tory. The furnishing of expensive surgical instruments or apparatus must be referred to the higher officers.

That this method of providing for the indigent sick is in a large degree satisfactory, many years experience has proven. The physicians, who are usually junior members of the profession, are faithful to their duties, if from no higher motive, for their personal advancement and reputation; and over them is the health officer of the city, who is charged with a general supervision, and to whom complaints can always be presented. A gratifying testimonial to the character and efficiency of this corps is that in the past year no well-grounded charge of oppression or neglect has been presented. An important advantage derived from the connection of these physicians with the Health Department is that each is officially a sanitary inspector, and his duties as physician to the poor bring to his knowledge many of the sanitary defects of his district. An objection of some weight to this system is the liability to extravagance in the use of medicines; but probably abuse is no more likely to occur than under any system involving so many individuals.

From the last report of the Health Office we find that 4,464 patients were treated during the year, to whom 22,961 visits were made. These figures indicate a marked diminution in the amount of sickness; for in 1871, with a less population and smaller territory, 6,357 patients were treated, and in 1872, 7,757 patients. The expense of the department for the last year, including salaries of physicians, medicines, and surgical appliances, was $11,137.38, or an average outlay for each patient of rather less than $2.50.

THE CINCINNATI HOSPITAL.

Provision is made for relief of those who, for any reason, cannot be treated at home, at the Cincinnati Hospital, for whose origin and early management we are indebted to the eminent Daniel Drake, M.D., who in 1822 obtained a charter for a public charity hospital and lunatic-asylum. The institution thus established developed with the needs of the city until some twenty-five years since, when an insane-asylum, independent of the hospital, was established. So that, for the present, we shall consider only an institution for the relief of ordinary sickness among the indigent of our city. Some ten years ago a structure commensurate with the needs of a large community, and in accord with modern ideas of hospital construction, was erected at an expense, including the

present value of the site (which has been in the possession of the city fifty years) of $1,100,000. In appointment and management it ranks among the best of the country. Located at an isolated point in the suburbs is a branch known as Roh's-Hill Hospital, used exclusively for contagious diseases; it has capacity for over a hundred inmates, and affords accommodations for pay as well as charity patients. It is subject to the same administration as the Cincinnati Hospital.

The benefits of these establishments are given to all persons needing medical or surgical treatment who have resided within the city limits one year, and who are supposed to be in indigent circumstances. But little formality attends the admission of patients, the superintendent and resident medical officers usually deciding upon the merits of the applicant; and to the superintendent is given discretionary power to admit cases of urgency which do not comply with the legal requirements. From the last Report of the Board of Trustees I extract the following figures:

Number of charity-patients treated in year 1877

Average daily population

3,954 337

The daily cost of maintenance per patient was, gross, 614 cts. ; net, 51 cts.

For the comfort of our tax-payers I offer the following table of comparison :

This result is largely due to the efficient administration of Henry M. Jones, who for a long period has been superintendent of the institution.

The average time of stay in hospital was 30.1 days; each patient therefore cost the city a trifle over fifteen dollars.

To provide the means to sustain the institution, a tax is levied upon the whole taxable property of the city, the maximum levy being five-tenths of a mill, aggregating ninety thousand dollars; a sum sufficient to meet all the expenses of the establishment. The supervision and general management of the hospital is intrusted to a board of seven trustees, two of whom are appointed by the concurrent action of three judges of the Superior Court, two by the.

action of five judges of the Common Pleas Court, and one by the governor of the State. Each trustee serves five years; and their terms are so arranged that one is appointed annually. In addition, one member ex officio enters the Board two years after his election; and his Honor the Mayor of the city is ex officio a trustee. The period of service is so long, and the sources of appointment so varied, that the office is removed from political intrigue; and, as the position is without salary and possessed of no "influence," in a modern acceptation, it is neglected by the politicians. As a consequence the Board has nearly always been composed of men whose private character placed them above suspicion, and whose great motive has been the welfare of the unfortunate under their care. The medical administration of the house is intrusted to a staff of sixteen physicians, eight of whom serve alternately for four months, with no pecuniary compensation. Medical lectures are delivered by the staff to all students who pay five dollars per session; the fund thus obtained being devoted to sustaining a medical library, which is free to all who desire to use it.

THE INFIRMARY.

