Although the number of new cases in New York City, Los Angeles, and San Francisco multiplied quickly over the first two years of the epidemic, at first the number of people with AIDS in Philadelphia rose slowly. Within the first year, only seven cases were reported locally, but by early 1983 trends in Philadelphia seemed to be catching up to the rapidly growing epidemic witnessed in New York and California. The disease also appeared in New Jersey, particularly in the urban corridors between Philadelphia and New York and between Philadelphia and Atlantic City, and in Delaware.

As gay men watched their friends and lovers die in increasing numbers, they organized in response. Philadelphia Community Health Alternatives (PCHA, later known as the Mazzoni Center), a health clinic founded in 1979 to serve the local lesbian and gay community, formed the Philadelphia AIDS Task Force to provide social services to those affected and offer information about AIDS and other sexually transmitted diseases through a local hotline. Meanwhile, social clubs like the Gay Men’s Chorus and Girlfriends Motorcycle Club joined forces to raise funds for PCHA’s education and prevention efforts.

Spread of AIDS

By the middle 1980s public health authorities recognized that the AIDS epidemic had grown beyond the communities of gay men in which doctors first identified the disease. Researchers in the United States and France had identified HIV as the cause of AIDS in 1983, and thus definitively determined that the disease could be transmitted through blood-to-blood contact, including needle-sharing among intravenous drug users, blood transfusions, and from an infected mother to her unborn child. At the same time, in cities around the country, reports showed the growing incidence of HIV and AIDS among African Americans and Latinos, particularly within networks of intravenous drug users and among their sexual partners and young children. Although those in this “second wave” of new cases had likely been infected for some time, their low access to medical care combined with the long latency period of HIV, during which time the virus spreads throughout a patient’s system but does not produce symptoms, to initially mask the prevalence of AIDS within communities of color.

In Philadelphia, by 1985 African Americans made up almost half of all reported AIDS cases, and the majority of cases among people under twenty five years old. David Fair, a longtime local gay activist and secretary-treasurer of a local predominantly Black health care workers’ union, and Rashidah Hassan, a nurse who had worked with PCHA and its AIDS Task Force, became dissatisfied with the groups’ failure to effectively reach out to African Americans at risk of contracting HIV. To stem the rising tide of new infections in Philadelphia’s Black community, in 1986 they founded Blacks Educating Blacks About Sexual Health Issues (BEBASHI), one of the nation’s first Black AIDS service organizations. Perceiving that the AIDS Task Force’s efforts to reach out to the Black community had been undercut by its reputation as an all-white organization, BEBASHI representatives worked through existing social institutions like African American churches so that their education and prevention messages that would resonate with Black audiences.  In New Jersey, Project IMPACT (Intensive Mobilization to Promote AIDS Awareness through Community-based Technologies) also reached out to African American leaders in urban areas.

In 1987, as the AIDS community nationwide became frustrated with the dearth of effective treatments and President Ronald Reagan’s reticence on the epidemic, grassroots AIDS politics took a radical turn. In March, a group of New York activists founded the inaugural chapter of the AIDS Coalition to Unleash Power (ACT UP), an organization whose protest actions became the public face of AIDS advocacy in the United States during the late 1980s and early 1990s. The group quickly spawned a network of chapters in cities across the country and abroad, including Philadelphia, South Jersey, and Delaware.

Dramatic Demonstrations

Members of the Philadelphia branch of ACT UP began staging theatrical “die-ins” and other dramatic demonstrations to highlight the human cost of high prescription drug prices and inadequate public health policy. To protest the Catholic Church’s opposition to condom use, in May 1991 around one hundred ACT UP Philadelphia members interrupted a prayer service for people with AIDS conducted by  Archbishop Anthony Bevilacqua and tried to place wrapped condoms near his hands and feet, shouting, “These will save lives–your morals won’t.” In addition to public protests, ACT UP became well known for creating memorable visual messages to both educate people about AIDS and mobilize those affected by the epidemic. In this vein, during one holiday season the Philadelphia chapter circulated stickers featuring an HIV-positive Santa Claus with the tagline, “If only Reagan and Bush had told the truth, Santa wouldn’t have to die from AIDS.”

During the mid-1990s, ACT UP declined in national prominence as the white gay men who filled much of the organization’s ranks passed away, grew tired of activism, or gained access to the highly effective (but expensive) class of new antiretroviral drugs that became available due to advances in HIV treatment research. The Philadelphia chapter, however, remained vital due to the recruiting efforts of a core group of members, who reached out to lower-income people of color, among whom the nationwide AIDS epidemic continued to grow fastest. The changing membership in turn shaped the direction of the group’s activism, as it increasingly focused on affordable housing, HIV prevention in prisons, and access to medications for impoverished people in the United States and throughout the developing world. Working with Health GAP (Global Access Project), a coalition of AIDS activists and allied organizations, Philadelphia ACT UP members pressured the White House to move forward with a coordinated response to the worldwide AIDS pandemic.  This effort, supported by numerous AIDS action groups in Philadelphia and the Cooper Early Intervention Program in Camden, culminated in 2003 with President George W. Bush’s announcement of the President’s Emergency Program for AIDS Relief (PEPFAR), a five-year, $15 billion commitment funding HIV prevention and drug access programs in Africa. In 2008, Congress reauthorized the program through 2013, and expanded its funding to almost $48 billion.

Four Decades

As the epidemic entered its fourth decade, the Philadelphia Department of Public Health estimated that 1.3% of the city’s population was living with HIV or AIDS, about three times the national average. Center City and the surrounding area had the greatest prevalence of cases in Philadelphia County, with additional areas of high concentration in the Northeast, West Philadelphia, and around Germantown. Despite the city’s relatively large percentage of people living with HIV and AIDS, local trends reflected patterns of infection for the United States as a whole, inasmuch as the epidemic in Philadelphia disproportionately affected African Americans, and in particular men who had sex with men and women, among whom the disease was growing fastest.

Regionally, statistics collected by the Centers for Disease Control from the beginning of the epidemic through 2008 showed New Jersey ranking fifth-highest in number AIDS diagnoses among the fifty states; Pennsylvania ranking seventh; and Delaware ranking thirty-third (although in rate of cases per thousand population, Delaware ranked eighth-highest in the nation). By 2010 Philadelphia accounted for the highest proportion of AIDS cases in Pennsylvania, surpassing other counties by far (20,411 diagnosed cases from 1980 to 2010, compared with 1,098 in Montgomery County, 1,743 in Delaware County, 802 in Bucks County, and 603 in Chester County).  In South Jersey, by 2010 the disease was most prevalent in Atlantic County.

In light of these realities, activists reignited the search for an AIDS cure. In 2009 a group of veteran Philadelphia activists, many of whom had been part of ACT UP chapters around the country during the organization’s heyday, founded the AIDS Policy Project to advocate for funding and scientific research on treatments to not only slow the spread of HIV within a patient’s system, but eliminate it altogether.  In this way, Philadelphians sought to lead the way to the end of the AIDS epidemic once and for all.

Dan Royles is a Ph.D. Candidate at Temple University.  This essay is derived from his dissertation research on the political culture of African American AIDS activism. (Author information current at time of publication.)

In its early decades Byberry was controlled by the city, and from 1938 onward it was one of the several hundred state hospitals that were the core of American mental health care. Many of those hospitals were “noble charities,” some of the earliest having opened at the urging of the humanitarian reformer Dorothea Dix, who sought to move the “insane” poor out of jails and prisons. Following the therapeutic theories of the day, the asylums (later renamed state hospitals) offered rural retreats from the growing cities and at least the promise of treatment.

Unlike most of those hospitals, Byberry was opened as a city institution in Northeast Philadelphia to relieve overcrowding at Blockley, a huge institution in West Philadelphia that held the indigent insane in what one observer called “an ancient monasterial structure” as well as many varieties of the poor and homeless. In 1911, overcrowding in the “insane department” (also known as the Philadelphia Hospital for the Insane) led to the transfer of some inmates to Byberry City Farms (the city’s poor farm). Two years later, admissions of the insane to Blockley ended, and Byberry provided shelter and custodial care, usually at the most minimal levels and with considerable overcrowding. By 1914, Byberry held 2,267 residents, by far the largest of Pennsylvania’s twenty-one county mental institutions and larger than seven of its eight state hospitals. After a series of scandals across the state, in 1938 the Commonwealth took over Byberry and several other city institutions and renamed them state hospitals.

But renaming a huge overcrowded custodial institution a “hospital” simply heightened the gap between humanitarian intention and custodial reality. While some of the newly admitted were offered more active care, many inmates became “institutionalized” into a unique community experience, with tedium relieved by work crew duties, sitting in day rooms, or wandering around the grounds. Scandals of abuse and neglect were common. Overcrowding was a constant problem: a 1934 national survey of institutional care of the mentally ill reported that Byberry had over 4,500 inmates, while its rated capacity was 2,500. In contrast, Friends Hospital, a private institution, held 155 patients, less than its rated capacity of 190, and private sanitoria such as Fairmount Farm had even fewer (twenty-two residents, with a rated capacity of forty-four).

