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
... William Penn's Quaker Colonies
plus medicine, economics and politics ... nearly 4,000 articles in all
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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.
To understand the dynamics of the following medical anecdote, the reader should understand the thrust of Miriam's First Rule of Management. Miriam is my oldest daughter, with long experience managing many firms, large and small. Her rule is that when an employee starts misbehaving for no good reason, eliminate the position. Invariably, well almost invariably, an employee who starts acting out doesn't have enough work to do. If you are managing a large organization, you should also consider firing the supervisor of that person, on the grounds the supervisor should have noticed there was not enough work for the employee to do and was probably covering up.
My anecdote concerns a session at the 2006 annual meeting of the American College of Physicians, ostensibly devoted to the conflict between generations of doctors. It didn't take long before the meeting turned into an uproar about the new work rules which prohibit a resident physician from working more than 80 hours a week. That's supposed to protect patients against mistakes of sleepy doctors, although some suspect it is mainly an outgrowth of a gap between what they do and what they expected to do. From the time they entered high school, future doctors have been taught to expect workaholic employment conditions, and while more normal people haven't been taught that message, that's irrelevant. The situation is aggravated by the increased admission of women to the profession, who for their part have been taught to expect a breathless race between finishing their work and getting home to relieve the babysitter. Perhaps in time the newly invented specialty of "hospitalists" will get established and accepted, along with accident room work as another harrowing occupation which abruptly ends its day by the clock rather than the backlogs. At the moment the pioneers must overcome the suspicion, only partly fair, that Miriam's First Rule applies to them.
If not, that Rule clearly does apply to the youngsters who now must go home to spend quality time with their families, because they are not allowed to exceed the new work rules. At the ACP meeting, a dozen of us Civil War veterans were treated to an appalling amount of teenage mumbo jumbo apparently emanating from unsuspected warfare between Generation X and the Baby Boomers, their supervisors, mentors, and colleagues. All of us Civil War veterans held the private opinion that Baby Boomers were a little self-indulgent, but in the eyes of Gen Xers the boomers are workaholic fanatics, incapable of relaxing even for a moment in order to enjoy the life of the good, the true and the beautiful.
As we passed out of the room at the end of the session, one of the silent gentlemen with white hair came over to me. We didn't know each other, but we recognized the signs of a silently shared opinion. The old doctor leaned over to me and muttered, "They offer nothing, but they want everything." I smiled, and we parted. I guess I might have told him about Miriam's First Rule, but it would have taken too much explaining.
There is a painting of the region around 8th and Spruce Streets in the 1750s, depicting a pasture, with cows, and three or four buildings between 8th and 13th Streets. When the Pennsylvania Hospital moved there in 1755 from its temporary location in a house located a block from Independence Hall, there were complaints that it was now located so far out in the woods that it was difficult and dangerous to go there. Still another description of the area is evoked by the provision which the Penn family placed in the deed of gift of the land, strictly forbidding the use of the land as a tannery. Tanneries have always been notorious for giving off noxious odors, so most people wanted them to be somewhere else, anywhere else. In any event, the main activity of Penn's "green country town" at that time was concentrated closer to the Delaware River, and the nation's first hospital was definitely placed in the outskirts. Two blocks further West the almshouse was already in place, but not much else. We are told that Benjamin Franklin had flown his Famous Kite at 9th and Chestnut, using a barn there to store his materials. It might be recalled that the population of Philadelphia, although the second largest English-speaking city in the world, was only about twenty-five thousand inhabitants at the time of the Revolution, and in 1751 was even smaller.
In any event, the first and oldest hospital in America was built on 8th Street between Spruce and Pine, and the Eighteenth Century buildings on Pine Street still present a breathtaking view at any season, but particularly in May when the azaleas are in bloom, and fragrance from the flowering magnolias fills the evening atmosphere for blocks around. Although some people today mistake the Pennsylvania Hospital for a state hospital, it was founded in the reign of George II, decades before there was such a thing as the State of Pennsylvania. The Cornerstone was laid by Benjamin Franklin, with full Masonic rites. Most doctors regard a hospital as a mere workshop, but the affection with which many Pennsylvania physicians regarded their special hospital is indicated by the number who have requested that their ashes be buried in the garden.
