{"id":11225,"date":"2014-10-23T11:40:34","date_gmt":"2014-10-23T15:40:34","guid":{"rendered":"https:\/\/philadelphiaencyclopedia.org\/?p=11225"},"modified":"2022-02-01T13:05:43","modified_gmt":"2022-02-01T18:05:43","slug":"city-of-medicine","status":"publish","type":"egp_themes","link":"https:\/\/philadelphiaencyclopedia.org\/themes\/city-of-medicine\/","title":{"rendered":"City of Medicine"},"content":{"rendered":"

In 1843, a student at the \u201cmed school of the University of Pennsylvania,\u201d as he called it in a letter to a friend in Boston, declared Philadelphia \u201cdecidedly the city of the Union for doctors, the facilities for study making it a perfect little Paris.\u201d The comparison reflected the renown of the French capital at that time for bedside teaching and anatomical dissection. By that point in the mid-nineteenth century, Philadelphia had become the country\u2019s pre-eminent medical city, known particularly for its wealth of opportunity for medical education. Although the city lost its edge in the early 1900s, it recovered later in the century to become a growing center of health care, research, and education. \u00a0Medical care and education remained integral factors in the social and economic fabric of the city.<\/p>\n

\"In<\/a>
In 1752 Pennsylvania Hospital received its first patients in rented quarters on Market Street. By 1804 it had completed the handsome set of structures now known as the Pine Street Building. Though long supported by many Quakers, the Hospital has always cared for all Philadelphians. It has as well continuously provided valued clinical instruction. (Photograph by Steven J. Peitzman)<\/figcaption><\/figure>\n

Philadelphia gained its early reputation as a city of medicine through the development of hospitals and medical schools. The founding of Pennsylvania Hospital<\/a> 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<\/a> (1712-84) and Benjamin Franklin<\/a> (1706-90), the nation\u2019s first hospital joined a movement\u2014rooted in Enlightenment thought, then underway in Britain\u2014to create \u201cvoluntary hospitals\u201d to care for \u201cstrangers\u201d and the \u201cworthy poor,\u201d funded and conducted by private philanthropy. From the outset, the hospital contributed to the city\u2019s allure in medical education. Its Wednesday and Saturday morning demonstration \u201cclinics\u201d drew crowds of nineteenth-century medical students.<\/p>\n

\"The<\/a>
The Southern Dispensary for the Medical Relief of the Poor opened in 1816 on then Shippen, now Bainbridge Street west of Third. The Renaissance Revival building still standing (318-320) dates from the 1858. Most row-house Philadelphians went to family doctors in their neighborhood (or the doctor came to them). Free dispensaries (clinics) served the poor and working poor; the Southern particularly cared for the immigrants of South Philadelphia. Young physicians and trainees valued the experience gained at such dispensaries. (Photograph by Steven J. Peitzman)<\/figcaption><\/figure>\n

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<\/a>; and the origins of the Municipal Hospital for Contagious and Infectious Diseases can be traced to before 1818.\u00a0 Specialty hospitals arose for care of the eyes, children, and maternity work. Reflecting the Quakers\u2019 concern for those \u201cdeprived of reason,\u201d Pennsylvania Hospital spawned a progressive Hospital for the Insane (1841) on then-rural grounds west of the city; a Friends Asylum<\/a> (1817) was founded in the Frankford countryside. With other Quaker women, in 1862 pioneer woman doctor Ann Preston<\/a> (1813-72) founded Woman\u2019s Hospital of Philadelphia<\/a> 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\u2019s medical schools established their own hospitals.<\/p>\n

The numerous hospitals served as objects of neighborhood pride and philanthropy, particularly service by women. In addition, their accident wards supported the city\u2019s vast industrial growth in the nineteenth century.<\/p>\n