Despair About Mental Illness

The meager city or state support, the absence of affordable alternative care in the community, and a deepening public and even professional despair about mental illness completed the transformation of Byberry into what University of Pennsylvania sociologist Erving Goffman termed a “total institution.”

Conscientious objectors performing alternative service during World War II witnessed and even surreptitiously photographed scenes of everyday neglect and even brutality that shocked them, though these conditions were well known to city and state officials. Novels and films like The Snake Pit and photographs in national magazines like Life and PM reached a broader public with the message that basic living conditions in the state hospitals were very poor. Byberry was among the worst in Pennsylvania.

The most damning indictment of the failures of Byberry and similar institutions appeared in the work of pioneering journalist and reformer Albert Q. Deutsch in his 1948 book, The Shame of the States. Byberry was “Philadelphia’s Bedlam,” the equal of the notorious London home for the mad in the previous century or in Deutsch’s words akin to Nazi concentration camps.

Deutsch’s account included stunning photographs of such scenes as the “male incontinent ward,” and documented the saddest and most terrifying parts of the huge institution. Other photographs of the era, including a 1946 report by the Pennsylvania Department of Welfare, showed similar scenes. Regardless of the public reaction, the absence of alternatives meant Byberry continued to grow. By 1947, the institution held 6,100 patients, with an average yearly cost per patient of $346.

Soon after the national census of state hospitals peaked in the mid-1950s, a series of changes began the era of deinstitutionalization. But the scandals at Byberry continued: unexpected patient deaths, mistreatment, and extensive use of seclusion and restraint. Lawsuits successfully challenged the image of an effective mental health facility and pressed the state for change.

Closing of Byberry

By the late 1980s, Byberry was regarded as a “clinical and management nightmare,” despite the fact that its census had fallen to about 500 by 1987.  In that year, Pennsylvania Governor Robert Casey directed that it be closed. Shutting Byberry led to the “unbundling” of psychiatric care for the seriously mentally ill, replacing the specialized community experience of a total institution with community programs provided by private non-profit agencies.

After the last residents left the huge campus, the physical plant of more than fifty buildings continued to decline. Byberry became a favorite visiting place for urban adventurers who wandered its structures and scavengers who stripped away copper and wiring. Eventually a plan to reuse the site led to demolition of almost all of its buildings in 2006 and construction of offices and housing (“Arbours at Eagle Pointe”).

But Byberry lived on in memory: Websites, rich with historical photographs and other documents, commemorated and even celebrated its notorious past.

George W. Dowdall is Professor Emeritus of Sociology at Saint Joseph’s University and Adjunct Fellow, Center for Public Health Initiatives, University of Pennsylvania. (Author information current at time of publication.)

The prestigious College of Physicians of Philadelphia, dominated by sanitarians, presumed it was not a new disease but an “epidemic phase” of indigenous summer diarrhea caused by miasmic vapors emitted from the ever-present filth in nineteenth-century cities. Rejecting the theory that cholera was spread by contagion, the fellows of the college believed predisposing conditions made the poor, the profligate, the immoral, those with weak constitutions, and especially certain ethnic groups, the most likely victims of the disease. To combat the epidemic, they advised the Board of Health to clean the city of filth, set up local hospitals, and educate the populace to avoid dangerous foods and habits they believed led one to be susceptible to the disease.  These recommendations were put into effect when cholera broke out in the city in July 1832. Meanwhile, to help the afflicted private charity and church groups provided nurses and places for recovery. The Catholic church especially responded to the challenge of aiding the Irish and other Catholic immigrants, with some nuns coming from as far away as Emmitsburg, Maryland, to meet the crisis. By mid-September the epidemic had run its course, leaving a death toll of 935.

Far in excess of 141 deaths took place in the state-owned Arch Street prison and the city almshouse where inmates suffered from overcrowding, appalling hygienic conditions, and generally poor health, which the fellows of the College of Physicians saw as proof of the validity of their theory of the etiology of the disease. In an attempt to stop the carnage at the prison, the authorities released inmates who had not been convicted of major crimes. Many fled to Chester, Berks, Lancaster, and other neighboring counties, spreading cholera as they went. Citizens fleeing the city also spread cholera to surrounding areas.

Philadelphia’s Lower Death Rate

Philadelphia’s death rates were one-quarter those suffered in New York City and one-twelfth those of Montreal. Medical authorities attributed the city’s good fortune to the use of water from the Fairmount Reservoir to cleanse filth from the streets, inspiring cities such as New York and Boston to create municipal water supplies modeled on that of Philadelphia. Unbeknownst to the medical profession, the disease was caused by a bacterium and was spread primarily through feces-contaminated drinking water. It was not clean streets but drinking water from the reservoir, uncontaminated by the cholera bacilli, which accounted for the city’s low death rates. In the Black and Irish districts south of South Street, the death rate from cholera was three to four times greater than in the city. While the College of Physicians attributed these deaths to the poverty and “racial” character of the population, in reality, these areas had very limited access to Fairmount drinking water and consequently suffered far more affliction than those with such resources.

Cholera returned to Philadelphia in 1849. Despite a 50 percent increase in population, only 747 people died from the disease. Medical officials again concentrated on eliminating filth and building neighborhood hospitals, but in fact this radical reduction in the death rate from cholera was due primarily to the expansion of the Fairmount water system. Again the largest concentration of deaths was in the almshouse, where at least 228 died.  Lesser cholera outbreaks occurred from 1850 through 1854.

Evidence Points to Contagion as Cause

Although fellows of the College of Physicians continued to advocate the miasma theory at mid-century, doctors trained in the city were challenging its validity.  In Columbia, Lancaster County, 75 miles west of the city, cholera broke out in September 1854, killing at least 127 people. Immigrants traveling west from Philadelphia on the railroad brought the disease to the city. Dr. T. Heber Jackson, of Philadelphia, attended victims and concluded that transmission of the disease was best explained by contagion, not miasma. He also questioned the prevailing belief in predisposing causes, pointing out the disease had struck rich and poor, Black and white, alike.

Philadelphia-trained Dr. John Atlee of Lancaster reinforced this criticism. He observed that an outbreak of cholera in Lancaster in the summer of 1854 had not developed spontaneously but had been brought to the city by infected people and spread by contagion. His discovery of microscopic particles in the effluvia of the Lancaster cholera victims gave credence to the germ theory that soon become medical orthodoxy. The analyses of these two physicians mirrored the research linking cholera to polluted water being done by Dr. John Snow of London. Although their work remains little known, it is illustrative of the richness of medical research and enquiry in mid-nineteenth-century Philadelphia.

Lesser cholera outbreaks occurred in 1866, 1891, and 1899. While many in the city’s medical community still advocated the miasma theory in 1866, they had come to believe that the disease was also spread by contact with fluids emitted by the victims. The Board of Health’s use of disinfectants greatly reduced deaths during that epidemic and marked another major step towards the acceptance of the germ theory of medicine. Typhoid epidemics and recurrences of cholera in the 1890s led the Board of Health to install water filtration systems for the city. No subsequent outbreaks of cholera occurred after the city expanded and improved sewage disposal and water treatment in the twentieth century.

John B. Osborne is an Emeritus Professor of History at Millersville University of Pennsylvania. (Author information current at time of publication.)

Philadelphia gained its early reputation as a city of medicine through the development of hospitals and medical schools. The founding of Pennsylvania Hospital in 1751 (America’s first general hospital) was an indication that by the mid-eighteenth century, Philadelphia had grown into a substantial urban complex with needs for services beyond what family and church could provide. Founded by physician Thomas Bond (1712-84) and Benjamin Franklin (1706-90), the nation’s first hospital joined a movement—rooted in Enlightenment thought, then underway in Britain—to create “voluntary hospitals” to care for “strangers” and the “worthy poor,” funded and conducted by private philanthropy. From the outset, the hospital contributed to the city’s allure in medical education. Its Wednesday and Saturday morning demonstration “clinics” drew crowds of nineteenth-century medical students.

Numerous hospitals subsequently arose within neighborhoods and nearby townships, supported by religious denominations or particular segments of the citizenry, such as African Americans or women. The city opened Blockley Almshouse in 1732, which later became Philadelphia General Hospital; and the origins of the Municipal Hospital for Contagious and Infectious Diseases can be traced to before 1818.  Specialty hospitals arose for care of the eyes, children, and maternity work. Reflecting the Quakers’ concern for those “deprived of reason,” Pennsylvania Hospital spawned a progressive Hospital for the Insane (1841) on then-rural grounds west of the city; a Friends Asylum (1817) was founded in the Frankford countryside. With other Quaker women, in 1862 pioneer woman doctor Ann Preston (1813-72) founded Woman’s Hospital of Philadelphia to provide clinical training for women medical students and nurses. Temporary hospitals, some immense, were thrown up throughout the city to care for soldiers during the Civil War, the Satterlee in West Philadelphia being the best known. Eventually the city’s medical schools established their own hospitals.

