The musings of a physician who served the community for over six decades
367 Topics
Downtown A discussion about downtown area in Philadelphia and connections from today with its historical past.
West of Broad A collection of articles about the area west of Broad Street, Philadelphia, Pennsylvania.
Delaware (State of) Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Religious Philadelphia William Penn wanted a colony with religious freedom. A considerable number, if not the majority, of American religious denominations were founded in this city. The main misconception about religious Philadelphia is that it is Quaker-dominated. But the broader misconception is that it is not Quaker-dominated.
Particular Sights to See:Center City Taxi drivers tell tourists that Center City is a "shining city on a hill". During the Industrial Era, the city almost urbanized out to the county line, and then retreated. Right now, the urban center is surrounded by a semi-deserted ring of former factories.
Philadelphia's Middle Urban Ring Philadelphia grew rapidly for seventy years after the Civil War, then gradually lost population. Skyscrapers drain population upwards, suburbs beckon outwards. The result: a ring around center city, mixed prosperous and dilapidated. Future in doubt.
Historical Motor Excursion North of Philadelphia The narrow waist of New Jersey was the upper border of William Penn's vast land holdings, and the outer edge of Quaker influence. In 1776-77, Lord Howe made this strip the main highway of his attempt to subjugate the Colonies.
Land Tour Around Delaware Bay Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Tourist Trips Around Philadelphia and the Quaker Colonies The states of Pennsylvania, Delaware, and southern New Jersey all belonged to William Penn the Quaker. He was the largest private landholder in American history. Using explicit directions, comprehensive touring of the Quaker Colonies takes seven full days. Local residents would need a couple dozen one-day trips to get up to speed.
Touring Philadelphia's Western Regions Philadelpia County had two hundred farms in 1950, but is now thickly settled in all directions. Western regions along the Schuylkill are still spread out somewhat; with many historic estates.
Up the King's High Way New Jersey has a narrow waistline, with New York harbor at one end, and Delaware Bay on the other. Traffic and history travelled the Kings Highway along this path between New York and Philadelphia.
Arch Street: from Sixth to Second When the large meeting house at Fourth and Arch was built, many Quakers moved their houses to the area. At that time, "North of Market" implied the Quaker region of town.
Up Market Street to Sixth and Walnut Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
Sixth and Walnut over to Broad and Sansom In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Montgomery and Bucks Counties The Philadelphia metropolitan region has five Pennsylvania counties, four New Jersey counties, one northern county in the state of Delaware. Here are the four Pennsylvania suburban ones.
Northern Overland Escape Path of the Philadelphia Tories 1 of 1 (16) Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
City Hall to Chestnut Hill There are lots of ways to go from City Hall to Chestnut Hill, including the train from Suburban Station, or from 11th and Market. This tour imagines your driving your car out the Ben Franklin Parkway to Kelly Drive, and then up the Wissahickon.
Philadelphia Reflections is a history of the area around Philadelphia, PA
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Philadelphia Revelations
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George R. Fisher, III, M.D.
Obituary
George R. Fisher, III, M.D.
Age: 97 of Philadelphia, formerly of Haddonfield
Dr. George Ross Fisher of Philadelphia died on March 9, 2023, surrounded by his loving family.
Born in 1925 in Erie, Pennsylvania, to two teachers, George and Margaret Fisher, he grew up in Pittsburgh, later attending The Lawrenceville School and Yale University (graduating early because of the war). He was very proud of the fact that he was the only person who ever graduated from Yale with a Bachelor of Science in English Literature. He attended Columbia University’s College of Physicians and Surgeons where he met the love of his life, fellow medical student, and future renowned Philadelphia radiologist Mary Stuart Blakely. While dating, they entertained themselves by dressing up in evening attire and crashing fancy Manhattan weddings. They married in 1950 and were each other’s true loves, mutual admirers, and life partners until Mary Stuart passed away in 2006. A Columbia faculty member wrote of him, “This young man’s personality is way off the beaten track, and cannot be evaluated by the customary methods.”
After training at the Pennsylvania Hospital in Philadelphia where he was Chief Resident in Medicine, and spending a year at the NIH, he opened a practice in Endocrinology on Spruce Street where he practiced for sixty years. He also consulted regularly for the employees of Strawbridge and Clothier as well as the Hospital for the Mentally Retarded at Stockley, Delaware. He was beloved by his patients, his guiding philosophy being the adage, “Listen to your patient – he’s telling you his diagnosis.” His patients also told him their stories which gave him an education in all things Philadelphia, the city he passionately loved and which he went on to chronicle in this online blog. Many of these blogs were adapted into a history-oriented tour book, Philadelphia Revelations: Twenty Tours of the Delaware Valley.
