Alfred Stillé (1813-1900), professor of the theory and practice of medicine at the University of Pennsylvania from 1864 to 1883, vividly described his experiences as a young intern in 1836 when he lived for six months in the children's asylum of the Philadelphia Almshouse.
It was a very interesting field for me from a humanitarian as well as a medical point of view. A hundred or more children [Stillé was the only house officer] were sheltered there on their way to the early grave to which most of them were destined. Illegitimate and other outcasts formed the majority, and ophthalmia, that curse of children's asylums, made of them a blear-eyed, puny crowd, most pitiable to see. I soon became convinced of the causes that produced the crippling and mortality of these outcasts and waifs. I pointed out to the committee of the board how the disease was disseminated by the children washing in the same basins and using the same towels, and how it was maintained by their having no shaded placed for exercise in the open air, and also by the insufficient food permitted them; for if the soup which they received one day was nutritious, the meat of which the soup had been made, and which formed their dinner on the following day, must necessarily be nearly devoid of nutriment. But of course, the committee on the children's asylum and the guardians knew better than I, and at the time, at least, nothing was done to correct this wrong.1
A Compendium of Lectures on the Theory and Practice of Medicine, delivered by Prof. Chapman, in the University of Pennsylvania