The numerous hospitals served as objects of neighborhood pride and philanthropy, particularly service by women. In addition, their accident wards supported the city’s vast industrial growth in the nineteenth century.

Philadelphia’s place as a center of medical education can be traced to 1762 when William Shippen Jr. (1736-1808), son of a physician and educated in England and Edinburgh, initiated some lectures on anatomy and midwifery on Walnut Street near Third. Also a product of Edinburgh and European experience, the energetic John Morgan (1735-89) in 1765 proposed an enlightened plan for medical education, and with Shippen, inaugurated lectures at the College of Philadelphia intended as part of a course of study leading to a degree in medicine. From 1789 through 1791, both the revived College of Philadelphia and the newly chartered “University of the State of Pennsylvania” offered medical lectures, by feuding faculties (Philadelphia’s early teaching physicians were a notably feisty bunch). The factions united as the forerunner of the University of Pennsylvania School of Medicine, America’s first. It won standing during the nineteenth century as one of the strongest in the nation, though strong in a stolid sort of way.

Perceiving room for another medical school in Philadelphia, if not an actual need, surgeon George McClellan (1796-1847) and some collaborators opened Jefferson Medical College in 1824. Both Penn and Jefferson welcomed huge classes, and so produced a high proportion of early American doctors. Jefferson’s faculty came to rival Penn’s in national reputation.

Beginning in the 1840s and 1850s, in Philadelphia (and elsewhere in the United States), the making of new medical colleges swelled into a kind of mania. Those after Penn and Jefferson that endured into the twentieth century included Hahnemann Medical College (1848); the Woman’s Medical College of Pennsylvania (1850; the first of its kind in the world); the Medico-Chirurgical College (1881); the Philadelphia Polyclinic and College for Graduates in Medicine (1883); and the Philadelphia College and Infirmary of Osteopathy (1899). Other schools, ranging from fully creditable to entirely fraudulent, came and went. Extinct schools included (among many) the co-educational Penn Medical University (1853), which had nothing to do with William Penn and was surely not a university. Lastly, the Medical Department of Temple College, later Temple University School of Medicine, opened in 1901. The availability of strong medical education for women, and the presence of several women’s hospitals, fostered growth of a sizeable community of women physicians and surgeons who practiced and taught here. Hahnemann Medical College taught the therapeutic system of German physician Samuel Hahnemann (1745-1843) called homeopathy, which flourished in Philadelphia.

By 1890, about 2,000 names appeared in the city’s medical directories, for a population of approximately one million. Most were doctors in the neighborhoods—serviceable, often hard-working. They saw patients in their homes and during office hours, and some attended at a hospital. They looked after illnesses severe and trivial, delivered babies, vaccinated, repaired fractures and lacerations, gave advice; and, more or less successfully, made a living.

But it was the downtown physicians and surgeons, most with senior faculty positions at Penn or Jefferson, who built Philadelphia’s reputation as the nation’s medical capital. Among the early figures were Benjamin Rush (1749-1813), a reformer interested in everything, concerned with better care of the insane, and signer of the Declaration, recalled (unfortunately) for his ferocious use of mercury and bleeding for yellow fever; Philip Syng Physick (1768-1837), “father of American surgery”; and editor and ophthalmologist Isaac Hays (1796-1879). Later in the nineteenth century came anatomist and brilliant polymath Joseph Leidy (1823-91); master teacher of internal medicine Jacob Mendez Da Costa (1833-1900); physiologist, neurologist, psychiatrist, and popular novelist S. (Silas) Weir Mitchell (1829-1914); internationally known surgeons Samuel D. Gross (1805-84), and W.W. (William Williams) Keen (1837-32), the latter very much a progressive mind and a teacher at Woman’s Medical, Jefferson, and the Pennsylvania Academy of the Fine Arts (anatomy). Gynecologists included Washington L. Atlee (1808-78), among the first to remove uterine fibroids, and Emeline Horton Cleveland (1829-78), one of the earliest women to perform abdominal surgery. Others gained repute through specialty practice centered on disorders of the eye, ear and throat, skin, nervous system, and mind. Active as well were oddballs and dissidents–followers of arcane sectarian systems, or the radical Quakers from Bucks, Montgomery, and Chester Counties who upheld the right of women to study medicine.

It was not, of course, novels or Arctic ice that established the stature of Philadelphia doctors in the nineteenth century. What then? One can extrapolate from what the distinguished anatomist and historian George W. Corner (1889-1981) wrote about the senior faculty at Penn: “The University’s medical teachers had always been superb clinicians—masters of diagnosis and treatment and polished expositors.” That is, they brought comprehensive knowledge and experience to their practices and teaching (and many were broadly erudite beyond their professional expertise).

For most of the nineteenth century, medical practice drew upon the foundational sciences of anatomy and morbid anatomy (pathology, the study of structural change in organs caused by disease). Philadelphia’s skilled anatomists dissected, taught, and wrote books that added to the city’s reputation as a city of medicine. Several brought back the ideas and methods they had studied in Paris. The reputations of Philadelphia’s doctors spread through their participation in national organizations, consulting or teaching visits out of town, and the praise of their students. They benefited from Philadelphia’s centrality in medical publishing: its enormous production of medical books in the nineteenth century far exceeded that of New York or Boston. Philadelphia physicians readily fed the publishers’ demands for new textbooks and manuals (including homeopathic). For more than 100 years, the American Journal of the Medical Sciences, edited and published in Philadelphia, prevailed as the country’s leading such periodical.

In the early twentieth century, however, Philadelphia lost its edge. Significantly, the influence of Philadelphia’s American Journal of the Medial Sciences declined, while the New England Journal of Medicine, published in Boston, gained scriptural standing. Not only Boston but also New York and Baltimore challenged Philadelphia for medical leadership of the United States, and in some ways won. The destabilizing factor was experimental laboratory research—or, unhappily for the Quaker City, the paucity of it in the city’s medical colleges. The decisive factor was philanthropy—or the paucity of it for Philadelphia’s medical colleges.

By the 1880s and 1890s the center of advance in medical science had shifted from the hospital wards and autopsy rooms of Paris to the universities and laboratories of Germany. Beginning in the 1860s and 1870s, the acceptance of microbes as the cause of many diseases leant enormous luster to the laboratory and its workers. Physiology, the study of function, seemed a promising field. A handful of young American medical graduates worked under German scientists in the 1880s and 1890s, then returned home to seek a place to do original laboratory research. The only likely locus in Philadelphia in this period was Penn, but it was not to be. One of these German-trained men, Simon Flexner (1863-1946), came to the university in 1899 but left in 1903, disappointed by the lack of interest and resources for investigation. He went to New York to head the new Rockefeller Institute for Medical Research. In a history of Penn’s medical school, George W. Corner wrote that in this period its leaders failed to recognize that “for a generation and more to come, the advance of medicine was going to depend on discoveries in biology and biochemistry that would rapidly alter the physician’s whole outlook.” Corner might have added physiology and bacteriology. It was indicative of local inertia that neither Jefferson nor Penn required course work in bacteriology until ten years after Robert Koch (1843-1910) in Germany announced the discovery of the microbe causing tuberculosis.

Aware of the need to move forward, progressive leaders at the Penn medical school in 1910 effected a reform program (really a coup), which promoted David Edsall (1869-1945), an alumnus and faculty member with sound credentials in both laboratory and clinical work. The insurrection displaced several senior professors and brought in promising researchers from outside the city. Regrettably, the “old guard” among faculty managed a counter-revolution: Edsall left Penn and soon guided the rise of Harvard University Medical School to pre-eminence.

Perhaps these events reflected the larger intellectual outlook of Philadelphia in the nineteenth century. Never as overtly concerned with pure knowledge as Bostonians, Philadelphians excelled in the realm of the useful and tangible: mechanical innovation and making things well, illustration and lithography, architecture and building, and the practice of medicine and surgery. Unlike at Harvard and Yale, at Penn the science, engineering, and medical schools occupied most of the space. Of course erudition and scholarship could be easily found in the city, but for the most part, the practical prevailed. The leading nineteenth-century physicians and surgeons of Philadelphia did publish a great deal that was new—careful anatomical and pathological observations, discerning descriptions of diseases, novel procedures and remedies. But animal experimentation in the laboratory seemed foreign.

As medical science advanced in Boston under Edsall, several accidents of philanthropy favored the ascent of Baltimore and New York City as national centers of medical education and research. In the nineteenth century, Americans saw medicine as practical work and a source of livelihood and thus not as an object of charitable support. Neither government nor individuals subsidized medical research. Few Philadelphians made donations to the city’s medical schools. (A modest exception was the Woman’s Medical College, embraced by its Quaker friends.)  Nor did this usually occur elsewhere. But in Baltimore, Quaker businessman Johns Hopkins unexpectedly bequeathed his immense fortune to the founding of a hospital and a university. The early trustees chose to build the university on the German research model, including a medical school linked to the hospital. The Johns Hopkins Medical School opened in 1893—with former Philadelphian William Osler (1849-1919) as one of its prized founding faculty.