He was a true Renaissance Man, interested in everything and everyone, remembering everything he read or heard in complete detail, and endowed with a penetrating intellect which cut to the heart of whatever was being discussed, whether it be medicine, history, literature, economics, investments, politics, science or even lawn care for his home in Haddonfield, NJ where he and his wife raised their four children. He was an “early adopter.” Memories of his children from the 1960s include being taken to visit his colleagues working on the UNIVAC computer at Penn; the air-mail version of the London Economist on the dining room table; and his work on developing a proprietary medical office software using Fortran. His dedication to patients and to his profession extended to his many years representing Pennsylvania to the American Medical Association.
After retiring from his practice in 2003, he started his pioneering “just-in-time” Ross & Perry publishing company, which printed more than 300 new and reprint titles, ranging from Flight Manual for the SR-71 Blackbird Spy Plane (his best seller!) to Terse Verse, a collection of a hundred mostly humorous haikus. He authored four books. In 2013 at age 88, he ran as a Republican for New Jersey Assemblyman for the 6th district (he lost).
A gregarious extrovert, he loved meeting his fellow Philadelphians well into his nineties at the Shakespeare Society, the Global Interdependence Center, the College of Physicians, the Right Angle Club, the Union League, the Haddonfield 65 Club, and the Franklin Inn. He faithfully attended Quaker Meeting in Haddonfield NJ for over 60 years. Later in life he was fortunate to be joined in his life, travels, and adventures by his dear friend Dr. Janice Gordon.
He passed away peacefully, held in the Light and surrounded by his family as they sang to him and read aloud the love letters that he and his wife penned throughout their courtship. In addition to his children – George, Miriam, Margaret, and Stuart – he leaves his three children-in-law, eight grandchildren, three great-grandchildren, and his younger brother, John.
A memorial service, followed by a reception, will be held at the Friends Meeting in Haddonfield New Jersey on April 1 at one in the afternoon. Memorial contributions may be sent to Haddonfield Friends Meeting, 47 Friends Avenue, Haddonfield, NJ 08033.
Although Bucks County, Pennsylvania, is staunchly Republican, it has been home to Broadway playwrights for decades; this handful of Democrats have long been referred to as lions in a den of Daniels. One of them really ought to make a comic play out of the two weeks in August 1777, when John Moland's house in Warwick Township was the headquarters of the Continental Army.
John Moland died in 1762, but his personality hovered over his house for many years. He was a lawyer, trained at the Inner Temple and thus one of the few lawyers in American who had gone to law school. He is best known today as the mentor for John Dickinson, the author of the Articles of Confederation. Our playwright might note that Dickinson played a strong role in the Declaration of Independence, but then refused to sign it. Moland, for his part, stipulated in his will that his wife would be the life tenant of his house, provided -- that she never speak to his eldest son.
Enter George Washington on horseback, dithering about the plans of the Howe brothers, accompanied by seven generals of fame, and twenty-six mounted bodyguards. Mrs. Moland made him sleep on the floor with the rest.
Enter a messenger; Lord Howe's fleet had been sighted off Patuxent, Maryland. Washington declared it was a feint, and Howe would soon turn around and join Burgoyne on the Hudson River. Washington had his usual bottle of Madeira with supper.
A court-martial was held for "Light Horse Harry" Lee, for cowardice. Lee was exonerated.
Kasimir Pulaski made himself known to the General, offering a letter of introduction from Benjamin Franklin, which letters Franklin noted had been requested by Pulaski himself. As it turned out, Pulaski subsequently distinguished himself as the father of the American cavalry and was killed at the Battle of Savannah.
Lafayette
And then a 19 year-old French aristocrat, the Marquis de Lafayette, made an appearance. Unable to speak a word of English, he nevertheless made it clear that he expected to be made a Major General in spite of having zero battlefield experience. He presented a letter from Silas Deane, in spite of Washington having complained he was tired of Ambassadors in Paris sending a stream of unqualified fortune hunters to pester the fighting army. Deane did, however, manage to make it clear that the Marquis had two unusually strong military credentials. He was immensely rich, and he was a dancing partner, ahem, of Marie Antoinette.
