In 1967, your best bet in Maryland was to not have an accident or bodily injury.

With the exceptions of R Adams Cowley?s "death ward" ? predecessor to today?s shock trauma ? most emergency departments were staffed by interns, or whomever the hospital could spare from making rounds.

In 1968, St. Joseph?s Hospital opened the state?s first modern emergency department ? with six full-time physicians working round the clock to treat anybody wheeled or walking through the door. This year they are celebrating their 40th anniversary and honoring some of the pioneers who founded the department.

"We saw as many patients as they do today," said Dr. Max English, 88, a general practitioner who helped found St. Joseph?s Emergency Department. "We used to see something like 100 patients in a day."

The hospital had taken 33,000 emergency cases a year when the department opened. Last year, St. Joseph Medical Center handled 52,000 emergency visits with a staff of 10 physician-partners and eight  nurse practitioners or physician?s assistants.

For those pioneers, it was a good idea but not exactly an easy sell.

The hospital promised $30,000 a year for the first year, English said, a substantial income but less than he made at his family practice.

"We were a group of six middle-aged, experienced doctors, each of which had a thriving practice and each of which had at least 26 years? experience," said Dr. Michael DeVicentis, 92, another founder.

They had six stretchers and three rooms, and were not paid by the hospital but by the patients on a fee-for-service basis. That first year, English said they made little more than the guaranteed salary, but the second year each took home about $50,000.

In the intervening 40 years, emergency medicine became a specialty ? and for some a calling.

"It?s an honor and a blessing to walk in the career footsteps of my dad, at least in one shoe," said Angie DeVicentis, a nurse practitioner at St. Joseph Medical Center?s Emergency Department.