For two hundred years, beginning with the first American resident physician Jacob Ehrenzeller, the interns and residents were paid no salary, so they had to live on the grounds. An Internet was just that, interned within the four walls for at least two years. Because the resident physicians had no money, they stayed in the hospital at night and on weekends, playing cards and swapping stories. The hospital was home for them, as it was for the student nurses, likewise unpaid but more strictly confined and supervised. This penury seemed acceptable because the patients were mostly charity ward patients, otherwise unable to pay for their own care. Ehrenzeller finished his medical apprenticeship and went to practice for many decades in the farm country of Chester County, but gradually upper-class Philadelphia moved from 4th Street westward to and beyond the hospital, and two of the richest men in American history, Morris and Biddle, had houses within a block of the hospital, although Morris never lived in his house, having more pressing matters in debtor's prison. Therefore, later resident physicians at the hospital had the potential of setting up a private practice in the area and becoming society doctors as well as academically prominent ones. Being a charity hospital in a rich neighborhood created the potential for volunteer work by the town aristocrats and large bequests for charity. The British housed their wounded in the hospital during the Revolutionary War and shot deserters against the red brick wall of the small cemetery to the north. A century later, there were a couple of dozen rooms for private patients in the hospital for the convenience of the doctors and the neighbors, but everyone else was a charity patient. And a century after that, the hospital still did not have an accounting department to collect bills and tended to regard people who asked for a bill as a nuisance. Benjamin Franklin is regarded as the Founder of the hospital, and his autobiography famously describes how he fast-talked the legislature into matching the donations of the public, not mentioning to them that he had already collected enough promises to see the project through. This seems in character; Franklin's biographer Edmond Morgan summed up that, "Franklin doesn't tell us everything, but what he does tell us, is straight." The idea for the hospital was that of Dr. Thomas Bond, whose house is now a bed and breakfast on Second Street, but it was characteristic of Franklin to be the secretary of the first board of managers of the hospital. In Quaker tradition, the clerk of a meeting is the person who really runs the show. It thus comes about that the minutes of the founding board were recorded in Franklin's own handwriting, among them the purpose of the institution, which is to care for the Sick Poor, and if there is room, for Those Who can pay. This tradition and this method of operation continued until the advent in 1965 of Medicare when charity care was displaced by concepts which the nation had decided were better. The Pennsylvania Hospital was not only the first hospital but for many decades it was the only hospital in America. Its traditions, sometimes quaint and sometimes glorious, cast a long shadow on American medicine.
REFERENCES
America's First Hospital: The Pennsylvania Hospital 1751-1841 William Henry Williams Ph.D. ISBN-10: 0910702020
Very few claimed to understand what Einstein's Theory of Relativity was all about, but everyone could understand that giving a wartime Nobel Prize to a conscientious objector on the enemy side was political dynamite. It was not entirely a clear case; Einstein had indeed been a C.O. and was indeed the only member of the 94-person Prussian Academy to refuse to endorse the War. However, he had such a long history of taking the unpopular side of every argument that it was not certain whether he opposed the war or was merely sticking his thumb in the Kaiser's eye. At the same time, the most promising English astrophysicist, Arthur Eddington, was petitioning as a Quaker to be granted alternative service rather than be compelled to fight. Since Eddington was just about the only person claiming to understand and endorse Einstein's incomprehensible idea, it did not seem convenient to the British government to seem to endorse a German claim to enormous scientific achievement. It was decided to agree to Eddington's draft exemption on condition he conducts his own proposal for a definitive test of the theory. According to this idea, the light coming from a distant star should bend as it went past the sun. This proposal had the hidden advantage that a test could not take place until the 1919 eclipse of the sun, visible only from Africa or Brazil.
