PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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Subcultures
E pluribus unum refers to thirteen colonies peacefully becoming a single nation. But it applies to Philadelphia in a different sense. Philadelphia is a city of neighborhoods.

Philadelphia Physicians
Philadelphia dominated the medical profession so long that it's hard to distinguish between local traditions and national ones. The distinctive feature is that in Philadelphia you must be a real doctor before you become a mere specialist.

Conventions and Convention Centers
When you have a big convention center, some circus is always coming to town. Philadelphia has always been a convention town, has had and still has lots of convention sites, and hopes to have more of the kind of famous convention we have had in the past.

Science
Science

New Jersey (State of)
The Garden State really has two different states of mind. The state motto is Liberty and Prosperity.

Academia, Medical Version
The first hospital in America generated the first medical school, the first medical society, and many of the unique features of American medicine. In modern times, the gusher of federal research funds not only distorted academic medicine, but academia as a whole.

Philadelphia Medicine (2)
Philadelphia is where medicine began in America

Customs, Culture and Traditions (2)
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Education in Philadelphia
Taxes are too high, but the tax base is too small, so public education is underfunded. Drug use and lack of classroom discipline are also problems. Business and employed persons have fled the city, must be induced to return. Deteriorating education, rising taxes and crime are the immediate problems, but the underlying issue is lack of vigor and engagement by the urban population itself.

Atlantic City, Brigantine and the N.I.H.

{Steel Pier}
Dr. William Osler

It would only be honest to say that Atlantic City was a rundown mess after World War II, cheap, sleasey and dispirited. But for academic medicine during a period of thirty or forty years, one small nook of A.C. was the most exciting place in the whole world. Only during several days at the beginning of May, however. The reason it was so attractive to scientists was that beach hotels were cheap and dilapidated; Atlantic City probably contained the worst on the East Coast. The Haddon Hall was an exception, rather elegant and far too expensive for most physicians in training; research is a young doctor's game. The medical profession's annual beauty contest for medical research was headquartered in Haddon Hall next door to the Steel Pier, surrounded by hundreds of cheap lesser hotels. The professors all stayed at Haddon Hall, but few others could afford it. Indeed, resident physicians from Philadelphia mostly found it cheaper to commute from home for ninety minutes than to stay overnight, residents and fellows from more distant cities stayed in the dumpy hotels. Nobody in that age group had much money to spend, so the commuting Philadelphians didn't miss out on much night life at the shore by going home every night.

{Atlantic City Skyline}
New Atlantic City Skyline

Before the spring meetings got popular after World War II, the hundred members of the most elite society of academic research professors on the East Coast assembled in Haddon Hall, all of them quite able to afford to stay in the headquarters hotel. This had been going on since William Osler founded it in 1885, at first in Washington, and then migrating to Atlantic City. As medical research began to flourish, the society grew a little, but at a pace too slow to keep up with the growth of medical scientists, so a second group of "Young Turks" formed a competitive society which met the next day, and ultimately a third group, the "Young Squirts", felt excluded by the old has-beens, and met on the third day of what eventually turned into a week-long parade of scientific presentations, each ten or twelve minutes long, starting before normal breakfast time, lasting until 10 PM, with occasional breaks. That is to say, the medical papers that everybody wanted to hear grew from thirty or forty a year to nearly a thousand. If a young fellow did well, the older professors would notice, and he would get employment offers. That kept the eminent older doctors around for the whole session, and provided an informal ranking of the worth of the program. Everybody wanted to advance up the ranks of prestige, and this system roughly sorted them out. However, it was an exhausting experience just to sit through all that and listen; the old professors tended to drop out and go home a little early. No matter how many outstanding papers were clamoring to be heard, no one could endure more than a week of straining for attention. It was strictly forbidden to present a paper which had been published or presented anywhere else, so it was usually difficult to guess in advance whether a paper was likely to be exciting. You could go home early if you wanted to, but at the risk of missing the real block-buster of the year, tucked away on the program with a bewildering scientific title. The younger wise-apples had a formula, that if one paper in three was outstanding, you were having a good meeting; you just had to grit your teeth and try to stay awake during the other two-thirds. Still, that got to mean that the reward for pursuing this grinding ordeal was to go home after learning about three hundred outstanding scientific advances that no one else knew about; knowing three hundred cutting-edge things that other doctors didn't know really did put you well ahead of the pack. Keep that up for ten or twenty years, and notable differences among colleagues would relentlessly emerge.