The hospital is designed for the reception and care of acute cases, and such as are not likely to require long-continued treatment or protection. To provide for the infirm and those who for any considerable time are physically incapable of caring for themselves, we have an infirmary some six miles from the city. The institution consists of a building, with a farm of a hundred and sixty-four acres, and the appropriate farm-buildings; the entire estate being valued at three hundred thousand dollars. The management is vested in three directors, one of whom is elected by popular vote each year, and serves for three years. As considerable patronage and the distribution of a large amount of money pertains to the office of director of the Infirmary, it always has due consideration at the political caucuses and conventions, and is ordinarily filled by a politician whose qualifications for intelligently administering to the relief of several hundred feeble and aged people are subjected to much less scrutiny, and are less influential in securing the position than his ability to "carry" a ward at the next election. Consequently the office has often been occupied by those who did no honor to themselves, and added nought to the comfort of the poor under their care. (The morning papers inform us that this day this institution passes to the control of the Board of Police Com

missioners, a larger and more influential body of politicians than was the Board of Infirmary Directors. We may confidently predict, as a natural result, that the evils of the past will be increased in the future.)

From the annual report for 1877 we learn the daily average of inmates has been 559, a slight decrease from the previous year. The cost of support has been 17 cents per day. This very low figure is probably explicable by the fact that a large amount of provisions was derived from the farm belonging to the Institution.

As to the character of inmates, we find two hundred and thirty who are above sixty years of age, and twenty-two less than ten years of age (a law within the past year has removed all children from such association), or nearly fifty per cent who are necessarily infirm. From the physician's report we learn that sixty-nine deaths occurred during the year, twenty-seven being from consumption and other essentially chronic diseases, and eighteen from old age; and we believe we are justified in the assumption that twice as many such cases remain.

We are surprised to read, that, because of overcrowding at the insane asylum, "nearly ninety harmless insane" are now domiciled at the infirmary; a proceeding deserving only condemnation. For, if they are so insane as to need any care, they are too insane to be placed in immediate contact with the class of people found in an infirmary. The superintendent says, "They often escape from the house, run into danger of being run over on railroads, and also annoy the people living in the vicinity in such a way that they become a burden to the institution and the neighborhood." It is presumed that the authorities of the insane asylum are responsible for such inappropriate disposition of those for whom they should

care.

This analysis of the population shows about two-thirds who evidently are fit subjects for such care, and experience among the poor warrants the belief that many who are temporarily incapacitated from maintaining themselves are received here; but, after allowing for all these, we are confident that many are to be found in such an institution whose worst malady is indolence, and who should more appropriately be found in a compulsory workhouse. The report of the superintendent gives no cheerful impression of his household, resulting from inadequacy of heating and laundry appliances, defective kitchens, and insufficient dining-room and dormitory space. The heating apparatus is not the kind for which

the house was constructed, and the statement that "we are greatly troubled with smoke and soot in the house" does not suggest the comfort and cleanliness so much to be desired in such institutions. From the statistics it is patent that the inmates are required to work, and we have been informed that numbers have left the infirmary because they had to labor. Such facts are creditable to the management of such a house.

INSANE ASYLUM.

Some twenty years since, the increased number of insane in the county demanded new provision for this class. Accordingly, the city and county authorities uniting, an asylum was erected in the vicinity of the city; and, as about eighty per cent of its inmates belong to the city, it claims attention as one of the charities of Cincinnati.

The entire establishment at this time is valued at about eight hundred thousand dollars. The house was designed in compliance with the most modern views; but the selection of the site was ill advised, being in a malarial region, so that the entire population of the house has been constantly liable to fever, and the success in construction was not commensurate with the designs of the directors. The consequence was inconvenience of structure and marked imperfection of ventilation. The capacity of the house, as designed, was for four hundred inmates; at present, with no increase of space, the population is over six hundred. The evil consequences are thus expressed by the recent superintendent: "Two, and often three, patients were obliged to occupy rooms originally designed for one. At risk of serious altercations and accidents, these and other evils of overcrowding have greatly embarrassed the working of the institution, and occasioned a constant feeling of insecurity and dread of serious calamity."

From the report for 1877 I take the following figures:

Whole number of patients during year.

793

1 These figures were obtained from Mr. Henry W. Lord's report, presented just prior to reading of the present paper.