 1884.
"The nearer we approached St, Mary's Street, the more
evident became the fact that a large portion of Philadelphia's
citizens found some means of living that obviated sweating
of the brows. The street itself is narrow, scarce wude enough
for two wagons to pass. The houses on either side are of the
hovel variety, built of wood, two stories in height, and the
fronts slant as though the scrawny buildings were about to
collapse upon their miserable inmates. Some buildings are
of brick, the doors reached by wooden stoops. Most of the
doors and windows, being open, reveal long vistas into darkness
with smoke and dirt begrimed walls, or into filthy dens called
rooms. That tall, white-fronted building, on the left, evidently
was once a church. Like all the surrounding dwellings it is
covered with foul stains and crumbling to a near destruction.
As we pass the 'Ram Cat,' a large tenem.ent inhabited by blacks
and whites and containing I am afraid to say how many ledgers,
we become objects of interest to the entire colony. Bleary-

62

eyed, besotted women of both colors gaze at us from the windows.
They lean far out from upper stories, and call to one another
above and below and across the narrow street to friends in
opposite houses. Uncanny, deformed, and unwholesome-looking
children amble to the gutter's edge and m.ake uncouth ges-
tures at us as we pass. Evil-faced things in men's clothing
creep along by the walls and glare at us with stupid, brutish
eyes. The street is rank with filth which is strewn every-
where. Through the gutters, which are so full that they over-
flow their channels, moves a sluggish mass of thick, opaque
fluid in which floats decaying animal and vegetable matter.
The very ground seems alive with humanity. It pours up out
of dark cellars, out of narrow courts. The houses on either
side are literally packed and swarming with mankind. The
ambulance stops before No. — , a miserable, filthy shanty
between which and the adjoining house a narrow, low-arched
alley runs to some region beyond. Up this way I go, till,
arriving at a still more unsightly hole at the rear of the main
house, I knock. The room was very small and dark. Its
one small window was tightly closed. A stove occupied the
space beneath a crowded shelf which served as a mantle. On
this shelf was a varied collection of religious emblems, dirty
articles of apparel, and cracked and broken plates filled with
half-eaten, greasy-looking food. The stove was without fire
and plentifully besprinkled with stains from tobacco juice, as
were also the walls and floor. On the latter was a perfect
covering of dirt, ashes, debris of all kinds, tramped down into
a species of matting, so that the original boards could scarcely
be distinguished. A table upon which reposed a miscellaneous
mass of everything, shoes, combs, rags, and paper, occupied
one corner of the room, and along the same side were heaps of
rags and indistinguishable objects in a vague mass of blackness.
In another corner was a large bed upon which lay an old, de-
bauched, drunken and besotted individual, once a man and

63

a blacksmith, now 'a fit subject for the Almshouse.' Two
young, ill favored, hangdog-looking men, both of whom will
probably be jailed or hung in the course of time and justice,
lounged about the room in company with a young woman.
The latter was quite bedraggled in appearance and although,
like most of the women of this neighborhood, she was probably
common property of all the men, had a not unpleasant face,
and her voice had in it almost a tone of refinement. This
tone was noticeable, for she repeated many of the men's re-
marks immediately after them, and thus produced a startling
contrast, although merely a refrain to what they said. They
were told to make the old man ready for his journey across
town, and this was soon accomplished. 'Getting ready' con-
sisted of investing the legs of the aged, whiskey-wrecked, and
retired blacksmith in a pair of trousers that for grease-spots
and stains were most remarkable and noteworthy. The old
man expressed some disgust and disapproval of what his
heirs were doing for his comfort, but being told to 'Shut up,'
that 'It's too late to kick up a row now,' he submitted. The
girl finally wrapped him up in a filthy sheet. This shrouding
of the patient in a sheet was evidently an attempt at gentility,
and did not meet with the approval of the two sons. However,
the girl remarked in her clear, sweet voice, that 'It is a shame
to send father out uncovered.' Supported by his two promising-
looking sons, while I bore up his legs, the old fellow was lifted
from his bed and carried to the street. What would have
seemed to me most peculiar, had I not become accustomed to
the ways and manners of the Blockley class, was the utter
indifference these people displayed to all the open filthiness of
their surroundings. They had no thought of shame that I
should see that filth-covered bed, or the dirt about the room
and on themselves. It was all a part of their everyday life.
They had never been clean, and never desired to cultivate the
state of cleanliness. By the time that we reached the street

64

a great crowd had collected and stood about the ambulance,
which had been backed up to the narrow entrance to the court.
The crowd was delighted and greatly impressed by the corpse-
like appearance of our burden, and several remarks were made
as to the strong probability that the man was dead. 'Ah,
there's mony a dead un car'ed out there!' remarked an old
hag, as we raised the patient into the ambulance.

"St. Mary's and Alaska Streets, although very short, must
contain as many inhabitants as any ordinary street of several
times their proportions; for the district all about seems to
open into them like sewers and drains into wider conduits.
The alley into which I went was a sort of side current, and I
noticed many others that were like it."

"Dolce far niente."

May 14, 1884.
"Spring, indeed Summer, has come; and, with the appearance
of grass and leaves and birds, the old pauper inmates of this
institution crawl forth into the sunlight. Every morning
the old women can be seen along the front of their building,
sitting in groups upon the cellar windows or beneath the trees.
Each group consists, I imagine, of intimate friends who together
form distinct social circles from which all outsiders are rigidly
excluded, and each little coterie seems always to occupy the
same especial locality. To these places they bring their cans
of tea, left over from breakfast, and there they sit until dinner
time. One would suppose that they would knit or sew or do
something by which the time would be occupied; but no, there
they remain in absolute dolce far niente, mumbling and gossiping
together. Professor P. said that a friend of his, when a resident
physician here, overheard two old crones talking together.
I've heard similar conversations myself. 'Well,' drawled one,
and paused to whifl twice at her pipe, 'when I Vv^as born I was
that small that they could set me in a pint cup.'

65

"Her friend assumed a listless air of interest, and inquired,
'And did you live?' 'Yes!' replied the first, with an air of
conviction, as though announcing a weighty fact, 'I lived and
I done well!' This exemplifies the sort of pleasant conversation
carried on between the old ladies of Blockley."

"Co-laborers in the Vineyard, Who Worked and
Slept and Starved Together.

