The physical structure of the Infirmary underwent many modifications and additions, which were made necessary by the volume and diversity of medical and surgical diseases of the eye and ear and were made possible by constant fund-raising. In 1868 the directors passed a resolution "that any person giving the sum of $4,000 will found a permanent free bed. This bed will, during the lifetime of the donor, be occupied by such patients as he may designate. After his death, the bed will remain free for the use of poor patients and will bear the name of the donor inscribed upon it." ¹⁵ The Life Governors and Subscribers include the who's who in New York City society: Agnews, Astors, Delafields, Delavanes, Dubois, Lenoxes, Macys, Phelps, Rhinelanders, Wainwrights, Vanderbilts, and Roosevelts, to name just a few.
       Construction of the Brooklyn Bridge began in 1870; it was designed by John Rogland and continued by his son 18 years later.

       In 1870 the Infirmary expanded to 75 inpatient beds, 2 full-time nurses, and 23 eye and ear surgeons (Fig. 7). One house surgeon and two consulting surgeons lived in the building. In 1890 the brownstone building was torn down and replaced, and in 1890 to 1893 three floors were added to the restored brownstone.

       In 1890 a state-chartered school of ophthalmology and otolaryngology (a postgraduate institute) and a school for nurses relative to eye and ear disorders were established.

       The New York Eye & Ear Infirmary Reports, the journal of the New York Eye & Ear Infirmary, was established in 1891, and the first issue was published in January 1893 (Fig. 8). The following reports were included in that first issue: a case of suppurative otitis media, a report of 15 cases of mastoiditis, seborrheic affections of the external ear, adenoid growths as a cause of ear diseases in children, and primary chondritis of the larynx.