In 1910 the Carnegie Foundation for the Advancement of Teaching, founded in 1905, in conjunction with the Council on Medical Education of the American Medical Association, engaged educator Abraham Flexner (1866-1959), Simon’s brother, to carry out an inspection of North American medical schools. Flexner’s famous report of 1910, Medical Education in the United States and Canada, furthered a process already underway to raise standards and close marginal, or worse, schools. Subsequently, Flexner directed the distribution of grants from the Rockefeller General Education Board to the stronger schools. Dogmatic and sometimes arrogant, Flexner insisted on the “full-time plan” (essentially, that medical school teachers be on salary, not mainly in private practice); nurturing of research; and assured access to hospital teaching beds. His vision also demanded a continued reduction in the number of medical schools in the United States, with no more than one school, fully part of a university, in each metropolis.

Neither “full-time” for clinical faculty nor the giving up of schools much appealed to medical Philadelphia, where at each older institution a distinct personality and heritage had evolved, upheld by alumni, faculty, and even students. For a time, however, Penn and Jefferson diligently worked towards a merger, or at least an awkward sort of coupling that would perhaps look like a merger to Flexner, but still preserve individual identities. The press touted the plan: “Philadelphia is now in a fair way to become a contender for the title of the medical center of America” said the Philadelphia Press on June 3, 1916—tacitly admitting that the city already had lost such status (other newspapers agreed). The unlikely merger plan dissolved in 1917, and with it, the expectations for major foundation funding. By 1920, the Carnegie and Rockefeller philanthropies had contributed approximately $80 million for the development and endowment of American medical schools. None of this money came to Philadelphia.

Although some meaningful local gifts aided the city’s medical schools in this period and Philadelphia surely had wealth, no one in the city matched John D. Rockefeller. The largest single act of philanthropy aimed at education was by banker Anthony J. Drexel (1826-93), whose admirable creation of the Drexel Institute for Art, Science and Industry (now Drexel University) in 1893 centered for the most part on providing affordable practical education matched to the industrial needs of the city and the age. An assessment of Philadelphia philanthropy from 1893 praised Drexel, while declaring that the city’s millionaires tended to send their dollars far away–to “famine stricken Russians,” the “red man on the frontier,” and, generally, to “the dark and hidden places of the earth.”

A sampling of the leading journals of experimental work in medicine in the mid-1920s reveals that although Philadelphia sent forth a few papers, Boston, Baltimore, and New York generated substantially more. The earliest American medical scientists to win Nobel prizes in physiology or medicine included researchers at the Rockefeller Institute in New York and Harvard Medical School in Boston, but none from Philadelphia. Of course, the city’s medical fabric was not entirely dormant. Sound scientific work developed in microbiology and in some of the stronger “basic science” departments of the medical schools. In the early 1920s, A. Newton Richards (1876-1976) at Penn, who as a young imported pharmacologist-physiologist managed to survive the counter-revolution of 1910, carried out with colleagues brilliant studies of the function of the kidney. In doing so, he attracted some of the city’s earliest research support from a foundation, the Commonwealth Fund.

Philadelphia’s opportunity for a medical revival came in the 1950s. A flood of research support which appeared from the National Institutes of Health (and other governmental funding) led to, if not a leveling, at least considerable opportunity for all of Philadelphia’s medical schools, and some hospitals, to expand their clinical services and increase research productivity. Soon the schools swelled into “academic medical centers,” keenly competing with each other while looking more and more like each other. Woman’s Medical admitted men, and Hahnemann ejected Samuel Hahnemann’s homeopathy, as it made an astonishing transformation from minute doses (a tenet of this practice) to a skyscraper stacked high with intensive care units. In the absence rational planning based on needs of the citizens, many of the old neighborhood hospitals became poor and closed, while a corridor of high-tech clinical centers—Pennsylvania Hospital, Jefferson, Hahnemann/Drexel, Penn, Presbyterian—formed an imposing east-west alignment downtown. Temple to the north struggled valiantly with the burdens of caring for the sick and shot-up poor, as did the surviving hospitals in deteriorating districts. Beyond the city’s borders, some of the larger community hospitals, such as Lankenau and Abington in the suburbs and Cooper in Camden, expanded their educational functions and established successful research programs. All of this growth created jobs for nurses, physicians, scientists, technicians, billers and coders, and more, and required the ceaseless construction of buildings and additions. The United States Bureau of Labor Statistics documented “education and health services” (combined in its statistics) as the region’s largest employment supersector.

Even in the period of decline in the early decades of the twentieth century, Philadelphia’s medical institutions never lost their reputation for the highest quality training of medical students, residents, nurses, and pharmacists; in fact, the attraction grew as the major centers expanded.  By the later decades of the twentieth century, “health care” and health-care education became the region’s dominant industry. White coats, short and long, continued as an enduring visible attribute of the city and region.

Steven J. Peitzman is Professor of Medicine at Drexel University College of Medicine. His historical work includes the book  A New and Untried Course: Woman’s Medical College and Medical College of Pennsylvania, 1850 – 1998 (New Brunswick: Rutgers University Press, 2000), and articles about medicine and medical education in Philadelphia and Germantown. (Author information current at time of publication.)

Edinburgh graduates Dr. John Morgan (1735–89) and Dr. William Shippen Jr. (1736–1808), together with Benjamin Rush (1735–1813), envisioned a society in Philadelphia like the Royal Colleges of Physicians of Edinburgh and of London, to regulate the medical profession and foster medical research and education. They sought to create a society that would give cohesion and prestige to the medical profession and serve the needs of the elite physician-professors of Philadelphia. Morgan, Shippen, Rush, and twenty-one other prominent Philadelphia physicians established the College of Physicians of Philadelphia in 1787 and elected their mentor, John Redman (1722–1808), its first president.

Fellows elected colleagues based on their contributions to American medicine and society. Notable fellows included famed surgeon Samuel D. Gross (1805–84) and the prominent American neurologist and writer Silas Weir Mitchell (1829–1914). The fellowship addressed challenges facing all Philadelphia physicians in the eighteenth and nineteenth centuries, particularly infectious diseases such as yellow fever, cholera, typhoid fever, and tuberculosis. During the yellow fever outbreak of 1793, the college participated in debates concerning the origin, spread, and treatment of the disease and recommended both quarantine and sanitary measures. It facilitated development of city health laws and creation of the Philadelphia Board of Health in 1794 to enforce these laws.

In its early years, the college rented rooms from the American Philosophical Society, which provided the space and means for fellows to review medical literature and learn from their colleagues. To this end, it developed an extensive library, a museum of medical specimens, lecture series, and meetings for the exchange of medical knowledge. Thanks to a large endowment by college fellow Thomas Dent Mütter (1811–59), the college built its first permanent home in 1863 at the corner of Thirteenth and Locust Streets. The activities of the college stalled during the Civil War, as one-third of its members volunteered for the war effort. After the war, membership and donations to the college increased. In addition to books and specimens, the college became well known for its collection of fine art and furniture. It soon outgrew this space and relocated to a larger, more opulent residence at Twenty-Second and Ludlow Streets in 1909.

The College Library

Fellows donated books from their personal collections to establish the library in 1788. The library grew with more such contributions as well as volumes written by members and purchases. In the later nineteenth century, the college appointed a professional librarian, and by 1900 it received over five hundred medical journals either by subscription or in exchange for the college’s publication, Transaction and Studies. By the 1970s, the library made available over three thousand current biomedical journal titles in dozens of languages. In this period, it served as a regional medical library and supported the needs of the area’s many medical schools and teaching hospitals. Its accumulation of books, journals, and manuscripts over more than two centuries produced one of the world’s most complete and treasured medical-historical libraries. It holds over four hundred incunables (books published before 1501), the great anatomical atlases beginning with Vesalius, as well as the texts, manuals, and periodicals used by practitioners for over four hundred years. 

The Mütter Museum

Medical museums were also an essential component of nineteenth-century medical education, and in its early years, the college developed an essential component of nineteenth-century medical education—a medical museum. After Thomas Dent Mütter resigned from his post at Jefferson Medical College in 1856, he donated his collection of anatomical and pathological specimens to the College of Physicians. Mütter’s endowment of $30,000 required the construction of a fireproof building to house his collection, which led to the building of its first permanent home in 1863 at the corner of Thirteenth and Locust Streets. The endowment also supported the hiring of museum staff and acquisition of specimens and artifacts well into the twentieth century.

After the Civil War, the Mütter Museum grew exponentially with the specimens acquired during the war. The museum also displayed specimens from the work of physicians—from the plaster cast of conjoined twins Chang and Eng to the wax model of the horny protuberance from the forehead of a French woman. These anatomically curious collections generated an international frenzy, which soon made the Mütter Museum a top destination for physicians and students around the world.