May 20, 1884.
"V. has gone home for a week, in order to look for a place
in which to lay his head after his term at Blockley expires.
And our terms are fast expiring at Blockley for all of us. R.
and P. both leave at the end of this month, V. in July, and I
shall follow at the end of August. Six new men have already
arrived; or rather five new men and one new woman. The
year has been a delightful one in many respects, especially in
the daily intercourse of the members of our resident staff.
We have been a united family and free from domestic jars;
no one exactly remarkable for brains yet no one really dull.
v., my roommate, is a most amiable fellow, impulsive, capable
of bursts of energy but not steadily energetic; prone to excitable
periods of high spirits, with intervals of much depression; easily
encouraged and easily discouraged. P — Ips is the bright member
of the group, even-tempered, always the same, full of fun, a
good story-teller. M., my present colleague in the obstetrical
wards, is the scholar of the staff, well-read in medicine and
up to date in all theories. He is a handsome man, with genial
manners, but disposed to be argumentative and dogmatic.
If his opinion differs from yours, he will tell you just how and
why you are entirely in the wrong, and will instruct you in
the only right way, which is his own, and is derived directly
from the last author whom he has read on the subject under
discussion. His roommate, R., is tall, straight as an arrow,
and with breadth of shoulders to correspond with his height.

66

He is long limbed and lean, belongs to an old Virginia family,
and has the best traits of the Southern character. Cool-headed
as a prize fighter, he is the last man any one would care to
arouse pugnaciously. He has a fund of negro songs and stories,
and, although not talkative except among friends, he is quick
to see the ridiculous side of a situation. L. is another Southerner,
coming from South Carolina. In years, he is the oldest member
of our staff. There are many traditions about him, one of
which is that he served in the Confederate heavy artillery
during the Civil War. He is full of fun and good nature and
has the air of a man who has seen much of the world. His
hearty laugh is a pleasure to hear and always rings out at the
first hint of anything amusing. P — k — 1 is the typical ladies'
man of the staff. C, a rather elderly member of our group,
is from Barbados. He is a cynic, a doubter, a fault-finder,
always searching for the truth and finding it not. He has
read much and can be entertaining and agreeable, especially
as he has a certain dry, Scotch-like sense of humor. H. and S.
and M — ch are all agreeable in their way, and take their places
in our harmonious circle. McL., the Hospital Warden, is a
young, fine-looking man, with black, rather inscrutable eyes.
He is a good violinist. He lives and moves in a mist of diplomacy
of the Machiavellian type. No one ever heard him refuse any
request directly. His assurance that the matter will be 'attended
to at once' means that nothing will be done. He is more like
us, than as a superior officer, and we never think of him other-
wise than as a pleasant companion upon whom we can shake
off any unpleasant matter, with the assurance that, although
it may not end in accomplishment, still it is off our hands and
will not greatly burden his. Dr. Mary R. is respected and
liked by all of us but is somewhat apart from our masculine
circle.

"So much for the individuals. Collectively we are said
to be the most efficient resident staff that Blockley has possessed,

67

and have proved the advantages of a competitive examination
as a test for appointment over the old system of political or
personal influence. We are quite willing to accept the good
opinion of the authorities of the Hospital in that same cordial
and frank spirit that was displayed by Mr. Dandy Jim, that
gentleman of color, a resident of South Carolina, who being
highly complimented upon his personal appearance, reported
that

"*I looked in the glass and I found it so.
Just as Massa told me, oh!'

"It is a peculiar sort of life that we lead together, and one
which could be experienced nowhere else than in such a place
as Blockley. Many jolly evenings have we passed meeting
haphazard in one another's rooms or in the billiard parlor.
Our conversation is not always directed in strictly scientific
channels. In the freedom of friendly intercourse much is
expressed and related that would cause some astonishment
in a community of very conventional or pious people. But
all of this is interspersed with talk of peculiar or interesting
cases in our wards, and discussions as to their etiology and
treatment. In the daily, almost hourly, contact with one
another, we have learned of each other's characters, of all our
weak points. Then, in our isolated positions, we are engaged
in common work and interested in the same subjects. It is
much like college life, yet differs from the latter in this very
fact of a common occupation. We have been a united family,
not one row breaking in on our general comfort. We are far
from being a mutual admiration society, however, for I imagine
that we all see each other's faults although somewhat near-
sighted as to our own. But this very knowledge causes us to
avoid dangerous ground, or to accept the shock good-naturedly
when we do touch, or are touched, upon tender spots. All
this will soon be over and we shall separate far and wide, as

68

hundreds of other residents have done before us, while new
men come in to fill the vacant posts. But I believe that, with
the experience of practice and insight into human character
gained in our everyday work, we shall carry away also the
unseen, almost unfelt, influence of each other's lives, and shall
look back upon our Blockley days with as much satisfaction
for the experiences and friendships as for the opportunities for
medical training."

"Out After Game.

June 6, 1884.
"The afternoon suggested August in temperature, but only
June could produce such a blue sky and foliage of such fresh
and vivid green. Having loaded two holders with plates,
I tucked my tripod under my arm and stalked forth after game.
Game there was in plenty. All along the outwards front,
lolling lazily under the shade of trees or walls, or strolling along
the shadow covered walks, the old outwarders offered all that
could be wished for in the way of ragged picturesqueness. Nor
was the usual requisite amount of filth wanting to make the
subjects well-nigh perfect. Passing through the gateway into
the Hospital yard, I came upon a different class of humanity
yet of about the same grade. This was younger stock. A
few more years and these younger subjects will be found across
the wall advanced one more degree in the order of Pauperism.
A former Superintendent of Blockley, who must have been
fond of phrases and aphorisms, once remarked when speaking
of its inmates, 'Once a pauper, always a pauper.' Over the
archway of our entrance should be carved the well-known
legend, 'Abandon all hope ye who enter here!' The association
between Hospital and Almshouse is degrading and demoralizing.
Most of our patients belong to the discouraged class of citizens,
when not to the actually vicious. The habit of looking to the
Hospital and its associated department, the Poorhouse, as an
easy and natural means of support develops easily in people

69

without pride, energy, aspiration, and without any means of
support. We are well supplied with habitues who enter either
Hospital or Almshouse on the slightest excuse, and the influence
of this class of professional bummers, men and women, over
the younger patients with whom they associate in the Hospital
is all for evil.

"On I went, past groups of convalescents sitting on benches
beneath the trees or lying on stretchers in shady angles of the
walls. High up along the balconies of the fire-escapes, up on a
level with the tree branches, sat those less strong than the
patients below, who must be content to use these perches.
And not so uncomfortable are the lofty seats, for one obtains a
fine view there over the yard and what transpires therein, and
there is always more or less of a breeze. Halting by the Hospital
gate, I bring my camera into position and 'take it'; then out
into the great yard of the men's outwards. Far off, up by the
wall of the Insane Department, I see a large group of old men,
halt, blind, broken in every way. Two are sitting side by
side, apart from the rest, beneath a shadowing tree. This
is good for a foreground; then, back of them, the larger group,
and, as a background, the high, whitewashed wall of the Insane
Hospital, with its low, wide, gloomy arched gateway where
stands the porter's box. All about are trees with thick foliage.
The sunshine falls glaringly white in the open spaces. There
is stillness everywhere, except when broken by the low hum of
listless conversation. All this scene must be taken ere yet my
subjects are aware. Carefully the camera is placed and focused.
Everything is ready. Just then, the two old pals look up but
maintain their position. Six seconds, and I have them forever.
One other group now before I go! There is a heterogeneous
collection, all on one bench. At its end is an individual leaning
forward with elbows on his knees and hands idly clasped. He
may have been a pirate, pickpocket, or peddler. I do not
know. He was bad at all events. Next to him, sitting bolt

