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and worth about $1,360; Congress had been appealed to for an annual appropriation of $5,000 on account of the large number of nonresident patients treated.1

From the beginning of the hospital the raising of money and the supervision of expenditures was in charge of the board of lady visitors, and in each annual report acknowledgment of their indispensable work is made in most heartfelt manner. In 1879 it was found that the actual expense of maintenance in the new building was a little less than 41 cents per day, the daily average of patients being 30.9. Including interest, improvements, salaries, and all other expenses, the cost was less than 53 cents a day, a fair average for to-day.

On June 9, 1884, the original incorporators of the hospital, their associates and successors, accepted the provisions of the act of April 23, 1884, amending the Revised Statutes of the United States relating to the District of Columbia, and a reorganization was effected. During 1884 Dr. Grafton Tyler, one of the original incorporators and directors of the hospital, and Dr. Johnson Eliot, chairman of the board of hospital administration, died. Both were eminent in their profession and enjoyed the respect and confidence of the community, and were largely instrumental in making the Children's Hospital a success.

In 1884 the management of the hospital felt the need of enlarging the institution, and called on Congress for an appropriation of $10,000 toward the construction of the west wing, plans for which had been adopted. During this year the treasurer, Mr. F. B. McGuire, felt obliged by the pressure of his private business to resign a position the duties of which he had discharged from the organization of the hospi tal. He was succeeded by W. S. Thompson, who has continued to fill the office to the present time. It may be proper to say here that the annual reports of the president, Mr. Niles, and the treasurer, Mr. McGuire, are models in respect to the information they give as to the actual workings of the hospital. The reports of the president of no other institution in the District of Columbia excel those of Mr. Niles in the manifestation of a direct personal interest in, and knowledge of, the workings of the institution with which he was connected. Limited as the resources of the hospital have been at various times, and great as has been the pressure on the treasury, yet it has been the invariable practice of the institution never to allow the expenditures to exceed the receipts, but on the contrary the rule has been to have a small balance to provide for contingencies.

The president's report for 1886 records the fact that during the first

1Of the 4,233 patients receiving surgical and medical treatment from February 11, 1870, to November 30, 1875, 1,709 were residents of States. Of this latter number 501 came from Maryland, 585 from Virginia, 95 from Pennsylvania, and 92 from New York. The amount realized from the certificates during 1875 was only $630.53. The annual Congressional appropriation of $5,000 began in 1874-75 and has been continued since that date. The trustees looked forward to the time when the hospital would be self-supporting.

sixteen years of its life the hospital provided for 20,862 children, and of this number 70 per cent were cured or improved in health. The major portion of the revenues of the institution was derived from charitable bequests and donations from benevolent citizens. The attending physicians, at great sacrifice of their pecuniary interests, had labored diligently to bring success in their department; and the board of lady visitors was spoken of as the mainspring that had given to the hospital its practical force and effectiveness in the matter of material aid.

At the annual meeting held December 5, 1887, the by-laws of the hospital were amended in order to render eligible for election as directors all residents of the District of Columbia without distinction of sex or profession or vocation. A change was made in section 2 of the original certificate of incorporation by striking out the word "male," and, also, the words "five of whom shall be regular practitioners of medicine," so that the first clause of the section now reads "the government of the institution shall be vested in a board of twenty directors."

Also the by-laws were amended so as to provide that the directors at their annual meeting in December shall elect from the regular practicing physicians in the District of Columbia one consulting physician to serve for five years, and until his successor shall have been chosen, and a medical staff to consist of five consulting physicians and four attending physicians.

During 1887 Mr. Niles, the president of the board of trustees, died, and was succeeded by Mr. M. W. Galt,' who had been vice-president of the hospital since its beginning. Also the hospital lost the services of Mrs. Fannie Ricketts, the president of the board of lady visitors, by reason of her removal from the city. Mrs. Ricketts was succeeded by Mrs. Robert K. Stone.

In 1888 the revolution that had begun in hospital management throughout the country made itself felt in the Children's Hospital. The report of the board of lady visitors for this year expresses pleasure in the fact that the system of nursing adopted by the board of directors at the suggestion of the ladies had thus far proved a success. "Trained nursing," they say, "inaugurated in this country at the Bellevue Hospital in New York has been extended into the hospitals of nearly all the principal cities of the United States. The need of it in every hospital is self-evident. In accordance with the plans submitted by a member of the board of visitors, a graduate of the Bellevue School was appointed superintendent of nursing and matron of the hospital. A trained nurse was placed at the head of each ward, having under her three pupil urses. These nurses serve alternately in the white and colored wards. The pupils pledge themselves to remain for one year, and are to receive such instruction during that time as will fit them, after passing an examination by members of the medical board, to take charge of hospital wards or to nurse in private families."

Mr. Galt died February 23, 1898.

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