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a period of eighteen months, lives in the hospital, but receives no other compensation. The first board of visiting physicians consisted of Drs. J. Taber Johnson and I. S. Stone, gynecologists, and Drs. J. Wesley Bovée and Louis W. Richie, obstetricians. Changes in the medical board have occurred from time to time, the present board consisting of Drs. I. S. Stone and J. Wesley Bovée, gynecologists, and Drs. Henry D. Frye and John F. Moran, obstetricians.

Mrs. A. L. S. Thombs as matron was succeeded by Miss G. I. Pope as superintendent. The new by-laws provided for the annual appointment of the medical staff and of the house staff, the latter to be nominated by the medical board. The medical staff were to receive pay only from pay patients, and the house physicians were to receive salaries. As a result of the sweeping changes that occurred during the year, the receipts from pay patients fell to the lowest point since 1881, to $2,574.71. In January, 1890, the receipts from this source were but $184; in January, 1891, when the change took place, the amount fell to $136; in February to $82, and in April to $68. In May, however, the new order was well established, and the receipts rose to $288, and in June the amount reached $562.

The new staff were almost as sparing of words as their predecessors had been. In their first report of eleven lines of print they say:

The increase in number of patients during the past six months (the period of our connection with the hospital) and the evidence of increased popularity of the institution, both at home and abroad, are very gratifying and give promise of still further usefulness. We are not, however, insensible to the growing demands for better facilities in order that we may keep the hospital fully abreast with the spirit of scientific progress of the day in treatment of both gynecological and obstetrical cases as well as in pathological research.

We, therefore, recommend that steps be at once taken to secure the erection of a suitable building, on the L street front, in which proper arrangements could be perfected to make this institution compare favorably with any other, both in facilities and in results of surgical and other treatment.

In 1892, Drs. Stone and J. Ford Thompson made to the directors a lengthy report of the gynecological department, showing that 137 cases had been admitted from the dispensary and 192 from other sources. Of these 126 were private patients. Of the whole number 144 cases were surgical and 175 required medical or other treatment. Of the surgical cases 51 were of such a nature as to require capital operations for their relief. After discussing the surgical treatment in the hospital, the report says:

As a large proportion of all patients are sent to the hospital by other physicians for surgical treatment, it necessarily follows that surgical operations are of frequent occurrence. Due regard is, however, paid to all other methods when available as a means of cure. This statement can be easily confirmed by anyone who may be sufficiently interested to visit the institution and observe the methods employed. In closing this report we again call your attention to the need of better facilities in the pathological department. We have no suitable room for a museum, and many valuable and rare specimens have been lost for want of facilities for their preservation. Again, there is need for a competent microscopist and pathologist.

The internes are daily in attendance upon surgical and obstetrical cases and can not be permitted to do post-mortem work. There is a great need in this city for a hospital (which may with propriety be added to this one) where women may have treatment for hysteria and allied nervous disorders, especially when these diseases are consequent upon or connected with those peculiar to females. Many women are great sufferers from hysteria, insomnia, and neurasthenia. They are not subjects for a hospital like this, nor are they to be confined in an asylum for the insane. They need rest, seclusion, and moral management, as well as proper treatment to promote a cure. It is beyond our ability to provide for this class in the present building. They prove to be unsatisfactory cases, and have a demoralizing effect upon other patients who are fit subjects for this hospital. They in turn are unduly excited or influenced by the usual and unavoidable scenes in a hospital where surgical cases abound. It is earnestly recommended that you may give this matter your attention. In the event of the erection of a new building for surgical work, a part of the present structure could be appropriated to this class of cases.

It affords us great pleasure to again allude to the growth in popularity of the hospital and its increased usefulness as evidenced by the increasing number of patients, especially in the private rooms.

Drs. Bovée and King, the obstetricians, recommended the construction of two (so called) "delivery rooms," and a room where examinations, dressings, etc., can be made, all of which may be built adjacent to, but separate from, the present cottage, and connected with it by a closed corridor. Such rooms, separated from the lying-in rooms, and supplied with suitable appurtenances for artificial delivery and obstetrical operations, they said, are a part of every well-appointed lying-in hospital. The beds and operating table should be specially constructed for the purpose, upon the latest and most approved plans. The erection of a small building, containing such rooms and connected with the present building, would also render convenient the construction of better bath. ing facilities for the colored patients of the lying-in department than now exists.