70

upright, is an old man with a long beard and a rather respectable
face. His hat is aslant, just a bit to one side. He may have
seen better days. Beside him is a helpless, weak-faced-looking
object, incompetency and shiftlessness written all over him.
Then come two nondescripts, characters that are nice and
bummy, but not especially typical of any specialization in the
down and out class. I take them in one lot, and then stop by
the door of the store to have a short talk with the storekeeper
and Mrs. H., the schoolma'am. The store contains a little
of everything. It is like a large country establishment, and
has groceries, dry goods, pottery, hardware, all the articles
needed about the institution. Books are kept with each depart-
ment and payments are made by written orders, which are
countersigned by the Superintendent. Next I stray out through
the under passages beneath the Superintendent's quarters and
reach the street. There is an attractive view from the outer
gateway of the Insane Department, looking eastward. Beneath
the trees which meet above it, forming an arch of limbs and
foliage, runs the street, which is really a country-like lane,
called Vintage Avenue. Along one side, separated by a high
fence and narrow garden, extends the front of the Almshouse.
The central part, with its Ionic columns and Greek attic, can
just be seen high up above the level and gleaming through
the trees like an old temple. Beneath the verdant archway
goes the road into an indefinite vista, while, along its right
side, sloping downwards towards the river, extend meadows
now planted with various crops of vegetables. Going back
through the front buildings, I enter again the great courtyard
and take my way down to the Hospital. The sick are still
there, breathing in the fresh outdoor air, looking at the grass
and flowers, hoping perhaps for a better future. I am sure
that the little children do. To them life has not yet opened up
all the horrors of its possibilities. Some on crutches skip gayly
about the walks; and that little, sweet-faced girl lying in her

71

wheel-chair, a look of quiet contentment on her face, was brought
by me in an ambulance, last winter, from a miserable hovel
way down in the slums; from a small crowded room up three
flights of narrow, winding, rickety stairs. There she had
suffered an existence in the midst of foul air, foul talk, and
foul lives. Beneath a long awning fastened to the top of one
of the high walls and extending out over quite a space of ground,
is seated a row of women of different ages, while an old man
in a rusty long black coat and with a dilapidated, worn-out,
black silk hat is entertaining them with an eloquent address
or lecture. His hearers interrupt him with frequent bursts
of laughter and piquant repartee. The old gentleman's body
is slim and spare. His nose arches downward, like a beak,
to meet his pointed, protruding chin, made more prominent
by his sunken lips where the teeth have long been absent. I
cannot make out the subject of his talk to-day. Generally it
is a rambling disquisition upon his own varied abilities as a
singer, orator, man of the world, and temperance advocate.
He is a strange, addle-brained, harmless old man who, not
confined to the insane side, wanders about all over the institution.
He collects newspapers and gives them away to the inmates,
and thoroughly enjoys exercising his power as a conversationalist.
One of his chief r61es as an entertainer is his ability to sing one
song in twenty-five different tunes. The song is 'Old Hundred,'
and he not only employs this variety of tunes in its rendition,
but he indulges in a great range of keys and variations in pitch.
From moderately deep but very strained bass he soars suddenly
to high, shrieking falsetto. He knows also a large number
of temperance songs in high praise of water and low estimation
of wines and liquors. He considers himself to be one of the
really distinguished characters of the place, and, when feeling
that an occasion demands that he should appear to full advantage,
he dons a cap, made by himself, of striped ticking, shaped
with a peak and decorated with tassels and a number of brass

72

objects which the old fellow considers to possess an immense
value. Thinking that, even with this remarkable and striking
headgear he yet lacks the one thing needful, the final touch,
to finish the correct costume worthy of his importance, he
formed a large pair of spectacles from an old cigar box and
fitted it with window glass in lieu of lenses. It is seldom that
he presents himself in this complete and overpowering 'war
paint'; but, thus accoutred, I once found him in the entrance
hall at the Front, and, having my camera with me, I persuaded
him by dint of much barefaced flattery to step out upon the
pavement and 'be taken.' So I have his picture somewhere
among my collection standing in all his armor, in the peculiar
attitude which he fancied best suited his splendid presence.
Poor old man! His harmless little life goes on here from day
to day, sheltered from the rough jeers of a thoughtless and
heartless world. Here he is taken more or less seriously or
good-naturedly, and I believe that many fellow paupers, im-
pressed by his manner and pretensions, value him almost at
his own estimate. It was late into the afternoon when I climbed
the long stairs to my room, put the camera into its corner, and
fixed up preparatory to making my evening rounds through
the wards."

"Conspiracy.

June 17, 1884.
"For several weeks past M. has been desirous of a grand
combined attack upon Mr. S., the Superintendent. His room-
mate, R— 1, having gone, M. feels that it devolves upon him
to maintain the aggressive position of the resident staff towards
the tyrant of Blookley, Mr. S. has always regarded us with
suspicion, has employed his 'runners' to note our behavior
and spy upon our acts. A cause for war was not wanting,
for the table, during the month passed, has been growing steadily
weak in quality although the supplies have been abundant.
In January, a similar condition of affairs had called forth nuraer-

73

ous unpleasant comparisons from myself and others, even in
the dining room, which, coming to the ears of the ruler and
governor of the feast, had aroused his wrath and indignation.
He summoned us all to a conference in which he revealed all
the secrets of his housekeeping, the prices paid for all our table
supplies, together with the amount of the appropriation made
by the Board of Guardians for our maintenance. He closed
his very candid explanation by requesting us to come directly
to him with any complaints about the table, in the future.
All seemed well, for a time, but beneath the apparent candor
of the Superintendent's behavior was concealed much dark
and deep distrust. On our part there had always been a very
positive dislike of the head of Blockley, and we were disposed
to suspect him of insincerity and a desire to make us uncom-
fortable. We did not like him and he did not like us. All this
situation could have been endured, but the food began to
deteriorate again. This was too much; tough beefsteak,
roast beef that was uneatable, and a diet weak at every point.
So M.'s opportunity developed. He proposed that we should
make a demonstration before the Superintendent, in order
to bring him to terms. M. is usually a quiet and peaceable
man, and I could not understand his thirst for the fray. How-
ever, I promised to join him with the rest, mainly to keep
company and for the sake of some possible element of amusement.
Saturday night was selected for the time of our explosion.
Now it so happened that, on that especial night, we had an
unusually excellent dinner. Mutton chops were a part of the
fare, of such good quality that I partook of four of them and
ate largely and with zest of everything else. My companions
seemed to be indulging quite as freely in the substantial elements
of our feast. The absurdity of the affair struck me while eating.
Here we all were, eating largely of an excellent dinner, and,
when finished, we w-ere about to descend to the office of the
Superintendent and inform that official that he was only half-

74

feeding us, and that his viands were worse than worthless;
that they were positively dangerous to our health. However,
we had the memory of many bad dinners, and we were about
to assert ourselves after long forbearance, and stand up for
our rights.