{Steel Pier}
Old Steel Pier

From the lounge of the Haddon Hall, with non-members forced to stand in the back, the meeting moved to the 2000-seat movie theater in the Steel Pier, at about 1950. Things then came to an equilibrium; the movie theater was never completely full. We were told there were seven or eight even larger auditoriums on the Steel Pier, but it was never necessary to move to them. The first four years I attended these sessions I was being paid no salary at all, and most of my contemporaries were only getting token amounts beyond room and board. The eminent professors who were real members of the top society would find their way to front-row seats where they could ask questions, having had a chat with colleagues at breakfast in the Haddon Hall. But they had once been impecunious, too, and wore their brand-new Ivy League plaid jackets rather uncomfortably. Doctors who (gasp) worked for drug companies also gave signs of affluence, but they tended to drift over to the barber shop and have a shoeshine, where they picked up the gossip for their employers. Over a period of fifty years, I can recall first hearing of the wonders of several new antibiotics, a strange chemical called cortisone which seemed to cure rheumatoid arthritis, the introduction of the birth-control pill, the introduction of polio vaccine, the first drugs in the treatment of tuberculosis, and a vast array of novel explanations for disease phenomena that had seemed mysterious for centuries. In those days, a year without a new medical miracle was a very lean year, indeed. During this interval, the basis for curing at least thirty common diseases was first presented at the Spring Meetings in A.C., and since then medical practice looks nothing like it did in 1947.

http://www.philadelphia-reflections.com/images/missing_img.gif
Ten Passenger Jitney

Gradually the audience changed, too. At first, the people presenting papers came from at most ten medical schools, and mutterings of discrimination could be heard. In fact, it was plainly true, because only about ten schools had any extra money to fund research. When this news reached the U.S. Senators from the Mid and Far West, federal research money started to be spread around more evenly, just like the distribution of Senators. It was the appointment of one of the members of the original small nest of clubs to the Directorship of the N.I.H., the National Institutes of Health in Bethesda, Maryland, which really got the research spigot to flow. The point man was James Shannon, who knew what was what in cutting-edge research, and he sat there in the audience making up his mind who was who. For all the time of his directorship and for long afterwards, he enforced, really enforced, the rule of "no political influence in research grants". Lots of congressmen came to the N.I.H. with the news that their relatives had such-and-such a disease, and so they thought more money should be diverted to research in that area. Nothing doing. Shannon held the keys to the kingdom, and he knew it. He had a deft feel for how much money the research industry could usefully absorb, and then he went to Congress and demanded it. The purity of this process has frayed at the edges somewhat as the amounts of money grew to what is now thirty billions of dollars a year. Most experiments unfortunately fumble or fail, so a lot of money gets spent on blind alleys before someone gets it right. It takes a tough-as-nails idealist like Jim Shannon to survive the temptations of an N.I.H. Director, and among the temptations is just to give up and give out money indiscriminately to people who want to count all the grains of sand on the beach. If your idea was a good one, you got all the money you could possibly spend; if the idea was mediocre, in those days you got nothing at all. On the other hand, the estimation of overhead costs is something other mortals can quibble about. Shannon demanded and got about a third of the grant money to be given to the medical school administrations. That was barely enough in a research establishment emerging from the Depression of the 30s, and the World War. However, now that the pipeline is filled, it is increasingly doubtful that ten billion a year needs to go to administrators; the bean-counters took over, and the results are more open to criticism. After all, after someone finds a cheap cure for cancer, some disadvantages of perpetuating an aging retiree population start to emerge, and may outweigh the arguments for spending quite so much doing it. That may well be what the advisors to President Obama are growling at, but for now the example of his nose poked into the hornet's nest of favoring research for certain population (voter?) groups will restrain others who were once inclined to agree. After cancer is cured, perhaps then everything will seem different.

