Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Railroad Town
It's generally agreed, railroads failed to adjust their fixed capacity to changing demands. It's less certain Philadelphia was pulled down by that collapsing rail system.

Central Pennsylvania
"Alabama in-between," snickered James Carville, "Philadelphia, Pittsburgh, and Alabama in-between."

Sayre / Athens

{General John Sullivan}
General John Sullivan

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.

Originally published: Monday, October 25, 2010; most-recently modified: Wednesday, June 05, 2019