"McL., the Warden, had received a chop that was decidedly
questionable as to freshness. We would have desired rather
stronger evidence, but this could serve as something right in
hand for complaint. Suddenly H — n came in with a friend.
He ordered steak, as the chops had all been consumed. The
steak appeared. He took the dish, smelled at the contents,
exclaimed, 'My G — d!' and threw up his hands in a gesture
that might be interpreted as hopeless despair. Of course
every one laughed; but M. seized the dish and, getting on
his feet, began haranguing an imaginary Superintendent, holding
the plate in one hand and gesticulating with the other. The
plate was then passed all about for our inspection, and, of
course, we all pronounced the steak to be very foul and noisome.
M. took the lead and we all stormed down the stairs to the
Superintendent's office. McL. slipped out before our onset,
and had warned the Superintendent of the coming fray. Mr.
S. received us coldly, and with a frown upon his face. M. at
once began his attack.

"'Well,' said Mr. S., 'what do you complain of?'

" 'Well, Mr. S., I will begin with the breakfast. The steak
is so tough that no one can eat it. The butter is rancid and — '

"'The butter is all right,' broke in S. 'It's the very best
creamery butter.'

"H — n mildly suggests here that 'It had a very queer
taste.'

"'Yes,' said Mr. S. 'That's garlic; it's in the grass.'

'"Mr. S.,' said M., solemnly, looking the Superintendent
sternly in the eyes, and speaking as though he frequently fed
on grass and knew its peculiarities, 'I never tasted anything

75

in grass like that. No, sir, it is rancid. Then the milk is
sour or smoky, and we can't drink it. The beef is never eaten,
but goes away untouched. To-night the meat was spoiled,
and had the odor of — '

"'I see nothing out of the way with the steak,' interrupted
Mr. S.

"Mr. S. has lately deserted our common dining room and
has all meals served in his own private apartment.

"'At the resident physicians' table, Mr. S.,' said M., most
severely, 'there is very much out of the way.'

"'I have the same fare as you,' snapped Mr. S.

"'Then, Mr. S.,' said M. slowly, and with a tone of great
sadness in his voice, 'you do very wrongly and foolishly to
bring up your family upon the kind of food we receive.'

"'That's my own affair,' interrupted Mr. S.; and then,
as though he counted it as a telling stroke, he added sternly,
'You can speak of me all you wish, but you shan't bring in my
family.*

"M. apologizes instantly for anything that would have
implied this discourtesy. The talk drifts on. We all take
a part. It is finally agreed that the money appropriated for
our table shall be spent upon a few really good articles, with
less variety and no unnecessary viands. Thus shall we strive
to have a few good things rather than many indifferent ones.
This seemed very nice, philosophical, and within good common
sense; but the Superintendent took the matter to the Board
of Guardians, who referred it and us to the tender mercies of
its Committee on Diet and Classification. This committee
considered the whole affair, and determined to classify us as
unreasonable rebels, and the diet as too good for our over-
delicate and too particular appetites. And we seemed to be
on such very strong ground! Yet thus failed our grand demon-
stration."

76

"By the Way.

June 24, 1884.
"The Hospital clock, strangely right, has just struck the
hour of ten. It is very warm to-night. Scarcely a breath
of air is stirring, just enough to rustle the leaves of the trees
beneath my window. From far away somewhere comes the
sound of a piano, probably in some house on Darby Road. I
am alone to-night. V. has gone, leaving Blockley forever.
Last evening he began the work of packing his trunk, and
continued thus engaged far into the night. I had gone to bed
and to sleep before the trunk was filled. Business took him
to the City this morning, and I met him, just as with hands
filled with plate-holders I was on my way to the pathological
laboratory, darkness, and the red light. V. was rushing about
the Hospital in high spirits, shaking hands with the nurses
and bidding farewells. I walked with him over to the Front
and down Vintage Avenue to the Weigher's Corner. He was
full of jollity and life, glad to get away and evidently hopeful
of the future. So I left him, — at his best. We have lived
peacefully together, in the close association of roommates, for
almost one year. He has many faults and so have I, and we
recognize each other's defects, but have never insulted one
another with criticisms based upon our experiences of one
another's temperamental weaknesses. V. has endured much
discomfort at my hands without one word of protest. When not
engaged in squeaking and scratching on my fiddle, I occasionally
fire my revolver at a thick target placed against the headboard
of my bed. The only redeeming feature of my conduct has
been my respect for my roommate's side of our joint apartment.
I am sure that he would have thrashed me soundly if I had
trespassed. There must have been times and mental moods
in which V. found these diversions somewhat trying to his
nerves. The pistol practice has usually been indulged in when
he was away from the room. All this will indicate that V.

77

can be a very patient man. I wish to remember him always
in that mood in which we parted. It will surely be long before
we meet again."

There is a lapse in the journal of almost six months. This
marks the time of strenuous service in the medical wards.
It was in the heat of summer. The visiting chief had gone to
Europe for a vacation tour, and the doctor of the diary con-
ducted his ward work as best he could with his very limited
training.

The medical wards of Blockley were among the most valuable
in any hospital of the City for their varied experiences in all
sorts of acute, but more especially in complicated chronic
diseases. The necessity for constant service in these wards,
study of the patient's conditions, the reading of books and
journals, consumed the hours of the long, swelteringly hot
days. When night came there was little desire left for any
literary efforts upon the diary. Doubtless it is the steady
strain and tedious drudgery of this service, during the exhausting
heat of Philadelphia's summer, that influences the tone of the
journal when the young doctor resumes the record of his life
in Blockley.

The term of work in the medical wards lasted four months.
There was a wealth of cases of pulmonary tuberculosis that to-
day would not have been admitted to the Hospital, or would
have been kept apart in a separate building. In those days the
pulmonary tuberculosis cases \vere not separated from other
patients, although an effort was made to place most of them
in one large ward. In this same department was a narrow
ward, containing about ten beds, called the "Drunk Ward."
It was seldom at any season of the year that most of the beds
in this chamber of horrors were not occupied. Many of the
patients were strapped to the frames of their cots, so as to
restrain them during the stage of wild delirium a potu, when the

78

sodden mind is in a state of terror under the fancied visions
of devils, evil spirits, goblins, snakes, and all unclean beasts,
that hover about, gibber at the victim, jump at him, and clamber
over his bed. Many of these patients we saved by dint of
careful watching and proper medication and nourishment.
The fight seemed to be hardly worth the effort, as the drunkard
was sure to return to his cups, and a recurrence of delirium
tremens was as certain as the early termination of the miserable
life. The fatal cases of this condition died usually from broncho-
pneumonia, from sheer exhaustion, or from an intercurrent
chronic disease of the liver, kidneys, or heart; sometimes from
a combination of such diseases in the same subject. It was
not a pleasant part of the medical service, and yet always in
evidence and always demanding close attention. These rather
dreary days have carried the diary man on into August, before
the journal begins once more to tell its story.

