Philadelphia dominated the medical profession so long that it's hard to distinguish between local traditions and national ones. The distinctive feature is that in Philadelphia you must be a real doctor before you become a mere specialist.
Revolutionary Philadelphia's Patriots
All kinds of people were patriots in 1776, and many of them were all mixed up about what was going on and how they stood. Hotheads in the London Coffee House stirred up about an inoffensive Tea Act, Scotch-Irish come here to escape the British Crown, the local artisan class and the local smuggler class, unexpectedly prospering under non-importation, and the local gentry -- offended to be denied seats in Parliament like other Englishmen. Pennsylvania wavered until Ben Franklin stepped forward with a plan.
This Indenture Witnesseth, That Jacob Ehrenzeller, son of Jacob Ehrenzeller of the City of Philadelphia hath put himself, and by these presents, with consent of his said father, doth voluntarily, and of his own free Will and Accord, put himself Apprentice to the Managers of the Pennsylvania Hospital to learn the Art, Trade and Mystery, and after the Manner of an Apprentice to serve the said managers from the Day of the Date hereof, for and during, to the full End and Term of five years and three months next ensuing. During all of that Term, the said Apprentice his said Master faithfully shall serve, his Secrets keep, his lawful Commands every where readily obey. He shall do no Damage to his said Master, nor see it to be done by others, without letting or giving Notice thereof to his said Master. He shall not waste his said Master's Goods, nor lend them unlawfully to any. He shall not commit Fornication, nor contract Matrimony within the said Term.
He shall not play at Cards, Dice or any other unlawful Game, whereby his said Master may have Damage. With his own Goods, nor the Goods of others, without license from his said Master, he shall neither buy nor sell. He shall not absent himself Day nor Night from his said Master's Service without his leave: nor haunt Ale-houses, Taverns or Playhouses; but in all Things behave himself as a faithful Apprentice ought to do, during the said Term. And the said Master shall use the utmost of his Endeavor to teach or cause to be taught or instructed the said Apprentice in the Trade or Mystery of an Apothecary. And procure and provide for him sufficient Meat, Drink, washing Cloths and Lodging fitting for an Apprentice, during the said Term of five years and three months.
And for the true Performance of all and singular the Covenants and Agreements aforesaid, the said Parties bind themselves each unto the other, firmly by these Presents. IN WITNESS whereof, the said Parties have interchangeably set their Hands and Seals hereunto. Dated the first Day of June in the thirteenth year of the Reign of our Sovereign Lord George the third, King of Great-Britain, etc, Annoque Domini, One Thousand Seven Hundred and Seventy Three.
Signed and Delivered in the Presence of Jacob Ehrenzeller, Jacob Ehrenzeller Sr, Sam V. Coates
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The Ex-residents Association of the Pennsylvania Hospital became active early in the Nineteenth century, and naturally concerned itself with just who was the first interne or resident of the hospital. It seemed probable that the first interne of the Pennsylvania Hospital would also be the first interne in America. When this indenture was discovered in the archives, Ehrenzeller became a likely candidate, although being apprenticed as an Apothecary did raise some questions. Nor did Ehrenzeller perform his indenture after the completion of medical school, as is now the custom; the first resident physician in that sense was Caspar Wister, in 1812. However, in colonial times most physicians did not go to medical school at all, qualifying as practitioners by working in the offices of practicing physicians, just as lawyers did for a much longer time. The argument is somewhat complicated by the existence of a medical school, the College of Philadelphia, created in 1765, and the fact that the upper crust of colonial medicine had gone to medical school in Edinburgh. That group of seven physicians with degrees gathered themselves together (in 1787) as the College of Physicians of Philadelphia, which still exists as the nation's oldest medical organization.
Dorothy I. Lansing MD, then the clerk of the Section on History of the College of Physicians of Philadelphia, interested herself in these issues, and privately published a pamphlet about it. The argument for regarding Ehrenzeller as an interned physician revolves around the fact that his father had gone to medical school in Europe, and was regarded as a physician even though he made his living by operating a tavern after he came to Philadelphia. Furthermore, the 16 year-old Ehrenzeller found his apprenticeship disrupted by the Revolutionary War, particularly the occupation of Philadelphia in 1777 by British troops who used the hospital for their wounded. Nevertheless, young Ehrenzeller served as a surgeon at the battle of Monmouth (June 28, 1778). Among the minute books of the Board of Managers of the Pennsylvania Hospital was discovered a minute of June 26, 1773 with the terms that Jacob Ehrenzeller, Jr. "shall have leave at his own or his Father's expense to attend the lectures of the Medical Professors out of the Hospital during the last two years of his apprenticeship; to attend the Surgical Operations and Lectures in the Hospital free of any expense; and that the Apothecary for the time being shall duly instruct him in Physic and Surgery." Dr. Lansing concluded that this was "a unique concurrent internship: apothecary apprentice cum medical student arrangement that no doubt suffered innumerable changes due to wartime problems; Jacob Ehrenzeller was awarded a certificate of medical competency. The College of Philadelphia medical school having ceased to exist because of the war, he obtained no degree in medicine."
Dr. Lansing found even stronger evidence of his physician rather than apothecary status in the fact that immediately after the war he established a practice in Goshen, Chester County. While it was customary for practicing physicians of the time to support themselves as schoolteachers, storekeepers or bankers, Ehrenzeller was able to live exclusively on his income as a physician. Indeed, after his death in July 18, 1838, his estate was one of wealth. It seems unlikely that an apothecary masquerading as a physician would have flourished in those competitive times, and on this basis it is concluded that he came as close as the times permitted to the description of an interned hospital physician. The Ex-residents Society of the Pennsylvania Hospital was satisfied enough to declare Ehrenzeller to have been its first interne. And invites the rest of the nation's medical community to examine whether anyone else might have been better qualified to have that title earlier.
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