The experiment was hailed as a success, and a Nobel Prize followed shortly afterward, even though there were storm clouds over Brazil, and technical difficulties in Africa resulted in a rather blurred obscurity which would have baffled the public except for the enthusiastic acclaim of the only distinguished English scientist likely to understand the experiment. As telescopes have improved over the intervening century, it is now possible to observe the gravitational pull of much larger celestial bodies than the sun on a light which is coming to the earth from much more distant stars. Therefore, even schoolchildren can today see photographs of pinpoint starlight twisting into arcs of light while passing distant galaxies. Einstein the German has triumphed over Isaac Newton the Englishman, although the heady triumph probably did somewhat go to the heads of both Einstein and Eddington. Eddington the birthright Quaker allowed himself to be knighted, Einstein endorsed the dubious pacifist uprisings in Palestine, Eddington made a career of explaining puzzling scientific theories to the appreciative public. The direction of all this became clearer as some of the new theories Eddington promoted were discredited, and Einstein's pacifism has certainly become clouded by later thermonuclear events which he had a large hand in promoting.
Of the two, Einstein has proved to be the greater scientist, but Eddington would have been a scientific luminary without any association with the German, perhaps even a greater one without inevitable comparison between the two. Einstein spent the last 23 years of his life on the fringes of Philadelphia, at Princeton, but Philadelphia had little consciousness of his presence.
Running west from Oneonta and Binghamton, NY, the North branch of the Susquehanna runs due west for about fifty miles until it turns abruptly south at Sayre, PA. In the course of this westward run along the northernmost ridge of the Endless Mountains, it passes Apalachin NY, where the mobster chieftains got caught by the state police while holding a convention. At Sayre, named after an eastern railroad financier of the 19th Century, it joins the Chemung River at a large bowl-shaped refuge in the mountains which shelters it somewhat from the ferocious snows for which this part of Upper New York State is famous. Sayre usually gets a heavy snowfall or two in January, which lies on the ground until the Spring thaw in April. But that's pretty mild for this region, and the Iroquois made it a sort of headquarters, where Queen Esther of head-smashing fame made her home just before the Wyoming massacre in which she figured so prominently. Consequently, General Sullivan made his famous march to destroy the Iroquois by going northwestward up the Susquehanna to Athens, rather than following the Northeast Extension of the Pennsylvania Turnpike, as somehow seems more probable. Actually, Sayre was more of a 19th Century town, with the original settlement concentrated a few miles south at the region of Athens. Sayre is more modern, once was the location of a huge locomotive repair center, and has the Guthrie Medical Clinic at Robert Packer Hospital. Athens is older, quieter and has more stately charm, and is actually on the Chemung River with a two hundred yard portage to the Susquehanna.
Lehigh Valley RR Fame
Robert Packer was considered to be the ne'er do well son of Asa Packer, that go-getting industrialist of Mauch Chunk/Jim Thorpe, and Lehigh Valley RR fame. The father is said to have sent his son up to Sayre to get him out of the way, but once freed of the old tyrant's grip, Robert built things up into the second-largest locomotive repair center in the world. Robert Packer never had children and eventually set about building up the Robert Packer Hospital. Much taken with the Mayo Clinic model, he called Charlie Mayo and asked if had someone to suggest for running the local institution. Indeed, Mayo had just the fellow, Guthrie, who like the Mayos was a surgeon with a specialty in removing enlarged thyroid glands. As long as the railroads flourished, the Guthrie Clinic was headed toward the status of a major medical center with private rail cars for the surgeons and the like. However, the advent of diesel locomotives put an end to the main source of local prosperity, and the Guthrie Clinic settled down to a more modest status of a regional medical center, mainly in competition with the Geisinger Clinic further south on another bend in the Susquehanna. At present, the Obama Administration seems much taken with the model of the Midwestern group practice, of which both Guthrie and Geisinger are models. Perhaps the politicians do not realize that all of these clinics were based economically on the principle that surgeons can make enormous incomes if they are fed enough cases. Consequently, they are willing to reduce their own income in order to make group practice more attractive to the "feeders"; the department of surgery subsidizes the department of general medicine. Their competitors have long grumbled that this arrangement was an elaborate evasion of the medical ethical prohibition of fee-splitting. Most of that feeling has subsided, but a more serious present criticism is that the Obama Administration mainly seems determined to reduce surgical fees, so the whole arrangement may collapse when they do.