"Impressions and Memories.

August 5, 1884.
"I have had a busy afternoon. After working for about
two weeks in the Pathological Laboratory, which is nothing
more nor less than a lumber room for rubbish, M. and I made
a grand clearing out. The room is entered from the great clinic
amphitheatre, its door being at one corner of the great square
hall on a level with the upper gallery. The gallery itself, on
the side occupied by the laboratory, is walled with glass cases
containing specimens in jars of alcohol of almost every phase
of morbid anatomy, gathered through long years from the
post-mortem room. M. and I changed the positions of tables
and cabinets, so as to gain more space in the room, moved out
a mass of useless material which dated far back to former years
and had labels signed with the names of resident physicians long
ago forgotten. Then we swept up the filthy room, and J.,
my new roommate, washed the floor thoroughly with a mop.

79

The room is thus much improved, and will be more comfortable
and convenient. It was quite an act of unselfishness, for M.
and I can only benefit by the renovation for the space of three
more weeks. It has been a busy summer and will always be
an isolated one in my memory. The departure of the older
resident physicians, who belonged to our special circle, and
work in common, have thrown M. and me much together.
In some respects it has been the pleasantest part of my Blockley
experience. Only now and then comes a desire to be away up
North; but work soon causes forgetfulness of everything except
itself. To-night is a real August experience, not quite so enter-
taining as a midsummer night's dream. It is hot, close, and
damp. My gas is fully lighted and adds to the general heat.
Outside, there is not a breath of wind. The leaves hang lifeless
in the hot heavy air. Lead-colored clouds are above, in irregular
masses or drawn out into long ragged rolls. There is a constant
low vibration of insect sounds, broken occasionally at irregular
intervals by croaking choruses of frogs, coming up in a sleepy
monotone from the low-stretching country along the river.
Above this mixture of the noises of a night in summer, floating
across the fields from Darby Road, comes the jingle of an occa-
sional street car, with the clatter of the horses' hoofs upon the
cobblestones and the dull rumble of the wheels. A few notes
of a far-off piano mingle with these various sounds and tend
to increase, instead of to soothe, the general sense of oppression
so characteristic of a night in Philadelphia's August.

"In contrast to all this I cannot help recalling past summers
at Kennebunkport on the coast of Maine: the quiet river;
the old drawbridge and seaweed covered wharves; the quaint
village, elm-shaded, its wide square houses with dark cool
rooms within filled with old mahogany furniture and with East
India relics that recall lives of old sea-captains, long voyages,
and foreign ports and return to quiet, well-ordered homes.
They belong to an old-time epoch, these homes; but, in the

80

hush and twilight of the present, one fancies that he hears
faint voices and the laughter that echo the life and gayety and
pleasant social ways of generations past. I see in memory
the long line of rocky coast, sweeping away in circling outline
till it ends in a far-off misty point of ragged cliff. Across the
bay towers up the cone-shaped, flat-topped form of Mount
Agamenticus, while seemingly at its very foot gleam white-
housed villages, with here and there a church spire rising as a
beacon above the general level. Then there were the excur-
sions, the moonlight nights on the river, freshened by sea breezes,
while even the land winds were cool, freighted with the incense
of pine forests. There are upland pastures, rocky, covered
with low scrubby growths of fragrant sweet fern and blue-
berries and bay. Stretching far and wide, they lay warm in
the summer sunshine. From barren, wind-swept summits
wide landscapes spread out, bordered inland by dim, blue-
lined mountains, seaward by the ocean's flashing, changing, vari-
tinted surface; and over all a summer sky of blue, flecked with
snowy masses of slowly moving clouds. Away over the bare,
undulating country, narrow roads go, winding between irregular
stone fences over which wild vines grow in tangles, some of
them bright with flowers. I am on a road that enters a forest
of tall hemlocks where every sound seems hushed. To either
side long vistas stretch away over the clean-kept forest floor
strewn with cones and needles, flecked with spots of sunlight.
There is a spring by the narrow roadway, moss-lined, formed
in a crevice of the solid rock. Beside it lies an ocean shell for
cup, and, from the spring, a fine clear rill of water flows away
beside the road as it goes onward. There comes a break in
the line of trees; a turn in the road; and, right ahead, through
the long dark foreground in perspective, bordered by tall,
gaunt, ragged pines, bursts forth a view of the ocean's cliffs,
and the sea itself lies in purple splendor just beyond.

"These are some of my memories, to-night, as I sit in my

81

hot, stuffy, hospital room, hearing the mixed, inconsistent,
and incongruous sounds of suburban Hfe. Near at hand are
the wards filled with suffering, complaint, deceit, vice, crime,
and amid all this wretchedness a few heroic lives living on from
day to day, friendless, dying by inches in an Almshouse; and
yet with brave, patient faces, with sad but ready smiles awaiting
the end. Good and bad, these are my brothers and sisters
in the flesh, as God and afterwards the Devil made them; filled
with desires, with lusts, with ardent passions, all dominated
by intense selfishness. Call them modern barbarians? Nay,
friend! They are not so very different from yourself, your
respected parents, your brothers and sisters, your esteemed
wife, bereft of the conventionalities that blossom under the
mellowing influences of social culture and inherited instincts
of refinement. What can be done to help them into better
living? Thus far we seem to play about the outskirts of these
vast multitudes with our Church, our Benevolences, our Science
of Social Order. The priest speaks to Christians who sit on
cushioned seats, object to any crudities in the literary style
or substance of his sermon, listen to the soft ecclesiastical music,
view the mystery on the marble and guilded altar lighted by
the ecclesiastical light from ecclesiastical stained and pictured
windows, and then return to well-laden tables and well-cooked
Sunday dinners. Some dollars have been dropped into the
offertory under an impression that thus somebody is going
to be clothed and fed and led to see a little of sweetness and
light. The benevolent direct, contribute money, and engage
in learned discussions on the way to manage those strangling,
struggling, submerged multitudes ; and they may give temporary
material help to a few, so few in proportion to the mass, that
it resembles a child's offer of an apple to an elephant. They
scratch the surface of the vast marsh. But it needs to be
drained, trenched, filled in here and there, before it can bear
the fruit of bettered lives. It is a tremendous question, needing

82

management on a large scale. I doubt if anything more practical
than the developing of a mild and moral amusement for members
of churches and private societies can be gained by such effort.
It is so great that it needs the care of the nation, of a government
that can act as parent to this mass of grown-up and mentally-
delinquent children; a government that can educate, separate
the hopeless from the more efficient; that can coerce, compel,
punish; and all this on the basis of laws that are just but which
never fail of execution.