Philadelphia\u2019s place as a center of medical education can be traced to 1762 when William Shippen Jr.<\/a> (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<\/a> (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 \u201cUniversity of the State of Pennsylvania\u201d offered medical lectures, by feuding faculties (Philadelphia\u2019s early teaching physicians were a notably feisty bunch). The factions united as the forerunner of the University of Pennsylvania School of Medicine, America\u2019s first. It won standing during the nineteenth century as one of the strongest in the nation, though strong in a stolid sort of way.<\/p>\n

Perceiving room for another medical school in Philadelphia, if not an actual need, surgeon George McClellan<\/a> (1796-1847) and some collaborators opened Jefferson Medical College<\/a> in 1824. Both Penn and Jefferson welcomed huge classes, and so produced a high proportion of early American doctors. Jefferson\u2019s faculty came to rival Penn\u2019s in national reputation.<\/p>\n

\"This<\/a>
This posed photograph of the dissection laboratory of the Woman\u2019s Medical College of Pennsylvania (WMCP) from the 1910 yearbook conveyed the reassuring idea that the study of medicine, even anatomy, could be orderly and lady-like. The opening of Quaker-supported WMCP in 1850 and founding of Woman\u2019s Hospital of Philadelphia (1861) made Philadelphia the home of many early women physicians and surgeons. (Legacy Center Archives, Drexel University College of Medicine)<\/figcaption><\/figure>\n

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 <\/a>(1848); the Woman\u2019s Medical College of Pennsylvania <\/a>(1850; the first of its kind in the world); the Medico-Chirurgical College<\/a> (1881); the Philadelphia Polyclinic and College for Graduates in Medicine <\/a>(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 <\/a>(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<\/a>, opened in 1901. The availability of strong medical education for women, and the presence of several women\u2019s 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<\/a> (1745-1843) called homeopathy, which flourished in Philadelphia.<\/p>\n

By 1890, about 2,000 names appeared in the city\u2019s medical directories, for a population of approximately one million. Most were doctors in the neighborhoods\u2014serviceable, 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.<\/p>\n

\"A<\/a>
A fully expressed product of the Enlightenment, Benjamin Rush (1746-1813) became America\u2019s fist internationally recognized physician, though a controversial one. His fervid belief in the arterial localization of disease led to intensive use of bleeding and calomel (mercurous chloride) during the yellow fever epidemics of the 1790s. As doctor and citizen, Rush served the Revolution, advocated for abolition, embraced temperance, and offered ideas for the development of education in the new republic. (Engraving after painting by Thomas Sully, National Library of Medicine)<\/figcaption><\/figure>\n

But it was the downtown physicians and surgeons, most with senior faculty positions at Penn or Jefferson, who built Philadelphia\u2019s reputation as the nation\u2019s medical capital. Among the early figures were Benjamin Rush<\/a> (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<\/a> (1768-1837), \u201cfather of American surgery\u201d; and editor and ophthalmologist Isaac Hays (1796-1879). Later in the nineteenth century came anatomist and brilliant polymath Joseph Leidy<\/a> (1823-91); master teacher of internal medicine Jacob Mendez Da Costa<\/a> (1833-1900); physiologist, neurologist, psychiatrist, and popular novelist S. (Silas) Weir Mitchell <\/a>(1829-1914); internationally known surgeons Samuel D. Gross<\/a> (1805-84), and W.W. (William Williams) Keen<\/a> (1837-32), the latter very much a progressive mind and a teacher at Woman\u2019s Medical, Jefferson, and the Pennsylvania Academy of the Fine Arts <\/a>(anatomy). Gynecologists included Washington L. Atlee (1808-78), among the first to remove uterine fibroids, and Emeline Horton Cleveland <\/a>(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.<\/p>\n