The report for 1893 shows receipts from pay patients to the amount of $5,238; the two new delivery rooms had been provided, with bathrooms, closets, hot and cold water and good facilities for heating, an improvement that placed the hospital maternity on a thoroughly good basis. The gynecological department also received a new equipment of model surgical beds. A training school for nurses had been established and the first class was graduated. The next demand was for a nurses' home; and this need was supplied during the next year by an appropriation of $10,000. Owing, however, to the depressed condition of business the pay patients receipts decreased to $3,395, while the number of free patients increased; and in 1895 the income from pay patients was further reduced to $2,089. In this connection the observations of the superintendent, Ella Underhill, in her report for 1895 are pertinent: "Careful observation," says Miss Underhill, "has shown a decided indisposition on the part of many patients to pay even a small sum weekly, although circumstances point to their ability to do so. In this way many beds are taken up by people who might pay, thereby occupying other than free beds, increasing the income of the hospital, and

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depriving the really poor people of room which would otherwise be theirs. This is an established fact, but one which it is difficult to obviate."

In the report for 1895 also is the first statement made in regard to the school of nursing, then numbering 30 nurses, 18 under instruction at the Children's Hospital and 12 at Columbia. Out of 180 applicants in 1895 but 22 were accepted. Lectures were delivered on obstetrics by Dr. A. F. A. King, on gynecology by Dr. D. S. Stone, on general survey by Dr. J. Wesley Bovée, on anatomy by Dr. J. Foster Scott, on physiology by Dr. G. N. Acker, on diseases of the eye by Dr. Swan M. Burnett, on diseases of children by Dr. S. S. Adams, on special emergencies and fevers by Dr. J. Van Rensselaer, on materia medica by Drs. Stoutenburgh and Barton. Applications for entrance came from Illinois, Texas, Canada and other distant localities, but few from the section near Washington. Nurses from Boston, Philadelphia, and Baltimore applied for entrance to the post-graduate course in obstetrics. The graduates numbered 28, two of whom gained enviable reputations in smallpox work, two others obtained responsible positions in hospitals, and the remainder were doing private duty.

II.

When, in 1869, a department of diseases of infancy and childhood was established in connection with the Columbia Hospital Dispensary, the fact that cases of disease that could not properly be treated in a dispensary were so frequent as to impel Dr. S. C. Busey, then connected with that hospital, to consider the propriety of an attempt to establish in Washington a children's hospital. In March, 1870, Dr. Busey interested Dr. F. A. Ashford in the project, and they called in Drs. William B. Drinkard and W. W. Johnson. At the suggestion of Dr. Drinkard, the board of lady managers of the Washington City Orphan Asylum were interested and a committee of that body, consisting of Mesdames S. P. Lee, J. Zeilin, William Stickney, J. C. Harkness, A. J. Brown, A. E. Perry, H. S. Reynolds, and Miss Margaret Washington, was appointed to confer with the above-named doctors. The conferences were held at the home of Mrs. A. J. Brown, and the Misses Virginia and Sally C. Miller and Miss M. L. Thompson also were present. Drs. J. C. Hall, Thomas Miller, W. P. Johnson, C. H. Liebermann, and Grafton Tyler were interested in the subject.

Dr. Busey says that "from the time when he was first advised of our object, Dr. William P. Johnson manifested the liveliest interest in its success, and exercised an active and controlling influence in perfecting the organization. There was no lack of effort on the part of any one of these five [last named] gentlemen, but Dr. Johnson's enthusiasm and earnestness assured success." The laity was represented at first by Mr. F. B. McGuire, and afterwards by Messrs. J. C. Kennedy, M. W. Galt, S. V. Niles, Joseph H. Bradley, jr., and Rev. A. N. Zevely. On

1 Dr. Busey's Reminiscences, p. 118.