In Mrs. Moland's parlor, Washington sat down with Lafayette to tap-dance around his new diplomatic problem. It was clear America needed France as an ally, and particularly needed money to buy supplies. But it was also clearly impossible to take a regiment away from some American general, a veteran of real fighting, and give that regiment to a Frenchman who could not speak English and who admitted he had no military experience. Fumbling around, Washington offered him the title of Major General, but without any soldiers under his command, at least until later when his English improved. To sweeten it a little, Washington seems to have said something to the effect that Lafayette should think of Washington as talking to him as if he were his father. There, that should do it.
It seems just barely possible that Lafayette misunderstood the words. At any rate, he promptly wrote everybody he knew -- and he knew lots of important people -- that he was the adopted son of George Washington.
Well, Broadway, you take it from there. At about that moment, another messenger arrived, announcing Lord Howe at this moment was unloading troops at Elkton, Maryland. General Howe might have been able to present his credentials to Moland House in person, except that his horses were nearly crippled from spending three weeks in the hold of a ship and needed time to recover. Heavy rains were coming.
There's one good thing about living near the confluence of two big rivers, and one very bad thing about it. The rivers provide transportation in three directions, but about once every twenty-five years the rivers rise astonishingly and threaten to carry everything away. That deposits rich topsoil, making it even more attractive for settlers to locate there. At what we now call Northumberland located on the junction of the North and West Branches of the Susquehanna, there is a monument marking off the flood levels of the past two centuries. Even the least of these floods must have covered a lot of ground, and the highest one is so far above the head of a visitor that it is hard to see how anything could have survived it. Right now, the little town of Northumberland is a burnished little jewel. One hopes the Army Corps of Engineers either has or soon will abate the potential flood danger. It would be interesting to know if flood insurance is available, just as a sign of how experts currently evaluate the risk. The Endless Mountains (that's really their name) stretching almost to Cooperstown, catch a lot of rainwater and snow and occasionally funnel it all down the North Branch to Northumberland. The West Branch is even bigger. Having observed the 1936 flood in Pittsburgh, I can testify it isn't an experience soon forgotten.
Flood Levels
It happens the most prominent resident of the area arrived there in 1794 and lived out the last ten years of his life as a widower. Joseph Priestley, an English dissenting minister had stirred up enough uproar to cause his house to be burned to the ground. No doubt, the English wanted to suppress any repetition of the French Revolution but were willing enough to be rid of a protege of Lord Shelbourne so the government made full restitution of the value of his property when he finally agreed to emigrate. Pennsylvania was chosen on the advice of his good friend Benjamin Franklin. He bought extensive land at the river junction and constructed what most people would describe as a beautiful mansion on reasonably high ground with a river entrance. Although it is built of wood and William Penn's Pennsbury was brick, there is a definite similarity. Priestley's house somehow seems more open and livable, although the outhouse reminds us that plumbing costs were moderate at the time. And furthermore, the original building survives as Pennsbury did not. The original plans for it were later discovered in England, and so it has been possible to make it what it used to be, outbuildings and all. Priestley and Lavoisier did not get along even though they share the honors for discovering Oxygen. Lavoisier was a rich aristocrat, while Priestley was a prominent member of the dissenting class with advanced ideas about democracy. It is said that many of the ideas Thomas Jefferson had about the natural rights of mankind were brought into sharper focus by his association with Priestley. Priestley was primarily a political theorist, acting in the role of a minister. He regarded his chemical experiments as a hobby, motivated by the hope of discovering a bridge between religion and science. The relationship between Priestley and Lavoisier was a strange one, but it had political conjunction as well as a scientific one. Priestley was driven to America by English Tories the same year that Lavoisier was guillotined by French revolutionaries.
Although oxygen had been discovered while Joseph Priestley was still in England, he discovered carbon monoxide in Northumberland, using retorts and scientific instruments he designed and sent to his friend Wedgwood to manufacture. He also devised the idea of carbonated water while he was here. For these as well as chemical methodologies he has been described, at least by Anglo Saxons, as the Father of Chemistry. Following what he considered to be his main occupation he meanwhile founded the Unitarian Church in America. In the little town at the Susquehanna forks, he was unable to establish a viable Unitarian congregation beyond a few followers who came to his home. So, he somehow found the energy to establish the First Unitarian Church in Philadelphia, at 21st and Walnut Streets. (Aside from its historic significance, the present church building is a distinguished work of architecture designed by Frank Furness). Meanwhile, he was very active in national politics; Jefferson's defeat of John Adams' reelection is often ascribed to his efforts.