{Diving Horse}
Dr. James Augustine Shannon

Well, let's tell one story out of many that could be told. Around 1965 there were two competitive polio vaccines rumored to be in the pipeline. Jonas Salk had an injection method, and Albert Sabin had an oral vaccine. Anyone who had watched children run shrieking from a needle knew that Sabin had the preferred method, but Salk got to Atlantic City two years earlier than Sabin. The auditorium was filled with rumors of very dubious precision to the effect that Salk had used unfair methods to get to the stage of public announcement. For example, it was growled he gave the vaccine to the Russians to test, but they were afraid of it and gave it to the Poles. Regardless of such scurrilous gossip, which is here repeated only to show how hysteria can occasionally agitate even scientists, when Salk gave his paper at the Steel Pier, the standing ovation was thunderous. And so, as the meeting broke for dinner the crowds migrated over to a huge seafood restaurant named Hackney's and watched the new scientific hero get a little tipsy in public. That seemed to revive the rumors which became even less factual. But there is no doubt that by the time Sabin stood at the same podium and gave his presentation of the oral vaccine, the crowd had switched to his side, the ovations were unlike anything the scientists had ever heard. Anyway, as emotions now settle down in retrospection, we are all pretty happy that polio is nearly eradicated from all but a few corners of the earth, and these two men are both responsible for it. But so is Jim Shannon responsible for it, and he never got the ovations he deserved.

{Mr. Peanut}
Mr. Peanut

When the gambling casinos came to A.C. the cheap boarding houses were swept away, doctors in research were incidentally better paid, and the Spring Meetings migrated back to Washington. The dumps on the beach have been replaced by gleaming multistory hotels, the place looks much more prosperous. Doctors are in a position to know about the drug and alcohol addiction, the venereal disease and crime among the casino employees, and the personal tragedies among the gamblers. But anybody can see the new buildings and the clean streets. When a group of eight of us took a nostalgic trip to revisit the place, no doctor even mentioned the idea of going in to drink and gamble -- even the suggestion was preposterous. So we wandered over to Brigantine where there appears to be a large retirement community, where gambling and drinking seem equally unlikely. The elementary school in which we heard a talk about the old days was splendid beyond anything I remember in an elementary school. Among the audience the questions revealed there were many former employees of the old A.C., people who ran shops to sell salt water taffy, fudge and the like to crowds on the boardwalk. Some of them may have once driven Jitney buses, or pushed sightseeing wheelchairs. But not one of them showed the slightest sign of recognizing that on the first weekend in May, every year, a crowd of nerdy-looking serious fellows would move into familiar boarding houses for a few days, remaining mostly invisible during daylight hours. That was the academic doctor crowd, if anyone had bothered to ask, pouring into the Steel Pier movie theater, having the time of their lives listening to medical history being made. After a week they all went home, and nobody in A.C., later Brigantine, paid any attention to any of it. After all, A.C. is about salt water taffy, right?

(1818)

This makes everything so cmolpetley painless.
Posted by: Katherine   |   Jan 4, 2012 11:22 PM
This "free sharing" of ionfmration seems too good to be true. Like communism.
Posted by: Azia   |   Jan 2, 2012 9:37 PM
I liked your blog re Boyd theater. john
Posted by: jc esposito   |   Mar 21, 2011 8:11 PM
good posting. john
Posted by: jce   |   Dec 14, 2010 7:52 PM

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