Robert Packer Hospital
Curiously, prosperity looks as though it may be ready to return to the Endless Mountains, in the form of the fracking method of gas extraction from the Marcellus Shale which underlies this region. Coming as it does at a time when domestic oil production is growing inadequate, but alternative energy sources are not yet competitive, rail freight is returning to the region, and truckers by the thousand are migrating from economically depressed regions like Detroit. For reasons not immediately clear, the huge trucks which import water and chemicals for fracking are driven by non-residents. The smaller trucks which carry away (to Northern New York, they say) the brine effluent from the wells, are driven by locally recruited truck drivers. A certain number of bar room fights have been rumored to have grown out of this situation. Camp followers of the fair sex have occasionally drifted into town, but so far not in large numbers.
As the region has evolved, the third town of Waverly NY has joined the other two in what amounts to a seamless conurbation of about 30,000 people, nestled in the cozy valley.
Every once in a while, Philadelphia needs to be reminded of its Quaker origins, and the surprising number of people who will suddenly make an appearance to defend Quaker ideas. It would appear that Philadelphia needs to be reminded that Quakers see a value, even a joy, in silence. The present entrepreneurs in charge of Eastern State Penitentiary, presently a Hallowe'en showplace, are to be congratulated for rehabilitating a neighborhood formerly in decay. If you are looking for a collection of exotic restaurants after visiting the neighborhood art museums, this is the place to go. But I do wish somebody would put an end to the myth that silence and solitary confinement can drive you crazy because I don't believe they will.
Every Quaker family has to handle the problem that children don't naturally like to sit still. The first few times Quaker children are brought to meet, the kids have to be shushed, given books to read, and eventually be led out early to sit in the First-Day (Sunday school) classrooms, while their parents go back to the meeting room to sit in silence. Some kids get the message quicker than others, and the ones who keep misbehaving in meeting eventually have to face general disapproval as "spoiled" until they either quiet down or get sent to boarding school. So Quakers are familiar with the problem, learn how to deal with it, and tend to regard resistance to silence as a sign of immaturity.
Charles Dickens
Charles Dickens was once a newspaper reporter in Philadelphia and wrote many ecstatic articles about the city. However, he was paid by the word, and prospered mightily from some unnecessarily long articles directed to the folks back in England. One of them was a description of Eastern Penitentiary, built on the principle of the rehabilitation of criminal behavior by long periods of solitude, remote from distracting criminal influences in the community at large. The idea, which may well have originated with Dr. Benjamin Rush, later called the father of American Psychiatry, was widely imitated. There soon were over three hundred prisons throughout the world, dedicated to the idea and imitating the architecture. Whether he believed it or not, Dickens wrote a long, long, diatribe against the concept of solitude as rehabilitating, in which he imagined himself in the position of the poor prisoner, and declaring it would drive him crazy. Without much argument, Charles Dickens was responsible for the shift in public attitudes which eventually led the Board of Prisons to decide to tear it down. This was not exactly evidence-based psychiatric reasoning since a great many crazy people get sent to prison anyway. It isn't surprising that lots of crazy people were found in Eastern Penitentiary, but it isn't exactly proven that solitary confinement made them into lunatics. In fact, it isn't being based on evidence to claim that either the outcome of recidivism or the outcome of improved behavior is influenced by any form of incarceration, with or without corporal punishment, with or without capital punishment. It is definitely proven that incarceration is as expensive as psychiatric treatment, but that isn't saying a great deal. You can definitely cause temporary insanity with prolonged sleep deprivation, but you would suppose that solitary confinement would increase the amount of sleep, not reduce it.
When the time came to demolish Eastern Penitentiary, the Board of Prisons was advised it was so solidly constructed it was simply too expensive to tear it down. As the neighborhood gentrified, real estate values rose, but never enough to justify the demolition of what was essentially a fortress.
Even the relentless forces of decay have continued to be slower than the rise of rising in the price of the land. It's like those medieval castles still standing in Europe, occasionally attracting some American billionaire, but mostly just hollow shells. The deterioration on the interior is apt to go faster than deterioration of those stone walls, so the cells formerly occupied by Willie Sutton and Al Capone will need restoration sooner than the towers and parapets. But driving people crazy? It's doubtful. Its function was mostly to segregate the criminal elements of each succeeding wave of immigrants, as a quick review of the surnames of inmates easily demonstrates.>/p>
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.