For much of the twentieth century, the College of Physicians of Philadelphia worked quietly in the realms of public health and the history of medicine. On its 150th birthday in 1937, the college celebrated by establishing the medicinal plant garden that co-founder Benjamin Rush had envisioned. In 1976, the college established the Francis Clark Wood Institute for the History of Medicine, “to promote the historical resources of the college’s library and museum.” The college became part of the Consortium for History of Science, Technology and Medicine, founded in 2007, and was established as a Historical Landmark in 2009, considered “an outstanding property in the medical and cultural history of the United States.” The Historical Medical Library of the College developed a Digital Library to share and make more accessible literature important in the history of medicine.

For the better part of two centuries, the College of Physicians of Philadelphia has served medical professionals and the public. As an authority on the history of medicine and public health issues, the college became a vital participant in the medical community of Philadelphia and a respected institution both nationally and internationally.

Amanda Bevers Bristol is a Ph.D. candidate in the History and Science Studies Departments at University of California, San Diego, where in 2012 she received her master’s. She is completing her dissertation entitled “To Bind Up the Nation’s Wounds: The Army Medical Museum and the Development of American Medical Science, 1862–1913,” which has been supported by grants from the Social Science Research Council and the Consortium for History of Science, Technology and Medicine. (Author information current at time of publication.)

Coronaviruses, so-called because of their resemblance under a microscope to a crown, are a group of viruses that can infect a diverse array of mammals and birds, leading to an equally diverse array of symptoms and prognoses. The origin story of coronaviruses stretches back almost 300 million years, when the most recent common ancestor of all modern coronaviruses began to differentiate into distinct viruses. But only in the 1930s—just a few decades after the Russian biologist Dmitri Ivanovsky (1864-1920) discovered viruses in 1892—did humans become aware of coronaviruses, first in chickens, then in mice, and later in humans and other animals.

Coronaviruses became a topic of worldwide significance following the November 2002 report of an outbreak of severe acute respiratory syndrome (SARS) in Guangdong Province, China. Between its first identified appearance and July 2003, roughly eight thousand cases of SARS were confirmed globally, mostly in China. Of the twenty-seven cases identified in the United States, at least eleven came from Pennsylvania and three from New Jersey. Although the first probable case in Greater Philadelphia likely came from exposure in Toronto, the virus’s association with East Asia hit business owners in Philadelphia’s Chinatown, who reported income declining by as much as 60 percent in April 2003. Philadelphia International Airport screened new arrivals, and some individuals wore masks to curb spread. Limited human-to-human transmission made containment possible both locally and globally.

COVID-19 Emerges

Sixteen years later, a more transmissible coronavirus proved far harder to contain. In December 2019, epidemiologists and local health officials noticed a mystery pneumonia in Wuhan, China. By examining patients’ airway cells, a team of Chinese researchers identified a novel coronavirus—which they dubbed 2019-nCoV—as the cause of the outbreak. The virus—later named COVID-19 by the World Health Organization—spread rapidly, affecting more than two dozen countries by mid-February 2020.

In the Philadelphia area, officials from the city’s public health preparedness program and similar programs in suburban counties urged preparation over panic. The Inquirer noted in early February 2020 that the flu remained “more dangerous” than “the scary new virus.” Despite such attitudes, on March 11, 2020, the World Health Organization declared the novel coronavirus a pandemic, which recognized the virus’s international spread. In the wake of the World Health Organization’s announcement, disease control specialists increasingly advocated “social distancing,” or the restriction of physically close interpersonal intimacy, as well as mandated mask-wearing and shutdowns, despite concerns that some such mitigation strategies could violate individual human rights. Public health experts in the United States and elsewhere often pointed to Philadelphia’s erratic implementation of such measures during the city’s catastrophic 1918 flu epidemic to make the case for restrictions.

In late March 2020, Philadelphia experienced its first COVID-19 death. The number of confirmed cases in the Philadelphia area grew rapidly between March and May 2020. In response, federal, state, and local authorities adopted emergency measures to slow transmission. On March 12, the city government barred gatherings of over a thousand people; on March 16 it closed public schools and nonessential businesses; and on March 22 it issued a stay-at-home order. The switch to work from home and closure of cafes and restaurants left downtown streets deserted. Other jurisdictions adopted similar restrictions. The governor of New Jersey, Phil Murphy (b. 1957), ordered residents to stay at home on March 21, while his counterpart in Delaware, John Carney (b. 1956), did so a day later. On March 23, Governor Tom Wolf (b. 1948) of Pennsylvania followed suit, with an executive order that covered Philadelphia and nearby counties. Soon after the announcement of the first COVID-19 death in Philadelphia, local hospitals prepared for a surge of patients that could overwhelm their capacity. By the end of March lockdowns extended across the Greater Philadelphia region.

The widespread shutdowns in the spring of 2020 spurred debates about weighing individual liberties against the greater good. However, public health experts at Drexel University’s Urban Health Collaborative estimated that the first forty-five days of shutdown in the city prevented 6,200 deaths. Other measures also attempted to slow transmission. In June Philadelphia Mayor Jim Kenney (b. 1958) signed a mask mandate for indoor and busy outdoor locations and by September, eighty contact tracers—including a group of thirteen Community College of Philadelphia students—worked to curb the virus’s spread. Even with such measures, COVID-19 strained the region’s health care. As more and more victims succumbed to the disease in mid-April, one local hospital resorted to transferring body bags to the Medical Examiner’s Office in the back of a pickup truck. Recognizing the traumatic impact of the pandemic on the region, historians, librarians, and archivists in Greater Philadelphia urged members of the public to document their experiences for use by future historians.

Later Waves of the Pandemic

COVID returned after its deadly first wave. Cases spiked again in November and December 2020, with over seven thousand testing positive in the city during the week after Thanksgiving. A smaller surge followed in the Spring of 2021. By mid-August 2021, the city had reported over 160,000 positive COVID tests, and a month later the death toll stood at thirty-eight hundred.  Some groups—notably people of color, prison inmates, and undocumented workers—struggled to access testing, care, and financial support. Additionally, COVID-19 hospitalizations and deaths tended to cluster in neighborhoods with larger minority and low-income populations, following a pattern seen in epidemics that stretched back to the eighteenth century. This data prompted the Philadelphia Department of Public Health to craft a racial equity plan in July 2020 to improve access to testing and care, with the ambitious long-term goal of reducing the disparate impact on communities of color by preventing chronic health conditions that increased the risk of severe COVID-19 infection.

Vaccines, which rested in part on a revolutionary discovery by Philadelphia scientists, offered a more immediate route to limiting the death toll. On December 16, 2020, hundreds of Philadelphians who worked in medical settings received their first doses of a COVID-19 vaccination, which markedly reduced the likelihood of serious illness. The rapid development of a vaccine owed much to the research of University of Pennsylvania-affiliated biochemists Katalin Karikó (b. 1955) and Drew Weissman (b. 1959), whose work in the 1990s and early 2000s established how to modify messenger RNA (mRNA) to “teach” the human immune system how to resist infections. The mRNA vaccines produced by Pfizer-BioNTech and Moderna became by far the most widely used vaccines in the United States, Europe, and parts of Africa and the Americas, while by 2023, China too had embraced the technology in its fight against the virus. Locally, almost two-thirds of Philadelphia residents were fully vaccinated against COVID by June 11, 2021, when the city “reopened” by relaxing restrictions, although schools did not welcome back students fully until August. In 2023, Karikó and Weissman won the Nobel Prize in Medicine for their medical breakthrough.

Although vaccines provided strong protection against serious illness, they proved less effective at blocking the virus’s spread. The emergence of the BA.2 subvariant in the spring of 2022 led to another dramatic shift in pandemic response, as well as to renewed confusion. Effective April 18, 2022, Philadelphia reinstated its indoor mask mandate, becoming the first major U.S. city to do so. Later that day, U.S. District Judge Kathryn Kimball Mizelle (b. 1987) of Florida struck down the federal mask mandate for public transportation. Mizelle’s decision prompted transit agencies SEPTA and PATCO to rescind their own mask mandates, despite Philadelphia’s new mandate coming into effect the same day.

Vaccines and immunity acquired from infection made these later waves of COVID far less deadly than the initial surges of 2020-21. Nonetheless, the regional toll of the virus proved chastening. As of July 2023, COVID had claimed the lives of over 5,600 Philadelphians and over 8,000 in adjacent Pennsylvania counties. By then, almost 1,700 had also succumbed to the disease in New Castle County, Delaware, with nearly 4,500 New Jerseyites in Burlington, Camden, Gloucester, and Salem Counties dying. According to the team of Chinese researchers who first identified the virus that causes COVID-19, though, the risks of future spillover events involving coronaviruses remained.

Timothy Kent Holliday is a Lecturer in the Critical Writing Program at the University of Pennsylvania, where he received his Ph.D. in History in 2020. He is a historian of early America, focusing on the history of the body. (Author information current at time of publication.)