"Meanwhile, there still exist St. Mary's Street and Alaska,
Bandbox Row, and all the squalor of Port Richmond, long
lines of misery on Front Street, Second Street, on so many
streets that one cannot name them. It is at your next door
or in the alley behind your house.

"And so, what is the conclusion of this August night's
rambling thoughts? I cannot answer. A year of Blockley
life stands between me and much that seemed established and
forever, before I entered at these gates. The experience has
been somewhat demoralizing. At all events, the experiences
of Blockley and its inmates and our vast stretches of slums
combine to induce a sense of contentment that I am just a
plain, unimportant, and unknown medicus rather than a Hamlet,
born to a station and responsibility where he must exclaim: —

"'The time is out of joint; — O cursed spite!
That ever I was born to set it right!' "

Bacteriology in its modern aspects was at the very beginnings
in the days of the diary. The splendidly equipped laboratories
of all great modern hospitals, with the efficient specialists in
charge, were represented by the very meager and primitive
appliances described in the journal. Young men were beginning
to visit the institutions of Germany, and training thus acquired
was to develop a great change and most needed improvement
in all departments of American hospitals and medical schools,

83

but especially in those that related to the scientific study of
Pathology in all its phases. And yet the members of the resident
staff at Blockley in that antediluvian time, — somewhat better
than the Stone Age, it is true, — took themselves and their
laboratory work rather seriously, although the modern Patholo-
gist would have been amused, as well as saddened, at the waste
of valuable material for investigation, the primitive methods of
work, and the great lack of necessary training and information
and definite plan of action on the part of these young medical
scientists.

"The Pathol,ogical Laboratory; A Sacrifice upon the
Altar of Science.

August 8, 1884.
"In the Pathological Laboratory, the other afternoon,
it was found that we had need of the fresh blood and other
tissues of an animal. The laboratory is a small, well-filled
room way off in one corner of the clinic building. It overlooks
an old courtyard, high walled and carpeted with tall grass
except where clotheslines, hung from one old rugged tree to
another, have caused clearings of trampled grass to be made
by the capacious feet of the washerwomen. Cats, wild in
nature and appearance, infest this antiquated and secluded
quarter, and prowl in the shadow of the high stone walls with
their jutting eaves of tiling. In the laboratory we are working
up the subject of bacteria culture under the direction of Dr.
S. McL. suggested the sacrifice of a cat. This seemed to
answer our requirements, and he and M. went off in search
of one. But the Blockley cat is a wise animal, and looks upon
doctors only from high roofs and far-off vistas. McL. and M.
returned empty handed, but they had set a small boy upon the
warpath. His instructions were to bring any cat alive, no
matter from what quarter of Blockley it came, except a certain
black and white cat that lives in the Hospital Kitchen. This

84

cat, being pregnant and well on to full term, was to be respected.
The boy returned in the course of half an hour bearing in his
arms none other than the very forbidden female. He assured
us that she was not pregnant; never had been; might never
be; but his persuasive powers were in vain. He was ordered
to take her back and produce another within half an hour.
The fellow must have chased all over the institution, but he
appeared finally v/ith a large, indignant, and irate Tom-cat
struggling and spitting in his arms. Now McL. is not one
of our scientific circle but a mere interloper, and he has an
agreeable way of making a cat's-paw of any one. True to
his habit, he now proposed cheerfully that he would give the
victim chloroform while I held the excited beast. By this
time the cat, being released, had bolted to the nearest window
sill, was howling most dismally, and presented a perfect battery
of teeth, claws, and luffed up hair to any one who approached.
The prospect was not peaceful or pleasing, and I suggested
to Mcly. to go and soothe the Tom before I did the holding.
McL. would rather have sat on a hot stove than touch the
enraged and frightened Thomas. However, as we all laughed
at his backwardness, he finally determined to attack the enemy.
The cat was his own suggestion, and, in addition, he had no
especial association with the laboratory work. We felt that,
under the circumstances, he should be glad to make himself
useful. A small, strong box was brought. McL. plunged for
the cat, landed him in the box, and called loudly for me to
put on the cover and pour in chloroform. This I did, and the
cat died without any evidence of suffering. We obtained
all the needed material for our work, and then the poor dead
pussy v/as placed in a clean box, covered with cotton, and
ordered to be taken to the Potter's Field.

M., J., and I are up in the laboratory almost every after-
noon, and the work there consumes most of one's time from
dinner until supper. It is a queer place. On one side are vessels

85

of tin and felt with water jackets. Rubber tubes run in various
directions about the room from a central gas pipe. On shelves
along one side are crowded bottles containing every imaginable
substance from the bodies of former patients, all preserved in
alcohol, labelled with the names of former owners, and awaiting
to be prepared for the microscope. On other shelves are glass
pipettes of every size and shape, glass retorts and flasks, test
tubes, and many strange and rusty machines long unused and
the ver)'- uses of which are forgotten. Tables by the window
are covered with glass slides and cases of instruments. A
large cabinet in one corner holds our microscopes and the various
appliances which must be kept from dust and dirt. In the
centre against one wall is a small closet, absolutely light tight,
painted a dead black within, and containing numerous bottles
together with a large lantern with red glass. This is the finishing-
room for photographic work, and many hours have I spent there
in developing my views of Blockley scenery, of its life and
customs and queer inmates.

"Such is the Pathological Laboratory; never a cheerful
apartment, but most dismal towards the close of a dark, wintry
afternoon. Then cold, fierce winds come sweeping down into
the high-walled courtyard, sway the gaunt old tree tops, whistle
shrilly along angles and into corners. The tall, dreary wall
of the Hospital buildings, with its blank, dark windows, cuts
off all western light and makes an early gloom down in this
retired spot. Then it is that the bottles take on queer shapes;
that shadows seem to betoken more than their full value of
significance. One has the feeling that then, if ever, the souls
of departed paupers may revisit this alcoholic charnel-house,
and gaze with eyes of personal interest upon the aspect and
conditions of their preserved viscera."

86

"One Summer Day.

August 16, 1884.

"At ten o'clock in the morning, three youths ran down
the long stone steps of Blockley's front entrance and walked
rapidly away down the shaded lane to Thirty-fourth Street.
The tallest, about six feet two inches, was clad in dark blue
trousers, along the outer seams of which ran stout but tarnished
gold cording. His coat was of some mixed stuff, while his
head was covered by an old weather-beaten, Blockley uniform
cap. His name was M. The second youth was arrayed in
dark trousers with fine light stripes varying their duskiness.
He wore a black diagonal cutaway coat, and sported a modern
light felt plug hat; a very correct costume. This was P — Ips.
The third was clad in a well-worn suit of greyish-green mixture,
with trousers rather bagging in the knees and in sad need of
pressing. A dilapidated old Blockley uniform cap was his
headgear. This was the diary man.