His wife died of tuberculosis before they could move into the Northumberland plantation, but he lived there with his son and daughter-in-law for ten years, dying in 1804. The son was concerned with founding a utopian colony, but the wealthy daughter-in-law forced a return to England. The grandson generation returned to Northumberland, where the graveyard now has an impressive array of Priestley tombstones.
REFERENCES
The Invention of Air: A Story of Science, Faith, Revolution,and The Birth of America, Steven Johnson ISBN: 978-1-59448-852-8
THE Constitution is the product of many minds, its ideas have many sources. But final phrasing of the unified document can largely be traced to a lawyer, Gouverneur Morris. The Constitutional Convention would announce a topic, argue for days about different resolutions of it, and then vote on or amend a composite resolution ( unless the matter was deferred to another day of earnest wrangling.) After months of deliberation, that jumble of resolutions made quite a pile. The Convention then turned it all over to Gouverneur Morris for smooth editing and uniformity. Although Morris had arrived a month late for the Convention, he still had time to rise and speak his views more than any other delegate, 173 times. But comparatively few of his ideas identifiably survived the voting; by Convention's end, the delegates were most likely listening for elegance and poise, increasingly expecting the final edit to be his. He finished the task in four days, and the full convention only changed a few words before accepting it. This assembly needed a lawyer who would sincerely follow the intent of his client, rather than yield to the slightest temptation to warp it with his own views. The convention had heard his opinion about almost everything, were thus alerted to uninvited slants. He gave them what they asked for, wording it for persuading the nation, as he himself had been persuaded by what the delegates wanted. The remarkable degree to which he had faithfully served his client's wishes, rather than his own, only emerged twenty years later. During the War of 1812, he disavowed the Constitution he had written.
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
Preamble to the Constitution
Morris mostly shortened what the delegates had said. A word here, a phrase there, sometimes whole sentences were removed. After that, rearrangement, and substitution of more precise verbs. This lion of the drawing room, this duelist of the salon, undoubtedly had an enjoyable time twitting his less accomplished clients with brisk capsules of what, of course, they had meant to say. To remember that he was outshining Benjamin Franklin and most of the other recognized wits of the continent, is to savor the fun of it all. Of all people in the Enlightenment, Franklin was certainly Gouverneur's equal in sparkling exchanges of debate. Here, he did not even try.
John Peter Zenger
Where did this apparition come from? He was almost but not quite a lord of the manor, referring to his extensive riverfront estate in the Bronx called Morrisania, which dated back seven generations in America and ultimately belonged to him, but the title went to his half-brother. He was unquestionably a member of that small society which settled America before the English colonization. Even George Washington was only a fourth-generation American. The Morris side of the family had included two Royal Governors of New York, including the one who tried to imprison Peter Zenger for telling the truth. Gouverneur was his mother's family name, one of the Huguenots who settled New Rochelle in 1663. Under the circumstances, it is not surprising that his mother was a loyalist, and his half-brother a Lieutenant General in the British Army. Gouverneur Morris was a brilliant student of law, unusually tall and handsome for the era. He was as tall as George Washington, and Houdon used him as a body model for a statue of the General. Among the ladies, he created a sensation wherever he went. At an early age, however, he spilled a kettle of hot water on his right arm, which killed the nerve and mummified the flesh. The pain must have been severe, with not even an aspirin to help, and the physical deformity put an end to a big man's dreams of military valor. To a young mind, the physical deformity probably seemed more disfiguring than it needed to be, in addition to diminishing his own ideas of himself. He turned to the law, where he was probably a fiercer litigant than he needed to be. And more of a rebel.