During the colonial era, only elite deaf children received much education, and it typically took the form of private instruction or tutoring. William Mercer (1765?–1839?), who was congenitally deaf, studied under the distinguished Philadelphia artist Charles Willson Peale (1741–1827) after his father was killed in the Battle of Princeton. Peale and his wife, Rachel (1744–70), welcomed Mercer into their family of ten children from 1783 until 1786. Mercer was one of the first congenitally deaf individuals in the United States to become a distinguished artist.

The Pennsylvania School for the Deaf in Philadelphia (formerly known as the Pennsylvania Institution for the Deaf and Dumb), the third-oldest school of its kind in the United States, was one of many that emerged in the early nineteenth century following the advent of deaf education in Europe. Public education for the deaf originated in France in the 1760s when Jansenist priest Abbé Charles-Michel de l’Epée (1712–89) created the National Deaf-Mute Institute in Paris, the world’s first public deaf school. His work eventually inspired deaf education programs in other nations, including the Pennsylvania School for the Deaf which began when David Seixas (1788–1864), a Philadelphia merchant and crockery owner, began to educate and provide room and board to a small group of local indigent deaf children.

The First Eleven

Moved by his concern for impoverished children whom he regularly witnessed roaming city streets, Seixas brought eleven poor deaf children into his home, where he fed, clothed, and educated them. Among the first group of children were future artists John Carlin (1813–91) and Albert Newsam (1809–64). Carlin, who became deaf as a young child, later studied portraiture in France under esteemed artist Paul Delaroche (1797–1856). He spent his adult life working as an artist and poet in New York, where he served as an activist for the deaf. Newsam, brought to Philadelphia from Steubenville, Ohio, in 1820 by William P. Davis, who allegedly convinced Newsam’s guardian to allow him to take the child to Philadelphia and intended to exploit the young boy’s artistic talent for his own gain, entered the school at age eleven after local Episcopal Bishop William White (1784­–1836) found him on the streets and took him to Seixas’s home. There he received an education and developed his artistic talent. Newsam apprenticed with the local engraving firm of Cephas G. Childs (1793–1871) and eventually became a principal artist at the firm of Peter S. Duval (1805?–86).

Bishop White became intrigued by Seixas’s dedication to these poor deaf children and called for members of the American Philosophical Society to create a more permanent establishment. In May 1820, members of the society petitioned the Pennsylvania state legislature to officially recognize Seixas’s school, which it did in 1821. With the support of growing community interest and both philanthropic and state-sponsored funding, the institute officially opened at the corner of Eleventh and Market Streets in Philadelphia in the autumn of 1820 with Seixas as the institute’s first principal. Soon nearby states, including New Jersey, Maryland, and Delaware, began sending their indigent deaf children there. Seixas was later dismissed from his post for alleged sexual misconduct with several female students. The Pennsylvania School for the Deaf eventually appointed Abraham B. Hutton (1798–1870) principal in 1830, and he remained in that position until his death.

Pedagogical shifts that focused on oralism, or training in the reading of lips, affected Philadelphia’s deaf community. Early efforts to instruct the deaf typically relied on the manual method, or sign language. In the 1870s, deaf education experienced a significant transformation as more programs began adopting the oral method. Educators throughout Europe and North America embraced oralism as the progressive approach to “normalize” the deaf and incorporate them into mainstream society.

In the late nineteenth century, sisters Emma (1846–93) and Mary Garrett (1854–1915) expanded services for the deaf in the region. Emma Garrett attended the program for teachers of the deaf at Boston University run by Alexander Graham Bell (1847–1922), whose curriculum focused primarily on the oral method and on how to teach the deaf how to communicate and “behave” when interacting with the hearing community. After completing her education, Emma became a teacher at the Pennsylvania School for the Deaf and later served as principal of the Pennsylvania Oral School for Deaf-Mutes in Scranton. Like many deaf-education professionals of this period, she visited several countries to observe their teaching methods. Her observations of oralist methods, coupled with the widespread assumption that children (and especially deaf children) are incredibly imitative, led the sisters to establish an early intervention program in 1892.

The Bala Home

The Garretts established the Pennsylvania Home for the Training in Speech of Deaf Children Before They Are of School Age (also known as the Bala Home) at Belmont and Monument Avenues in Philadelphia. The school adopted a strict interventionist method that introduced the oral method at an early age. Emma served as superintendent of the institute until her death in 1893, when Mary assumed the post. Mary became a pioneer in the oral communication method as well as an advocate for the education of young women. She trained other notable educators of the deaf, including Margaret S. Sterck (1892–1984), who established the Delaware School for the Deaf in 1929, which remained active until 1945, when state regulations required that deaf children be taught in public schools.

After visiting oralist schools in other states, educators at the Pennsylvania School for the Deaf also shifted their program to include more training in the oral method. This decision reflected a broader international push for the method that had been adopted years earlier at the Milan Congress of 1880, where hearing delegates determined that sign language was a cumbersome form of communication and that the deaf should be taught to communicate in a “normal” way. In the decades following the Milan Congress, nineteenth-century pioneer in science Alexander Graham Bell (1847–1922) advocated that schools throughout the United States and Europe adopt oralism, viewed as the progressive approach to “normalize” the deaf and incorporate them into mainstream society. The Pennsylvania School for the Deaf became one of the largest schools for the deaf in the United States. The widespread teaching of oralism later sparked controversy because it eventually led to the near elimination of sign language and disenfranchisement of the deaf community.

New advocacy groups such as the Pennsylvania Society for the Advancement of the Deaf, created in Philadelphia in 1881, also pushed to incorporate deaf individuals into society and maximize their potential. It was joined in the early twentieth century by such organizations as the Philadelphia League for the Hard of Hearing and the Speech-Reading Club of Philadelphia. Religious leaders contributed to helping local deaf populations as well. Concerned for his deaf parishioners, Archbishop Patrick Ryan (1831–1911) envisioned an institute that would serve the needs of deaf Catholics. While not realized until the year after his death, the Archbishop Ryan Memorial Institute for the Deaf, established first on Vine Street and then later moved to Thirty-Fifth and Spring Garden Streets and eventually to Delaware County, was named in his honor.

Sign Language Resurges

After nearly a century during which the oral method dominated, the study of sign language resurged in the late 1960s. After passage of the Individuals with Disabilities Education Act in the 1970s, deaf schools nationwide employed a variety of educational methods. These approaches ranged from bicultural/bilingual education, in which American Sign Language is taught as a first language and written (or spoken) English is taught as a second language, to auditory-oral and auditory-verbal education. In the mid-1980s, Philadelphia schools adopted the more recent “mainstreaming” or inclusion model, in which deaf children attended public school for part of the school day while also receiving individualized deaf instruction. Programs such as the Clarke Schools for Hearing and Speech (located in Philadelphia and Bryn Mawr) later incorporated the “mainstreaming” model into their day school program. Critics argued that although this model provided inclusion and daily interaction with hearing individuals, deaf children found themselves isolated from other deaf individuals and received limited individualized support for special education needs.

Philadelphia played a significant role in the nation’s deaf education movement. The humanitarian project of a concerned citizen led to the creation of one of the nation’s largest and longstanding educational institutions for the deaf. In the early twenty-first century, the Pennsylvania School for the Deaf continued to serve deaf and hard-of-hearing children by offering a wide array of programs that served American Sign Language and English-language learning, as well as supported services and programming for students with cochlear implants. In 2013, St. Joseph’s University instituted a certification program to train teachers of the deaf and hard-of-hearing in 2013. Despite the strides in deaf education, however, mainstreaming programs remained the subject of debate over whether deafness should be categorized as a disability or as a condition to be “normalized.”

Holly Caldwell received her Ph.D. in history from the University of Delaware, where she wrote her dissertation on the medicalization of deafness and deaf education reform at Mexico’s Escuela Nacional de Sordomudos (National School for Deaf-Mutes). She is an Adjunct Assistant Professor of History at Chestnut Hill College and has also taught at Susquehanna University. (Author information current at time of publication.)

Before the era of professional dentists, most minor dental complaints were handled within the household. Finnish naturalist Peter Kalm (1716-79) observed these folk dentistry practices while traveling through the American colonies. Writing from Raccoon, New Jersey, in 1749, he remarked: “The remedies against the tooth-ache are almost as numerous as days in a year. There is hardly an old woman but can tell you three or four score of them, of which she is perfectly certain that they are infallible and speedy in giving relief as a month’s fasting, by bread and water, is to a burthensome paunch.” Though skeptical of women’s popular medicine, Kalm listed a number of “effectual” American cures, including botanical remedies used by Native Americans. European colonists of all nationalities relied upon Native American knowledge to assess the pharmaceutical uses of new world plants. For example, Pennsylvania Germans learned from Native Americans how to apply a decoction of a tulip tree’s (Liriodendron tulipifera) root bark to cavities.

