Greetings, loyal readers, and welcome to another installment of , our semi-regular series where we feature works by our dedicated Mütter Museum docents. This article comes courtesy of . You may recall her past article on Benjamin Rush and the Medicinal Plant Garden. This time Julie delves into the history of Pennsylvania Hospital and its significant contributions to healthcare and medicine.
Several hospitals claim to be America’s first hospital. Philadelphia General Hospital, an almshouse for the poor, was founded in 1729. The original incarnation of Bellevue Hospital in New York City was a six-bed infirmary which opened in March 1736 on the current site of City Hall. However, many people designate the title of the first American hospital to Pennsylvania Hospital in Philadelphia which received its charter on May 11, 1751. Pennsylvania Hospital was the home of many of the key developments of modern medicine.
In 1751, Philadelphia was a city of 15,000, the second largest English-speaking city in the British Empire behind only London. Dr. Thomas Bond (1712-1784), a native Philadelphian, studied medicine in the colonies and traveled to Europe to obtain a more advanced education. While studying in London, Bond became convinced that a hospital should be built in Philadelphia. His original vision was that building a hospital for the "poor sick" would get the suffering people off the streets and out of the sights of the other citizens.
In the 1700s, wealthy people were treated at home, with house calls made by minimally trained doctors and then cared for by family members, often the women of the household who provided food, cleaning and such comfort care as was available. The almshouses of colonial times were places to house the poor who did not have sufficient means or family to provide care. General hospitals developed to provide medical and rudimentary surgical care for those poor sick needing medical care by physicians, beyond what the almshouses could provide. Seamen’s hospitals developed to provide care for sailors who arrived in port cities, and were designed to isolate sick and potentially contagious arrivals. Women in need of maternity care were treated at home if possible and in specialized women’s facilities if not.
When Bond returned to Philadelphia, he attempted to convince others to support the idea of building a general hospital to take care of the "poor, sick and insane." Everyone Bond approached for support inquired what Benjamin Franklin thought of building a hospital. Bond had not initially approached Franklin, but when he did Franklin was supportive and went to the Pennsylvania Assembly for matching funds. As described by Benjamin Franklin in the original Petition to the Assembly of Pennsylvania to establish the hospital: the poor sick who had no place to go or family support and those who "were deprived of their rational Faculties" and "are a Terror to their Neighbors" could be contained and confined within such a hospital and thus removed from view of the other citizens.
The Assembly members were skeptical that the hospital would benefit the more rural areas of the colony, but Franklin garnered their support by requesting matching funds if he could raise 2000 pounds. He already knew he could raise that much, so when the Assembly agreed the funding was well established. Francis Scott Key, author of the "Star Spangled Banner," praised the hospital in a poem for keeping the sick and contagious away from society.
Pennsylvania Hospital first opened to patients in 1753, in temporary space near Independence Hall in the former mansion of Judge John Kinsey, a Quaker who had recently died. The site at 8th and Pine was considered out in the country by the standards of the time. Benjamin Franklin laid the cornerstone of the new hospital and included the Good Samaritan seal with the motto "Take care of Him and I will repay thee," affirming the charitable purpose. The building included rooms in the basement for the insane, first floor for men, second floor for women, and third floor for servants and isolation areas. Keeping the poor sick individuals away from the other citizens of Philadelphia was one way to reduce contagion during a time of frequent epidemics. The time spent by patients in the hospital was meant to be short; those judged to be incurable were not admitted. Patients were accepted after providing proof of burial funds so that the hospital did not end up covering those costs. Patients were to be discharged as soon as they were either cured or judged to be incurable. In those days, patients with cancer and long-term mental illness were considered "incurable."
No patient was to be accepted who played cards, dice or any other game or was known to beg in the city. Patients were expected to assist, as they were able, in nursing, working on the floors, washing and ironing the bed linens, washing and cleaning the rooms, and other services. Without antibiotics and with minimal pharmaceuticals, little medical treatment was available and infections were common. The poor patients arriving at the hospital had usually lived in crowded conditions, sharing beds and outhouses with many others, and often arrived covered with lice. Pennsylvania Hospital finally established an Officer of Hygiene to attempt to mitigate these issues in 1874.
Dr. Bond was a volunteer member of the first medical staff and was associated with the hospital until his death in 1784. He is viewed as the "Father of Clinical Medicine" because of his contributions to clinical instruction, providing lectures to students. When the Revolutionary War began, Bond and his son helped organize the medical section of the Continental Army. Bond was also a founder and trustee of the University of Pennsylvania and an officer of the American Philosophical Society.
Early medical training for physicians in the American colonies was minimal; there were few requirements for either admission or graduation. It was possible to become a doctor after just two four-month series of classroom lectures, without even touching a body, much less a live patient. The ability to pay for the classes seemed to be the primary criteria for medical school. No tests or evaluation were required, and physicians were often completely inexperienced.