The timing of circumstances drove him out of Morrisania, then out of Manhattan, as the invading British cleared the way for the occupation of New York City. Then up the Hudson River to Kingston, and on to the scene of the Battle of Saratoga. He had been elected to the Continental Congress but stayed in the battlegrounds of New York during the early part of the Revolution, helping to run the rebel government there, and making acquaintance with George Washington, whom he soon began to worship as the ideal aristocrat in a war he could not actively join as a combatant himself. With Saratoga completely changing the military outlook for the rebellion, Morris was charged up, ready to assume his duties as a member of the Continental Congress. By that time, Congress had retreated to York, Pennsylvania, George Washington was in Valley Forge, and the hope was to regroup and drive the British from Philadelphia. For all intents and purposes Robert Morris the Philadelphia merchant, no relative of Gouverneur, was running the rebel government from his country home in Manheim, a suburb of Lancaster. After presenting himself to Robert, Gouverneur was given the assignment of visiting the camps at Valley Forge and reporting what to do about the deplorable condition of the Army and its encampment. By that time, both the British and the French had about decided that the war was going to be decided in Europe on European battlefields, so the armies and armadas in America were probably in the wrong place for decisive action. Lord North had reason to be disappointed in Burgoyne's performance at Saratoga, and Howe's abandonment of orders, even though by a close call he had captured the American Capital of Philadelphia. Consequently, Lord North added the appearance of still another defeat by withdrawing from Philadelphia, deciding in the process to dispatch the Earl of Carlisle to offer generous peace terms to the colonies. Carlisle showed up in Philadelphia and was more or less lost to sight among rich borderline loyalists of Society Hill like the Powels. His offer to allow the Americans to have their own parliament within a commonwealth nominally headed by the Monarch went nowhere. The Colonist Revolutionaries were being offered what they had asked for, in the form of taxation with representation. To have it more or less snubbed by the colonists was certainly a public relations defeat to be added to losing Philadelphia and Saratoga. In this confused and misleading set of circumstances, Gouverneur sent several official rejections of the diplomatic overture and wrote a series of contemptuous newspaper articles denouncing the idea. It seems inconceivable that Gouverneur would take this on without the approval of Washington, Robert Morris, or the Continental Congress, to all of whom he had ready access. But if anyone could do such a thing on his own responsibility, it was Morris. One hopes that future historians will apply serious effort to clarifying these otherwise unexplainable actions.
With of course the indispensable help of retrospect, some would say Gouverneur Morris had committed a massive blunder. The Revolutionary War went on for six more years, the Southern half of the colonies were devastated, and the post-war chaos came very near destroying the starving little rebellion. The alternative of accepting the peace offering might have allowed America and Canada to become the world powers they did become; but the French Revolution or at least the Napoleonic Wars might never have happened, the World Wars of the Twentieth century might have turned out entirely differently, and on and on. Historians consider hypothetical versions of history to be unseemly daydreams ("counterfactuals"), but it seems safe to suppose Gouverneur Morris changed history appreciably in 1778. Whether he did so as someone's agent, or on his own, possibly remains to be discovered in the trunks of letters of the time. Whether the deceptive atmosphere of impending Colonial victory was strong enough to justify such wrongheaded decisions, is the sort of thing which is forever debatable.
While most of the credit for the style of the Constitution must go to Gouverneur Morris, there is a record of a significant argument which Madison resisted and lost, about the document style. During the debates about the Bill of Rights, Roger Sherman of Connecticut rose to object to Madison's intention to revise the Constitution to reflect the sense of the amendments, deleting the language of the original, and inserting what purports to be the sense of the amended version. That is definitely the common practice today for organization by-laws and revisions of statutes; it is less certain whether it was common practice at the end of the 18th Century. In any event, Sherman was violently opposed to doing it that way with amendments to the Constitution. After putting up a fight, Madison eventually gave up the argument. So the 1789 document continues to exist in its original form, and the fineness of Morris' elegant language is permanently on display. It may even help the Supreme Court in its sometimes convoluted interpreting the original intent of the framers. In any event, we now substitute the unspoken process of amending the Constitution by Supreme Court decision, about a hundred times every year. By preserving the original language, the citizens have preserved their own ability to have an opinion about how it may have wandered.
REFERENCES
Gentleman Revolutionary: Gouverneur Morris, the Rake Who Wrote the Constitution : Richard Brookhiser: ISBN-13: 978-0743256025
The Right Angle Club runs a weekly lottery, giving the profits to the Children's Educational Fund. The CEF awards scholarships by lottery to poor kids in the City schools. That's quite counter-intuitive because ordinarily most scholarships are given to the best students among the financially needy. Or to the neediest among the top applicants. Either way, the best students are selected; this one does it by lottery among poor kids. The director of the project visits the Right Angle Club every year or so, to tell us how things are working out. This is what we learned, this year.