\"Progressive<\/a>
Progressive surgeon W[illiam] W[illiams] Keen (1837-1932), a graduate of Central High School, taught at the Woman\u2019s Medical College of Pennsylvania and later at his medical alma mater, Jefferson Medical College. He advocated laboratory research and accepted the germ theory. Keen also counts as a pioneer in neurological surgery and collaborated with S. Weir Mitchell (1829-1914) in studies of nerve injury acquired during the Civil War. He also taught anatomy at the Pennsylvania Academy of the Fine Arts. (National Library of Medicine)<\/figcaption><\/figure>Some Philadelphia doctors strayed well beyond medicine. In addition to the novelist S. Weir Mitchell, physician and pathologist William Pepper<\/a> (1843-98) led the founding of the Free Library of Philadelphia<\/a> and two museums. Philadelphia can claim two<\/i> physicians who found fame as Arctic explorers\u2014the erratically adventurous Elisha Kent Kane (1820-57) and Isaac Israel Hayes <\/a>(1832-81). James E. Rhoads (1828-95) gave up an exhausting practice in Germantown<\/a> for Quaker work in service to the freedman and Indian, and he later served as president of Bryn Mawr College<\/a>.<\/p>\n

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 <\/a>(1889-1981) wrote about the senior faculty at Penn: \u201cThe University\u2019s medical teachers had always been superb clinicians\u2014masters of diagnosis and treatment and polished expositors.\u201d That is, they brought comprehensive knowledge and experience to their practices and teaching (and many were broadly erudite beyond their professional expertise).<\/p>\n

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\u2019s skilled anatomists dissected, taught, and wrote books that added to the city\u2019s reputation as a city of medicine. Several brought back the ideas and methods they had studied in Paris. The reputations of Philadelphia\u2019s 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\u2019s centrality in medical publishing<\/a>: its enormous production of medical books in the nineteenth century far exceeded that of New York or Boston. Philadelphia physicians readily fed the publishers\u2019 demands for new textbooks and manuals (including homeopathic). For more than 100 years, the American Journal of the Medical Sciences<\/i><\/a>, edited and published in Philadelphia, prevailed as the country\u2019s leading such periodical.<\/p>\n

In the early twentieth century, however, Philadelphia lost its edge. Significantly, the influence of Philadelphia\u2019s American Journal of the Medial Sciences <\/i>declined, while the New England Journal of Medicine<\/a>,<\/i> 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\u2014or, unhappily for the Quaker City, the paucity of it in the city\u2019s medical colleges. The decisive factor was philanthropy\u2014or the paucity of it for Philadelphia\u2019s medical colleges.<\/p>\n

\"Medical<\/a>
Medical Hall (later Logan Hall, Claudia Cohen Hall) opened in 1874 soon after the University of Pennsylvania moved to its campus in West Philadelphia. A Gothic design by the professor of architecture Thomas Webb Richards (1836-1911), it is the oldest extant medical school structure in the city. (Photograph by Steven J. Peitzman)<\/figcaption><\/figure>\n

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 <\/a>(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<\/a>. In a history of Penn\u2019s medical school, George W. Corner wrote that in this period its leaders failed to recognize that \u201cfor 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\u2019s whole outlook.\u201d 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.<\/p>\n

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 \u201cold guard\u201d among faculty managed a counter-revolution: Edsall left Penn and soon guided the rise of Harvard University Medical School<\/a> to pre-eminence.<\/p>\n

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\u2014careful anatomical and pathological observations, discerning descriptions of diseases, novel procedures and remedies. But animal experimentation in the laboratory seemed foreign.<\/p>\n

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\u2019s medical schools. (A modest exception was the Woman\u2019s Medical College, embraced by its Quaker friends.)\u00a0 Nor did this usually occur elsewhere. But in Baltimore, Quaker businessman Johns Hopkins<\/a> 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 <\/a>opened in 1893\u2014with former Philadelphian William Osler (1849-1919) as one of its prized founding faculty.<\/p>\n

In 1910 the Carnegie Foundation for the Advancement of Teaching<\/a>, founded in 1905, in conjunction with the Council on Medical Education of the American Medical Association<\/a>, engaged educator Abraham Flexner<\/a> (1866-1959), Simon\u2019s brother, to carry out an inspection of North American medical schools. Flexner\u2019s famous report of 1910, Medical Education in the United States and Canada<\/i><\/a>, 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 \u201cfull-time plan\u201d (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.<\/p>\n