"We took a car and rode to the steamboat landing at the
Zoological Garden, and came within an ace of missing the
boat. By dint of rapid walking and running we stepped on
board in time, and were off up the Schuylkill River for Riverside.
It was a brilliant day; cool, with a clear atmosphere and a
cloudless blue sky. Every point on trees and on buildings
stood out in sharp relief. The steel grey of the river, with
its banks .of vari-tinted green above which the hills rose in
smooth grassy slopes, glistened and flashed in the bright sun-
light. A cool breeze blew from the west and the weather was
perfect. On reaching Riverside we sat down on the long porch
of the ancient tavern, overlooking the grove with its many
small tables and music pavilion, and fortified ourselves with
sherry cobblers. Then we started for our walk up the Wissa-
hickon. On our right the steep bank descended directly to
the river, while the left rose in forest-covered heights, and huge
boulders and clift's jutted out along the pathway in strange,

87

grotesque forms. I had promised my friends much good scenery
on this expedition, and M. and P — Ips assumed an air of appre-
ciation by sudden starts and stoppings, dramatic gestures,
and rapturous exclamations in exaggeration of feeling and
expression. They had their fun at my enthusiasm for the
landscape, and our laughter and joking took much breath and
wind that was needed for hill climbing. We passed several
picnic groups, and finally, in a secluded nook, came upon a
long, rustic table at which were seated two rows of girls clad
in black jerseys and white dresses. These maidens smiled
very pleasantly upon us, and P — Ips suggested that they were
quite ready to invite us to dinner. The invitation was at
once forthcoming to the extent of a cordial offer of lemonade.
They brought out a tin pail and passed the lemon-flavored
drink around. It was amusing to see P — Ips standing with a
whole group of laughing girls about him, his white felt hat
tipped back on his head, holding the half-emptied glass in
his hand and smiling most benignly upon his entertainers.
M. was much admired by the ladies, and one black-eyed siren,
especially, stole to his side and darted enraptured glances at
his handsome face. The. girls told us that they were the
'Daughters of Veterans.' On being asked where the sons were,
they said that the sons were all at work, but would join them
in the afternoon.

"On we went along the wild beautiful road that has no
equal in any park in the world; that is like a remote gorge
among rugged mountains far from the haunts of men and Block-
ley patients. The cool air was heavy with mingled perfumes
of forest and moist river banks and flowing stream. It was
a day to be stored away in memory. Life seemed free and
before us, and we had escaped from the gloom of Blockley
and were off with nature under the greenwood tree. We dined
at the Valley Green Hotel, an ancient road house. Then
we continued our walk far up the valley, until the lengthening

88

shadows warned us that the afternoon was waning. We turned
back and walked in the cool dusk of the deep and now sunless
gorge. A bridge takes us across the little river, and we climb
the long hill by a road which runs through woods so dense
and heavy that at noon they are in twilight, and arrive finally
at the Wissahickon Inn. We walked all over the lower floor
of this spacious hotel in search of the bar, but were informed
that there was none. This news was quite disappointing,
especially to P — Ips and M., who had become excessively thirsty
and claimed to be in dire need of stimulants. Then we strolled
over to the railroad station and returned to the City by train,
arriving at Blockley in time for supper."

"On the; Eve of Departure;.

August 30, 1884.
"The position of a Blockley resident physician has always
been one of authority. In the former years, before the competi-
tive examination regulated the choice of candidates; in those
balmy old days of the old Board's reign, at that time when
every Board meeting is said to have closed with a wine dinner
or supper; in those lazy, shiftless, and extravagant days each
resident doctor had his especial Guardian who would always
support him, and upon whose friendly and powerful aid the
young doctor could call, whenever he found himself to be wedged
in a 'tight place,' either professionally or morally. This relation
between Guardians and doctors is said to have been so intimate
and cordial, that the gentlemen of the Board and resident
staff got drunk together. This is surely a test of very close
friendship. If the pauper inmates of those times numbered
among them as many individuals as capable of social and con-
vivial enjoyment as some of my patients in wards and outwards,
an assorted and carefully selected number of elect paupers
might well have joined in the festive combination of Guardians
and doctors. The merriment of the occasion would not have

89

been lessened by their presence. As a natural result of this
close association between the Guardians and the resident doctors,
the latter were regarded with profound respect by all Hospital
attendants and officials. Gradually the resident medical men
acquired more and more authority, until the resident physicians
almost owned the Hospital. Into such a place as this we, coming
from stations in which we had never held much authority,
were suddenly placed upon our merits, not by appointment
but by competitive examination. Our relations with all under-
officials, nurses, and pauper inmates were almost those of masters
and slaves. After living in such circumstances for several
months we became naturally overbearing, dogmatic, and, it
must be confessed, more or less brutal. We met the slightest
curtailment of our rights with indignant protest. Trouble
came at last. We were at odds with the Superintendent.
But now there was no Guardian for each man to visit. The
Board at once took grounds against us and supported the au-
thority of the Superintendent. There is a certain degree of
unfriendliness and suspicion that has developed among the
heads of the various departments of our institution. This
forms a rather interesting picture of phases of institutional
life. I imagine that such epochs of internal strife occur at
times in most institutions, public as well as private; the various
heads of departments all at enmity, the under-officers joining
the factions of their respective chiefs, while every one is pretend-
ing to be cordial or at least diplomatically friendly. Perhaps
Blockley just now needs another meeting of that efficient,
antirevolutionary force, the Committee on Diet and Classification.
M. and I had even thought that we might experience some
difficulty in having our baggage removed from Blockley without
some troublesome interference, as the time for our departure
had arrived. The authorities could hardly suspect us of an
attempt to pack away a pauper in our trunks, but might fancy
that we had purloined some bit of Blockley to serve as a memento

90

of our experiences. M. and I engaged the express yesterday
afternoon, and this morning at seven o'clock it arrived. The
heavy trunks and boxes were loaded into the wagon, and our
goods were passed out through the gates.

"The walls of my room look bare to-night, and the room
itself has a cheerless and forsaken appearance. This afternoon
I worked for the last time in the laboratory, where I have spent
so many afternoons. I could overlook the quaint old courtyard
with its high stone walls and ancient trees. The cats that
prowled through its long grass have most familiar yowls, and
should I ever hear their peculiar pitch of voice, no matter in
what corner of the world, I shall always think of the old, sleepy
courtyard overlooked by the laboratory with its preserved
horrors. I finished my work, summarizing the results of obser-
vations made during the month, just as dusk was settling down.
For the last time there I heard the slow, deep tones of a neigh-
boring church bell ring out the hour that suggested supper.
For the last time, hastening to respond to the suggestion, I
put away the instruments and closed the windows. As I locked
the door and passed through the great empty and darkening
clinic room, with its huge amphitheatre of seats, I could almost
imagine them peopled with shadowy medical students of the
past and future, while from away down in the arena comes
the memory of a voice repeating the oft-heard words, 'The
next case, gentlemen, which I bring before you, is one of especial
interest.' The case will come in, and the lecturer will expatiate,
and the students will take careful notes and lose them on the
way home; but there will be new men to assist, for we are
about to step down and out,"

"The Fulness of the Time.