The usual system of giving scholarships to the best students has been criticized as social Darwinism, skimming off the cream of the crop and forcing the teachers of the rest to confront a selected group of problem children. According to this theory, good schools get better results because they start with brighter kids. Carried to the extreme, this view of things leads to maintaining that the kids who can get into Harvard, are exactly the ones who don't need Harvard in the first place. Indeed, several recent teen-age billionaires in the computer software industry, who voluntarily dropped out of Harvard seem to illustrate this contention. Since Benjamin Franklin never went past the second grade in school perhaps he, too, somehow illustrates the uselessness of education for gifted children. Bright kids don't need good schools or some such conclusion. Since dumb ones can't make any use of good schools, perhaps we just need cheaper ones. Or some such convoluted reasoning, leading to preposterous conclusions. Giving scholarships by lottery, therefore, ought to contribute something to educational discussions and this, our favorite lottery, has been around long enough for tentative conclusions.
It is now safe to conclude the data show better schools generally lead to better academic results later on. Compared with other children who competed in the lottery pool but did not win the lottery, the scholarship students were far more likely to graduate from high school and be admitted to college. Since they were randomly selected, the different talents of the students could not account for this difference. So, it seems possible to say the school teachers -- not the ability of the kids -- caused the difference. That's extreme; obviously smarter kids do better in school. It could still be argued it was not the new teachers in those chosen schools, but rather the new companion students who made the difference, by means of peer pressure and good example. But kids who won the lottery were regardless better off for the experience, and Philadelphia is better off. The evidence at least implies children born in poverty can benefit from better schools than the ones we have been providing them; one does not have to be a doctrinaire liberal to agree we should get to work improving inner-city schools.
Just what improving schools means in practical terms, does not yet emerge from the experience. Some could say we ought to fire the worst teachers, others could say we ought to raise salary levels to attract better ones. Most people would agree there is some level of mixture between good students and bad ones. At that point, the culture mix becomes harmful rather than overall helpful; whether just one obstreperous bully is enough to disrupt a whole class or something like 25% of well-disciplined ones would be enough to restore order in the classroom, has not been quantitatively tested. What seems indisputable is that the kids and their parents do accurately recognize something desirable to be present in certain schools but not others; their choice is wiser than the non-choice imposed by assigning students to neighborhood schools. Maybe it's better teachers, but that has not been proved.
It seems a pity not to learn everything we can from a large, random experiment such as this. No doubt every charity has a struggle just with its main mission, without adding new tasks not originally contemplated. However, it would seem inevitable for the data to show differences in success among types of schools, and among types of students. Combining these two varieties in large enough quantity, ought to show that certain types of schools bring out superior results in certain types of students. Providing the families of students with specific information then ought to result in still greater improvement in the selection of schools by the students. No doubt the student gossip channels already take some informal advantage of such observations. Providing school administrations with such information also ought to provoke conscious improvements in the schools, leading to a virtuous circle. Done clumsily, revised standards for teachers could lead to strikes by the teacher unions. Significant progress cannot be made without the cooperation of the schools, and encouragement of public opinion. After all, one thing we really learned is that offering a wider choice of schools to student applicants leads to better outcomes. What we have yet to learn, is how far you can go with this idea. But for heaven's sake, let's hurry and find out.
It was sixty years before Philadelphia had a second hospital, so the way things were done at the Pennsylvania Hospital tended to set patterns. The central pattern was: charity for poor folks, during a period when prosperous people were treated in their homes. Since Franklin was the secretary of the Board of Managers, it is in his own handwriting that we see "Founded for the sick poor and, if there is room, for those who can pay." In 1900, two-thirds of all hospital beds in Philadelphia were still ward beds for the poor. In 1948 when I was a two-year unpaid intern there, a posted sign said the accident room charge was fifty cents, but in fact, it was only collected if the patient happened to have insurance. The student nurses ran the place unpaid, and the main exceptions were the two paid administrators, the Steward, and his secretary. Philadelphia was settled for religious freedom, enjoyed many new religions, and consequently had a long era of Methodist, Episcopal, Presbyterian, two Jewish hospitals and the hospitals belonging to three Catholic Orders.