If a tooth could not be saved, eighteenth-century Philadelphians had several options. Doctors routinely performed extractions, but in the absence of a trained doctor, artisans handy with forceps, such as blacksmiths, might also suffice. The practitioners included enslaved people, such as the runaway sought by an advertisement in the 1740 Pennsylvania Gazette: “A Negro man named Simon, aged 40 years…” who could “Bleed and Draw Teeth… .” Doctors practiced dentistry into the nineteenth century, but beginning in the 1730s, individuals identifying as dentists advertised in American newspapers. On June 15, 1738, William Whitehead became the first in Philadelphia to place such an advertisement when he offered his services as an “Operator for the Teeth” in the American Weekly Mercury.

Itinerant Dentists

From the 1760s onward, an influx of formally-trained dentists arrived in Philadelphia from England and France. Some itinerants, like Robert Wooffendale, an immigrant from London, worked in temporary offices for weeks at a time. In advertising for patients, Wooffendale emphasized his training under Thomas Berdmore (c. 1740-85), who had served as dentist to King George III. By the end of the eighteenth century, these dentists offered diverse services ranging from teeth whitening to repairing scurvy-addled gums. Prices for dental work suggest that access to dentists may have been cost-prohibitive for many. In 1785, the well-regarded French dentist James Gardette (1756-1831) charged 11 shillings and 3 pence for a cleaning. This was slightly more than the cost of an evening’s concert ticket. However, charitable dentists such as James Molan (active in the 1790s) also treated impoverished Philadelphians for free.

Individuals who extracted teeth or “plugged”–that is to say, filled cavities–often sold powders and instruments for home hygiene and cosmetics. In addition to boar-bristle brushes and scurvy lotions, their wares included false teeth made from a variety of natural materials. Making realistic, practical, and comfortable teeth required artistry. Painter and naturalist Charles Willson Peale (1741-1827) carved dentures from ivory, the most common material for making teeth until about 1820. He later became an early experimenter with porcelain teeth. When he advertised porcelain dentures of his own design in 1826, local dentists responded by touting the superiority of their work. They included Frenchman Antoine A. Plantou, who very probably introduced what he called “incorruptible teeth” to Philadelphia in 1817. Incorruptible teeth were made of various inorganic materials, including porcelain, enamel, and minerals, although the exact composition varied with the manufacturer. Inorganic materials could withstand decay and wear far better than ivory, and thus became preferred materials for constructing dentures.

Many early innovations in dentistry emerged from the work of James Gardette (1756-1831), who improved the cosmetic appearance of dentures by using a mortised gold plate to mount one’s natural teeth. Gardette, a native of Agen, France, trained at the Royal Academy of Surgery in Paris in 1773-75 before becoming a surgeon in the French Navy. During the American Revolution, he was stationed in Newport, Rhode Island, where he first began practicing as a dentist. By 1784, Gardette had settled in Philadelphia, although he often worked itinerantly. Among his many accomplishments was the development of a procedure similar to extraction and reimplantation, in which he partially extracted a molar, severed and killed the nerve below, and allowed the tooth to reset in the gums. This allowed for a relatively painless filling afterward. Via this procedure, Gardette successfully determined that teeth could be replanted under particular conditions. Additional work in this vein demonstrated that it was not possible to transplant teeth from one human mouth to another.

Over 130 Dentists by 1845

By 1845, McElroy’s Philadelphia City Directory listed more than one hundred and thirty dentists serving Philadelphia and one serving Camden, New Jersey. Some were second-generation dentists, such as Emile Blaise Gardette (1803-87), the son of James Gardette, and Gustavus Plantou, the son of Antoine Plantou. A number of these dentists had broad medical training, as denoted by their “M.D.” suffixes. Others, like James W. Newberry, were dentists and artisans. Newberry dabbled in watchmaking, likely because dental tools were versatile for fine jewelry work. Although the vast majority of the dentists listed in the 1845 directory were white, a handful of African American dentists operated in antebellum Philadelphia. They included James McCrummell (? – 1867), an abolitionist who in 1848 created a denture for an accused fugitive from slavery, Mary Walker (1818-95?). Walker was missing several of her front teeth, so the denture disguised a distinguishing feature of a suspected runaway.

Most medical colleges in Philadelphia offered courses and lectures on dentistry, but dental colleges did not appear until mid-century. The first was the short-lived Philadelphia College of Dental Surgery, which was founded in 1852 and became the Pennsylvania College of Dental Surgery in 1856, with Henry C. Carey (1793-1879) as president of the institution. By 1863, a second Philadelphia Dental College opened, followed by a dental school at the University of Pennsylvania in 1878. Some of these institutions admitted women. In 1869, German-born Henriette Hirschfield-Tiburtius (1834-1911) became the first woman to complete a full college course in dentistry when she graduated from the Pennsylvania College of Dental Surgery. She returned home to practice as Germany’s first degreed woman dentist. Dentistry also became part of the curriculum at the Woman’s Medical College of Pennsylvania, which was open to women of color. By the early twentieth century, Philadelphia’s independent dental colleges merged with local universities as Temple University acquired the Philadelphia College of Dental Surgery (1907) and the University of Pennsylvania absorbed the Pennsylvania College of Dental Surgery (1909).

Dental journals and societies marked the growing professionalism of dentistry. The most notable of the Philadelphia-based journals, The Dental Cosmos (1859-1936), became the most important national dental journal in the United States and later merged with the Journal of the American Dental Association. The Philadelphia County Dental Society met for the first time at the College of Physicians, then at Thirteenth and Locust Streets, on November 30, 1886. By 1899, a group of dentists on the other side of the Delaware River founded the Southern Dental Society of the State of New Jersey in Camden.

Dental Equipment Breakthroughs

The publisher of The Dental Cosmos, Dr. Samuel Stockton White (1822-79), also founded Philadelphia’s most successful dental depot. Established in 1844, for the next century the S.S. White firm offered functional and elaborately decorated dental tools and office furniture  suitable for treating fashionable society. White’s company manufactured and sold dental engines, motor-operated machines with interchangeable heads for drilling and cleaning. A key component to the engines was a flexible rotary shaft. In contrast to a solid or fixed shaft, a flexible shaft allowed for more creative engine configurations. The realization that flexible shafts could be useful to aircraft manufacturers led the company to explore engine technology more broadly in the 1930s and 1940s. Other area companies contributed to the improvement of dental tools. In 1935, Wallace Carothers (1896-1937) invented nylon for Delaware-based chemical company DuPont, and nylon-bristled toothbrushes were introduced a few years later in 1938.

In the early twentieth century, the establishment of dental museums allowed local dental colleges to teach the history of dentistry alongside clinical practice. At their inception, these institutions consisted of collections of dental artifacts for the use of dental students. In 1915, the University of Pennsylvania acquired the Thomas W. Evans dental museum. Dr. Harold L. Faggart, D.D.S., both a practicing dentist and lecturer in dental history, helped to found Temple University’s dental museum in 1938. Faggart also donated some of his research on early dentistry to the Library Company of Philadelphia for the edification of the public. After extensive fund-raising efforts, Temple’s Dr. and Mrs. Edwin Weaver III Historical Dental Museum opened in 2003, allowing Temple’s collections to remain on permanent display. Its most notable holdings included the dental equipment of three generations of the Flagg family, but artifacts ranged from dental product ephemera to specimens of work created by former alums.

Dentistry continued to diversify in the early to middle twentieth century. In 1913, Latino students at the University of Pennsylvania founded the Latin American Dental Society. The following year, Penn admitted women to the School of Dental Medicine for the first time, yielding the school’s first class of women graduates in 1917. That same year, Carrie Kirk Bryant became the first woman to become an instructor in dental medicine at the University of Pennsylvania. Helen E. Myers, D.D.S. (1912?-62), a 1942 graduate of Temple University, became the first woman to be commissioned by the U. S. Army Dental Corps. By 1952, women dental students at the University of Pennsylvania had founded their own dental society.

Growth of Dental Schools

As new areas of specialization developed and related professions, such as dental hygiene, emerged, dental campuses and enrollments expanded at Penn and Temple. In 1969 Penn added the Dental Research Building and the Levy Oral Health Sciences Building. By 2015, the University of Pennsylvania boasted more than 10,500 alumni of the dental school and offered both predoctoral and postdoctoral training in a variety of specializations. Temple’s Kornberg Dental School suffered a series of low ratings in the mid-1940s, but recovered by the 1980s and opened a sizable annex to its clinical facilities in 1990. Around this time, Temple faculty emphasized teaching new developments in cosmetic dentistry, as use of bleaching agents and veneers was becoming increasingly popular. Temple’s graduates maintained an active alumni community, with more than 7,000 members as of 2015. From the eighteenth to the twenty-first centuries, dentistry in Greater Philadelphia became increasingly characterized not only by how it was practiced, but also by who could be a practitioner.

Jessica Linker is a doctoral candidate at the University of Connecticut, Storrs, and the recipient of fellowships from a number of Philadelphia-area institutions, including the Library Company of Philadelphia, the American Philosophical Society, and the McNeil Center for Early American Studies. Her work focuses on American women and scientific practice between 1720 and 1860. (Author information current at time of publication.)