The staff members of Pennsylvania Hospital were integral to the formation of the University of Pennsylvania College of Medicine, founded in 1765 as the first medical college in the colonies. Dr. John Morgan, a physician trained in Edinburgh, was the founder of the College. Students enrolled in anatomical lectures and classes on the "theory and practice of Physick." Morgan supplemented the traditional minimal classroom studies with actual bedside training, practicing on patients at Pennsylvania Hospital. The hospital was staffed by unpaid interns who lived in the hospital during the 2+ years of their training.
Dr. Benjamin Rush was a member of the medical staff of Pennsylvania Hospital from 1783 until his death in 1813. Rush was dedicated to his patients, even staying during the yellow fever epidemic in Philadelphia in 1793, when many other affluent members of society fled the city. Rush is known as the "Father of American Psychiatry" due to the many developments in treatment of the mentally ill which he instituted. From a 21st century viewpoint, many of the advances that Rush promoted, such as bloodletting, look primitive and have been disproved. However, at the turn of the 19th century, improving the lives of mental patients by reducing the use of straitjackets, removing confining locks and cuffs, and moving the ward from the basement to hospital floors with windows for natural light were breakthrough advances. In 1787, Rush, along with Morgan and 22 other Philadelphia physicians, founded The College of Physicians of Philadelphia.
Dr. Phillip Sung Physick joined the staff in 1794 and served as a professor of surgery and anatomy at the University of Pennsylvania. Physick, considered the "Father of American Surgery," developed many new techniques for treating fractures and dislocations as well as inventing needle forceps. In 1804, the surgical amphitheater opened at Pennsylvania Hospital, allowing students to observe operations from raised seating. The amphitheater was used for operations until 1868. Large audiences of medical students and practitioners watched surgeries. The surgeon was often silent during the operation, with discussion among the medical team kept to an absolute minimum of glances or nods, with the watching audience eagerly interpreting every word or movement.
Because of the extreme pain and high risk of post-operative infection, surgeries before the development of anesthesia were limited to those critical to saving a patient’s life. Pain management at the time was limited to providing patients the option of opium, liquor or a knock on the head with a mallet. Surgeons tried to avoid entering the abdomen, thorax or cranium as the inability to control or prevent post-operative blood loss or infection often killed the patient. Surgery requiring entry into the body was undertaken only when all other options were exhausted, and operations often were accompanied by loud screams until the patients went into shock.
Ether had been used as a medication to reduce spasms or convulsions for about 200 years before its use as a party drug began in the United States in the early 19th Century. Crawford Long was a medical student at the University of Pennsylvania during the days of the "ether frolics" when students covered their noses and mouths with ether-soaked rags to induce euphoria. Long noted that people appeared to not feel pain after breathing ether. In 1842, by then a Georgia surgeon, Dr. Crawford Long first used ether as an anesthetic during an operation to remove neck cysts. He did not immediately publish his findings, though, so the first surgical use of ether was initially reported by another.
Pennsylvania Hospital was also the first hospital in the colonies to have an apothecary shop in the hospital. The apothecary was initially stocked with the import of 112 pounds of drugs imported from London. Many of these initial drugs were minerals and herbs, often compounded with animal fats or other substances. An early plan to develop a garden of medicinal plants in the courtyard was approved in 1774 but not implemented until the Bicentennial of the United States in 1976. At that time, the Physic Garden was designed to grow a number of plants which would have been commonly grown in the 18th and 19th centuries, including digitalis for heart concerns and ginger for gastrointestinal upset.
Walking the grounds now provides a glimpse into the lengthy history of medicine in Philadelphia and the first general hospital of the colonies.
Sources:
- Atlas Obscura. Accessed April 27, 2021.
- America’s Civil War. Accessed April 27, 2021.
- Bicker, Josh. Fugitive Leaves, December 18, 2020. Accessed April 27, 2021.
- Brown, Michael. In T. Schlich, ed., The Palgrave Handbook of the History of Surgery. London: Palgrave Macmillan, 2017. Accessed April 27, 2021.
- Ewing, Rachel. May 1, 2017. Accessed April 27, 2021.
- Wood Library-Museum of Anesthesiology. Accessed April 27, 2021.
- Accessed April 27, 2021.
- Pennsylvania House of Representatives: House Speaker Biographies. Accessed April 27, 2021.
- Morton, Thomas G. and Frank Woodbury. Philadelphia, PA: Times Printing House, 1895. Accessed April 27, 2021.
- Benjamin Franklin Historical Society. Accessed April 27, 2021.
- Wust, MaryKate. Penn Medicine News. October 13, 2017. Accessed April 27, 2021.