With the advent of the Civil War, PGH (Philadelphia General) grew to seven thousand beds, all of them free, when it was discovered more soldiers were dying from diseases than from wounds. Surgeons and obstetricians built specialty hospitals for their patients, mostly small ones, like Babies Hospital, Preston Retreat, Contagious Disease (mostly polio), Casualty, and a host of tuberculosis and psychiatry hospitals, Eye Hospitals, HEENT Hospitals, Children's Hosptial, and a number of small paying hospitals. The Civil War and the invention of anesthesia created a need for small hospitals for people who could pay, like Skin and Cancer.often in the shadow of larger charity hospitals for those who couldn't' pay. The first question any audience asks with bewilderment is about the cause of so many current hospital mergers. Part of the answer is we once had too many hospitals, and the rest of the answer was that the Flexner Report created a surplus of government money, intended to support research, and similarly stimulated by the creation of Blue Cross in the 1920s. Flexner favored research money, and the Universities grabbed it. The insurance mechanism was the best available means to save money when you were well, in order to spend it later when you were sick, but insurance muffed the chance. They chose one-year term insurance, mostly because short-term business was paying the bill. When money was no object, money was wasted.
The quickest example of honey attracting flies was observed shortly after 1965, when Philadelphia teaching hospitals (there were 104 of them at the time) went to Mayor Rizzo, suggesting PGH should be closed, ostensibly in order to facilitate the flow of federal funds to private hospitals. Thus they would help teaching hospitals absorb the abundant flow of government charity while eliminating the $11 annual cost of PGH to the City. That transformation from mostly charitable to largely private hospital care took from 1977 to 2010, to the private amusement of those who had been present at the meeting. At the end of this transformation, their positions had reversed; the teaching hospitals now bemoaned the shocking disappearance of the city's medical charity through PGH, casting such people back onto the teaching hospitals. Vannevar Bush probably had a hand in this, as the pretext was that only teaching hospitals did research. Meanwhile, they lobbied strenuously to retain monopoly control of federal research money, at the expense of charity beds within the teaching hospitals. In other words, we had a reasonably satisfactory system of charity care until charity patients demanded equal facilities from public money. Lyndon Johnson gloried in his achievements, but the fact is they opened the door to the unsupportable expense. The nursing profession was utterly flummoxed to be given degrees in return for the disappearance of their profession. If the combatants had stopped long enough to ask, there simply was not enough money to do what politics was demanding. The nursing school was always the heart of the hospital; the doctors were too busy tending to patients. And charts which they mostly falsified to save wasted time. Adding to the confusion was the effect of shifting nurse training costs, from the hospitals (diploma) to university responsibility (bachelorette degrees) and the adverse effect on nurse quality was noticeable. Doctors no longer married nurses, for example, they married lawyers and similar pre-professionals. The greatest effect, aside from higher cost, was to remove the loudest objectors from the scene, at just about the wrong time. The universities were clamoring to transform the nursing profession into administrators, in order to satisfy a seemingly insatiable demand stirred up by muddling the medical record-keeping system with the task of creating huge records which no one has time to read. The public regards medical matters as too obscure to understand and so does not appreciate how much cost has been created by switching everything non-essential around. It seemed obvious to them that non-essentials were poorly done. But not being medically trained, they weren't able to tell what was non-essential. Improving legibility and interphysician communication was nice, but it wasn't the main business of a hospital. Physicians learned to practice good medicine in tents and scarcely saw any difference.
Lawyers have learned something, too. They learned that antitrust violation is not signaled by per se violations or even vertical integration. It is signaled by mergers. Senator Specter may have kept Robert Bork from the Supreme Court. But the Law is slowly catching up with mergers, and Bork's books are still in print.
The future of hospitals does not lie in buildings. Doctors' practices are easily moved to retirement villages where the old folks are. Patients are there a long time, and equipment is easily moved there to be with them. It would save a lot of money because diseases are disappearing. Something like five diseases now represents something like 80% of the cost, but all that money spent on hospital buildings has already been spent, so it will take too long to get there peacefully. For all I know, five new diseases will replace five old ones, but the trend is downward. Costs keep going up. Doesn't that tell you something? What's going to happen to all that real estate after we cure cancer?
109 Volumes
Philadephia: America's Capital, 1774-1800 The Continental Congress met in Philadelphia from 1774 to 1788. Next, the new republic had its capital here from 1790 to 1800. Thoroughly Quaker Philadelphia was in the center of the founding twenty-five years when, and where, the enduring political institutions of America emerged.
Philadelphia: Decline and Fall (1900-2060) The world's richest industrial city in 1900, was defeated and dejected by 1950. Why? Digby Baltzell blamed it on the Quakers. Others blame the Erie Canal, and Andrew Jackson, or maybe Martin van Buren. Some say the city-county consolidation of 1858. Others blame the unions. We rather favor the decline of family business and the rise of the modern corporation in its place.
Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