Neither \u201cfull-time\u201d 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: \u201cPhiladelphia is now in a fair way to become a contender for the title of the medical center of America\u201d said the Philadelphia Press<\/i> on June 3, 1916\u2014tacitly admitting that the city already had lost<\/i> 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.<\/p>\n

Although some meaningful local gifts aided the city\u2019s medical schools in this period and Philadelphia surely had wealth, no one in the city matched John D. Rockefeller<\/a>. The largest single act of philanthropy aimed at education was by banker Anthony J. Drexel<\/a> (1826-93), whose admirable creation of the Drexel Institute for Art, Science and Industry <\/a>(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\u2019s millionaires tended to send their dollars far away–to \u201cfamine stricken Russians,\u201d the \u201cred man on the frontier,\u201d and, generally, to \u201cthe dark and hidden places of the earth.\u201d<\/p>\n

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\u2019s medical fabric was not entirely dormant. Sound scientific work developed in microbiology and in some of the stronger \u201cbasic science\u201d departments of the medical schools. In the early 1920s, A. Newton Richards <\/a>(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\u2019s earliest research support from a foundation, the Commonwealth Fund<\/a>.<\/p>\n

\"The<\/a>
The Alfred Newton Richards Medical Research Building of the University of Pennsylvania, built between 1957 and 1964, was certainly not Philadelphia\u2019s first space for biomedical research. It is, however, the most widely known, being one of the most acclaimed designs of notable modernist architect Louis Kahn, himself a Philadelphian. It symbolizes the increase in laboratory science in the city which occurred in the 1950s and 1960s. (Photograph by Steven J. Peitzman)<\/figcaption><\/figure>\n

Philadelphia\u2019s 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\u2019s medical schools, and some hospitals, to expand their clinical services and increase research productivity. Soon the schools swelled into \u201cacademic medical centers,\u201d keenly competing with each other while looking more and more <\/i>like each other. Woman\u2019s Medical admitted men, and Hahnemann ejected Samuel Hahnemann\u2019s 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\u2014Pennsylvania Hospital, Jefferson, Hahnemann\/Drexel, Penn, Presbyterian\u2014formed 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\u2019s borders, some of the larger community hospitals, such as Lankenau and Abington<\/a> in the suburbs and Cooper <\/a>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<\/a> documented \u201ceducation and health services\u201d (combined in its statistics) as the region\u2019s largest employment supersector.<\/p>\n

Even in the period of decline in the early decades of the twentieth century, Philadelphia\u2019s 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. \u00a0By the later decades of the twentieth century, \u201chealth care\u201d and health-care education became the region\u2019s dominant industry. White coats, short and long, continued as an enduring visible attribute of the city and region.<\/p>\n

<\/pre>\n
Steven J. Peitzman<\/i><\/b> is Professor of Medicine at Drexel University College of Medicine. His historical work includes the book\u00a0 A New and Untried Course: Woman\u2019s Medical College and Medical College of Pennsylvania, 1850 \u2013 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.)<\/i><\/p>\n","protected":false},"featured_media":12090,"template":"","egp_featured_subjects":[2012],"class_list":["post-11225","egp_themes","type-egp_themes","status-publish","has-post-thumbnail","hentry","egp_featured_subjects-health-and-medicine"],"acf":[],"_links":{"self":[{"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/egp_themes\/11225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/egp_themes"}],"about":[{"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/types\/egp_themes"}],"version-history":[{"count":13,"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/egp_themes\/11225\/revisions"}],"predecessor-version":[{"id":36877,"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/egp_themes\/11225\/revisions\/36877"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/media\/12090"}],"wp:attachment":[{"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/media?parent=11225"}],"wp:term":[{"taxonomy":"egp_featured_subjects","embeddable":true,"href":"https:\/\/philadelphiaencyclopedia.org\/wp-json\/wp\/v2\/egp_featured_subjects?post=11225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}