August 31, 1884.
"It would be an interesting work to sum up one's experiences
in Blockley and strike an average of how much good and how

91

much bad was contained in the result. But I believe that
these pages record considerable observations of that character
and, at the close, it might be well to drop a somewhat worn-out
subject. The close! Trunks packed and off and all the various
preparations accomplished that denote the final breaking up
and end of the term of service! To-morrow closes the journey
of the year and introduces us to new experiences. P — Ips
said to-day, speaking of changes, that he had no desire to settle
down for three years yet, but was going to be content with
'odd jobs.' For his part, he had no ambition beyond content-
ment; and if he had enough money to supply food and to buy
cigarettes, his strong hankerings after gold and glory were
but short-lived and came at intervals. He is a philosopher,
in his way, and one feels that his idea of living is a very com-
fortable one, at least in theory. Whether one could really
be content thus is a question. It is twelve, midnight, and I
have just had a call to visit one of M.'s patients in the 'Drunk
Ward,' a miserable sot who has come here with delirium tremens,
and is bellowing and roaring like a bull. Not having as yet
had the 'rams,' I fail to note much sympathy for those in that
unpleasant condition. Of course, one should have pity for
the miserable and afflicted; at least, the popular idea is that
one should have, whether the misery is self-inflicted or is the
result of uncontrollable circumstances. But sympathy as a
sentiment is at a low par in Blockley. One is so frequently
deceived, that he becomes disposed to attend to what is evidently
required, without much expenditure of sentiment. Regarding
the worthiness of an inmate for any more physical excitation,
we are forced by sad experience to regard the subject in an
inverse method from that common to the law, and to consider
him or her guilty until innocence is proven. I imagine that
there may be natures, rare it must be confessed, which can
progress in the study of human character beyond the knowledge
of man's evil traits, and see the elements of good even in the

92

Vvorst characters. This abilit}^ to rise above the conception
of human meanness and degradation is certainly a mark of a
greater mind than most of us possess.

"Life among unmasked humanity reveals a certain simian
degeneration that gives little encouragement to look for regenera-
tion and reform. It has at least the advantage of shocking
one's sense of moral security. The observation of human
hoggishness in others recalls one to himself, and he soon learns
that am.ong a world of hogs he himself may become none the
least of the swinish herd. The study of humanity in the rough
can well weaken one's smug confidence in himself. Why am
I not as bad as that sot whose alcoholic ravings at this very
moment are disturbing the medical ward? Possibly onl}-
because I have not had his surroundings. Why are the
apparently pure-minded ladies of this City not similar to those
wom.en who wait in Dandy Hall until the hour arrives for the
birth of their bastard offspring? Is it possible that the pure
would fall if subjected to temptations and influences such as
the impure suffer? But, instead of hinting at such a possibility,
if one could only believe that the low and degraded have much
that is good in their natures in common with the so-called
respectable! Perhaps it requires a much more extended
knowledge of the world, a deeper study of mankind, and a more
kindly temperament than I have had, before one can appreciate
the goodness of man. It certainly requires but a short time
to appreciate the bad. The proper spirit, born of prolonged
and intimate relations with various grades of society, must
be that which induces Julian Gray, in Wilkie Collins' 'New Mag-
dalen,' to exclaim, 'Who but a Pharisee can believe that he is
better than his neighbor? The best among us to-day may be
the worst among us to-morrow. The true Christian virtue
is the virtue which never despairs of a fellow-creature. The
true Christian faith believes in man as well as in God. Who
shall dare say to man or woman, "There is no hope in you"?

93

Who shall dare say the work is still vile, when the work bears on
it the stamp of the Creator's hand?'

"As yet I cannot fully appreciate these words. I am not
yet educated up to their standard of judgment and their broad
liberality and hopefulness. But I would like to let the para-
graph stand as an expression of hope in fallen humanity which
the murk of a year's life in Blockley envelops with a cloud of
doubt but yet not quite of denial. Life in the open, in an
atmosphere free from close contact with the slums, may give
a clearer and more optimistic point of view.

"It is far into the night. The new day comes, and with
it I and my comrades go forth into the outside world again,
among the ways of busy, active, robust men. It is like one
who emerges from the twilight of a sultry and windless forest
into the sunlight and breeze of ocean cliffs. And there he
sees his ship ready, straining at her cables; and all the exhila-
ration of life and effort calls him out where the heaving, rolling
water is blue and to the far horizon and into the unknown
beyond."

Almost twenty-nine years have run their course since
the journal of Blockley days was tossed into a box with other
papers and forgotten. Times have changed. Methods in
medical and surgical practice have been revolutionized. The
slums of Alaska and St. Mary's Streets have been cleared to
give place for a children's playground, or have experienced a
change of population. Russian Jews have settled where degener-
ates of the Black and White races once lived in promiscuous
intercourse. The large Italian Colony is quartered to the
westward of this area. The efforts of several private societies
for social betterment have been crowned with a success that
should encourage similar work on the same lines but on a much
more extended scale and affecting larger areas of the widely-
extended slum districts.

94

But the union of almshouse and hospital in our great cities
is still too often in force, and the shadow of pauperism darkens
the whole public institution. It is not essential that the poor
of a community should be petted. It is far better that justice
without sentimentality should prevail in all the conditions of
life. It is not a virtue to be poor. In this country of ours,
except for ill health or old age, the causes for absolute poverty
are apt to be gross shiftlessness, want of thrift, or are the out-
come of drunkenness and vice. Yet our fellow-citizens who
are poor because of physical weakness or ill health should be
cared for by the city as a part of the regular functions of govern-
ment, not as a charity grudgingly given. The man, woman,
or child who is forced to seek the shelter of the general hospital
of an}'' city should enter its protecting walls without a thought
of dread that such a step in any way is associated with pauperism.
Every society or church hospital admits patients who are cared
for without charge or who pay but a small nominal fee. No
thought of disgrace attends the acceptance of this free service.
Surely our great wealthy cities should care for their invalid
poor under the same honorable conditions. The medical
attention in all its details should be executed at least as efficiently
as in the hospitals conducted by various church organizations
or by private benevolence.

It is exceedingly strange that the conscience, as well as
the interest and good judgment, of our citizens has not long
ago placed the Almshouse as a department apart and separate
and entirely foreign to the City Hospital.

The writer of the diary and his colleagues separated to the
four winds. But each took his place in the plain rank and file
of his great profession, perhaps all the better equipped for
service by the knowledge of good and evil, of true and false
science, of loyalty and good-fellowship gained by the experiences
developed during one year of life in Blockley.

UNIVERSITY OF CALIFORNIA LIBRARY
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