The Philadelphia Dispensary opened in rented space but was able to erect a handsome building on Fifth Street between Chestnut and Walnut in 1801. Both Quaker and non-Quaker citizens supported the enterprise, originally headed by the admired Episcopal Bishop William White (1748-1836) and administered by other prominent Philadelphians, particularly members of the Wistar/Wister family. Benjamin Franklin (1706-90) headed the first subscribers, who could each list two persons for free care. Many prominent physicians served as regular dispensary doctors or consultants. An employed apothecary prepared the pills, tinctures, salves, and the like, which almost all patients received: the name “dispensary” well fit the function. The Philadelphia Dispensary also offered  inoculation against smallpox. In the early decades of the nineteenth century, the dispensary cared for large numbers of African Americans, and then Irish following their increasing immigration in midcentury.

Overwhelmed with clientele, the Philadelphia Dispensary in 1816 made loans to support the founding of the Northern Dispensary, serving the Northern Liberties into Kensington, and the Southern Dispensary (chartered in 1817) for Southwark, Moyamensing, and Passyunk. These functioned very much like the parent institution. Eventually, dispensaries could be found in the various townships and neighborhoods. For example, the Germantown Dispensary (later Germantown Dispensary and Hospital) opened modestly in one room in 1864, an initiative of the prominent physician James. E. Rhoads (1828-94). The Camden City Dispensary was founded in 1866, with members of New Jersey’s prominent Cooper family enrolling as “life members” (subscribers). Norristown Hospital and Dispensary was among facilities in the region to offer  both inpatient and outpatient services; founded in 1889, it soon changed its name to Charity Hospital, and later Montgomery Hospital.

Specialty Dispensaries

The evolution of Philadelphia’s various dispensaries reflected changes in the region’s population and in medicine. The Southern Dispensary in Philadelphia, for example, saw increasing numbers of immigrants from Eastern Europe and Italy as well as African American migrants from the South during the late nineteenth and early twentieth centuries. With the growth of specialization in medicine, specialty dispensaries arose for skin diseases, eye and ear problems, pediatrics, and for the ubiquitous and deadly tuberculosis. The older dispensaries organized their clinics by categories of disease. Nonetheless, the major dispensaries of Philadelphia remained mainstays of outpatient medicine for ailments such as coughs and catarrhs (colds), “rheumatism,” dyspepsia, and diarrhea and earaches among children. Dispensaries in industrial areas also looked after cuts, burns, and various injuries not needing hospitalization or major operations.

Something like a dispensary mania surged in the second half of the nineteenth century. The strong presence of the alternative therapeutic practice homeopathy in the city led to homeopathic dispensaries. The House of Industry and the College Settlement also offered dispensaries. Jewish anarchist physicians opened their Mt. Sinai Dispensary at 236 Pine Street in 1900. The major hospitals spawned dispensaries, as did some of the medical schools.

Medical education had played a major role at dispensaries from the beginning, since young doctors used them to gain experience. Alumnae of the Woman’s Medical College of Pennsylvania founded an outpost, the Barton Dispensary (named for a founder), on Third Street in South Philadelphia in 1895; it later moved, when the college did, to East Falls. The “Medical Society for Self-Supporting Women” for some years in the late 1880s conducted an evening dispensary for working women, with women physicians as staff.  In 1883 surgeon John B. Roberts (1852-1924) and others opened the Philadelphia Polyclinic and College for Graduates in Medicine at Thirteenth and Locust Streets. This “short course” school for those already holding the M.D. aimed at providing practical experience sometimes lacking in conventional medical schools. Instruction depended largely on the institution’s dispensary practice, although later, at Lombard Street between Eighteenth and Nineteenth, it added a hospital (later known as Graduate Hospital).  While many Philadelphia physicians practiced at a dispensary sometime in their careers, and some even founded one, other physicians thought the proliferation was getting out of hand. They suspected that persons capable of paying a fee to a private practitioner nonetheless would seek care at a dispensary–what was referred to as “dispensary abuse” or more broadly, “charity abuse.” This tension arose in other cities as well.

Clinics Evolve

Over the course of the twentieth century, other forms of free clinics gradually replaced dispensaries. A 1929 report on medical facilities in Philadelphia listed seventy-one dispensaries, almost all of them outpatient practices of hospitals, medical schools, or other organizations. Only the Northern Dispensary and the Southern survived as independent entities. The original Philadelphia Dispensary had merged with the outpatient services of Pennsylvania Hospital in 1922. By the 1940s, health clinics conducted by the Philadelphia Department of Health assumed some of the work once done by the city’s dispensaries. Outpatient departments of hospitals and medical schools expanded (and eventually could gain reimbursement with the advent of Medicare and Medicaid in 1966). Nonprofit agencies such as the Public Health Management Corporation also opened free-standing clinics, including the Mary Howard Health Center, managed by nurses and serving Philadelphia’s homeless population. Into the 1980s and 1990s, community-minded medical students and faculty physicians at Hahnemann Medical College and the Medical College of Pennsylvania (the former Woman’s Medical College of Pennsylvania, coeducational as of 1970) reinvented the free neighborhood night clinic. Surprisingly, the term “dispensary” resurfaced in 2017 with a novel connotation—the place to go for medical marijuana.

Philadelphia’s dispensaries of the nineteenth and early twentieth centuries, including the nation’s first such institution, served basic health needs of the poor, particularly first-generation immigrants, though their educational function may have been at times exploitive. Various free or low-cost clinics continued to operate in the early twenty-first century, demonstrating a persistent need despite the availability of health insurance and the federal Medicare, and Medicaid programs.

Steven J. Peitzman is Professor of Medicine at Drexel University College of Medicine. His historical work includes the book  A New and Untried Course: Woman’s Medical College and Medical College of Pennsylvania, 1850–1998 (Rutgers University Press, 2000) and articles about medicine and medical education in Philadelphia and Germantown. (Author information current at time of publication.)

Duffy’s Cut takes its name from Irish railroad contractor Philip Duffy (1783-1871), who came to the United States in 1798, the year of the United Irishmen rebellion. He was among the contractors to gain work from the Pennsylvania Canal Commission, created by the Pennsylvania Assembly in 1825 to oversee construction of what came to be called the Main Line of Public Works, which was projected to cut travel time between Philadelphia and Pittsburgh to three to four days instead of the three to four weeks travel time by Conestoga wagons. In 1828, the Canal Commission approved construction of two rail lines—the P&C (eighty-two miles) and the Allegheny Portage (thirty-six miles). Duffy’s mile 59 contract was the second of his six contracts with the P&C in the period 1829 to 1849, and the most expensive contract along the entire system, at $23,500. Duffy also obtained contracts with the West Chester Railroad and the Reading Railroad.

Duffy lived in a rented house in Willistown Township, south of the P&C line, with ten non-naturalized Irish laborers who worked with him on mile 9 of the West Chester Railroad (which was intended to link up with the P&C). The bulk of Duffy’s crew for his mile 59 contract arrived in Philadelphia from Derry in late June 1832 aboard the bark John Stamp. Their average age was 22, and most of them were desperately poor. The lure of labor opportunities in canal and railroad construction in the United States drew progressively more Irishmen across the Atlantic in the 1830s.

Duffy brought forty-seven men and at least one woman from the John Stamp to mile 59 to work with the ten already living with him, making a crew of fifty-seven to work on the P&C cut and fill. As the work commenced, cholera arrived in Philadelphia and an epidemic gripped the Delaware Valley. In July and August, perhaps 1,000 people perished in the epidemic in the Philadelphia region. By early August, cholera had reached the workers’ camp in Chester County and sources indicate that some of them tried to flee. Quarantines of food and also of humans were employed throughout the United States during the 1832 epidemic, and evidence suggests that a quarantine of the workers was attempted at mile 59, perhaps imposed by the East Whiteland Horse Company (some of whose members lived adjacent to the work site). By the end of August, all fifty-seven workers had perished.

Archaeological excavations and forensic analysis of seven sets of remains from within the railroad fill in 2009-2012 revealed that those workers sustained blows to their skulls at the time of their deaths and one had a bullet shot into his skull at close range, but none had defensive wounds. Railroad records indicate that locals shunned the workers when cholera struck the camp, and it is likely that fear of cholera and perhaps even nativist sentiment contributed to the deaths of the work crew. Five of the excavated remains were reburied at West Laurel Hill Cemetery in Bala Cynwyd, Pennsylvania, in March 2012, and one was reburied at Holy Family Cemetery in Ardara, Donegal, Ireland, in March 2013. The events at Duffy’s Cut provide an example of the pervasive fear of contagion and of what historian Alan Kraut has called “the immigrant menace” in early America.

William E. Watson received his Ph.D. in history from the University of Pennsylvania and is Professor of History at Immaculata University. He is author of several books, and coauthor of The Ghosts of Duffy’s Cut and Irish-Americans: The History and Culture of a People. (Author information current at time of publication.)