During the latter part of the nineteenth century, few changes occurred in drug therapy and the treatment of nonsurgical disorders, which comprised the bulk of medical practice. Major improvements occurred in the diagnosis and prevention of infectious diseases and in surgery, which was revolutionized by the discovery of anesthetics and antiseptic techniques. Dispensaries and hospitals continued to expand as providers of health care in urban areas, with dispensaries playing the larger role. Hospitals assumed a significant educational role. The number of physicians increased at a rate comparable to the growth in population in the latter part of the nineteenth century. The 55,055 physicians enumerated by the census in 1860 increased to 132,002 in 1900, about 175 physicians per 100,000 population at both dates. Medical schools graduated enough students to assure a reasonable supply of physicians in almost all towns and villages in the country, although urban areas continued to have more physicians per capita. The physician who began practice in a large city entered a highly competitive profession. He usually started by caring for the tenement population, perhaps augmenting his income by working as a dispensary or railroad physician or assisting another practitioner. His earnings were low and he had few regular patients. Eventually he found a neighborhood where he was able to attract enough patients to establish himself. Competition from other physicians and from pharmacists and dispensaries remained a problem throughout his career. A physician who chose a small town or rural area, where most of the population lived, had a different type of career. Rural families were poor and the physician’s services were low on their list of priorities. Professional relations reflected this fact. Established physicians often greeted the newcomer by sending him their nonpaying patients. Once the rural physician established a clientele, he had less difficulty keeping it than an urban physician. The stability of rural populations enabled him to retain the patronage of families from one generation to another. The rural physician worked longer hours than his urban counterpart and had to be more self-reliant because of the absence of specialists and hospitals.