A Toast to Doctor Franklin Click Title To Read Comments (1)

Benjamin Franklin

Benjamin Franklin's formal education ended with the second grade, but he must now be acknowledged as one of the most erudite men of his age. He liked to be called Doctor Franklin, although he had no medical training. He was given an honorary degree of Master of Arts by Harvard and Yale, and honorary doctorates by St.Andrew and Oxford. It is unfortunate that in our day, an honorary degree has degraded to something colleges give to wealthy alumni, or visiting politicians, or some celebrity who will fill the seats at an otherwise boring commencement ceremony. In Franklin's day, an honorary degree was awarded for significant achievements. It was far more prestigious than an earned degree, which merely signified preparation for later achievement.

And then, there is another subtlety of academic jostling. Physicians generally want to be addressed as Doctor, as a way of emphasizing that theirs is the older of the two learned professions. A good many PhDs respond by rejecting the title, as a way of sniffing they have no need to be impostors. In England, moreover, surgeons deliberately renounce the title, for reasons they will have to explain themselves. Franklin turned this credential foolishness on its head. Having gone no further than the second grade, he invented bifocal glasses. He invented the rubber catheter. He founded the first hospital in the country, the Pennsylvania Hospital, and he donated the books for it to create the first medical library in the country. Until the Civil war, that particular library was the largest medical library in America. Franklin wrote extensively about the gout, the causes of lead poisoning and the origins of the common cold. By inventing bar soap, it could be claimed he saved more lives from infectious disease than antibiotics have. It would be hard to find anyone with either an M.D. degree or a PhD. degree, then or now, who displayed such impressive scientific medical credentials, without earning -- any credentials at all.

1793: Germantown Nurses the Yellow Fever Click Title To Read Comments (1)

yellow fever Phila

The French Revolution continued from 1789 to 1799 and created the opportunity for a second revolution in the colonies which a second overstretched European country would lose. The slaves of Haiti just about exterminated the white settlers, except for some who escaped, taking Yellow Fever and Dengue with them. Both diseases are Mosquito-borne, so they flare up in the summer and die down in the winter, although the Philadelphians who received the exiles didn't know that. Yellow Fever in Philadelphia was bad in 1793, came back annually for three more years, and flared up badly once again in 1798. It could easily be seen that it was worse in the lowlands, absent in the hills. Seasonal, it reached a peak in October, disappeared after the first frost. In the early fall, people died a horrible yellow death, jaundiced and bilious.

Dr. Rush

The Yellow Fever epidemic had a profound effect on many things. It was one of the major reasons the nation's capitol did not remain in Philadelphia. It made the reputation of Dr. Benjamin Rush who announced a highly unfortunate treatment -- bleeding the victims -- thus provoking numerous anti-scientific medical doctrines based on the considerable value of doing nothing at all. It took a full century for American scientific medicine to recover from this blow to its reputation. Whatever criticism Rush may deserve for his Yellow Fever blunder, it definitely is not true that he was a scientific lemon. Medical students are regularly surprised to learn that he is the physician who first identified and described the tropical disease of Dengue, or "break-bone fever", which was a somewhat less noticed feature among the Haiti exiles in Philadelphia. In still other scientific circles, Benjamin Rush is ofter referred to as the "Father of American Psychiatry". He was one of the founders of the College of Physicians of Philadelphia, the oldest medical society in North America. Medical colleagues who today scoff at the yellow fever episode seem to forget that Rush stayed behind to tend the sick during a devastating epidemic, while many of his more cautious colleagues fled for their lives. An unhesitating signer of the Declaration of Independence, whatever Rush did, he did courageously.

One very good non-medical thing the Yellow Fever epidemic accomplished was to put an abrupt end to the torch-light parades of window-breaking rioters agitating, with Jefferson's approval, for an American version of the guillotine and the terror. Federalists like Adams and Bingham never forgave Jefferson or his admirers for this, so the class warfare movement might likely have got much worse if suddenly everyone had not dropped tools, and headed for the hilly safety of Germantown.

The President of the new republic, George Washington, was in Mt. Vernon in the summer of 1793, wondering what to do about the Yellow Fever epidemic, and particularly uncertain what the Constitution empowered him to do. He finally decided to rent rooms in Germantown, and called a cabinet meeting there. His first rooms were rented from Frederick Herman, a pastor of the Reformed Church and teacher at the Union School, although he later moved to 5442 Germantown Ave, the home of Col. Franks. Jefferson chose to room at the King of Prussia Tavern.

During this time, Germantown was the seat of the nation's government. As was fervently hoped for, the cases of yellow fever stopped appearing in late October, and eventually it seemed safe to convene Congress in Philadelphia as originally scheduled, on December 2.

Although Germantown was badly shaken by the experience, it was a heady experience to be the nation's capitol. Meanwhile, a great many rich, powerful and important people had come to see what a nice place it was. Germantown then entered a second period of growth and flourishing. Walking around Germantown today is like wandering through the ruins of the Roman forum, silently tolerant of visitors who would have never dared approach it in its heyday.

Cost of Medical Care Click Title To Read Comments (1)

Milton S. Hershey

On several occasions, Richard A. Kern M.D. (1891-1982) told the story of his part in the founding of the Hershey School of Medicine. Dick Kern was a distinguished professor of Medicine at Temple University, well known for his contributions in the field of asthma and allergy, a past president of the College of Physicians of Philadelphia, and a former Grand Master of Pennsylvania Freemasonry. The Milton S. Hershey School was considering the creation of a medical school and needed advice.

Milton Hershey had been a strict Mennonite, which is closely related to Quakerism, and had accumulated a huge fortune making chocolate candy. He left generous trusts to endow a theater and various other public services in the town of Hershey, but his ownership shares in the chocolate company had been left to the Hershey School for orphans. The value of the shares had far outgrown the ability of the school to employ them usefully, and they were considering a medical school. In 1963, as at present, everybody else was wondering how to get out from under the crushing cost of running a medical school. The sudden inquiry from a donor both willing and able to start a whole new medical school from scratch was an opportunity not likely to appear again soon. Kern carefully considered the options, including the danger of scaring off the naive potential donors with too high a price. Finally, he screwed up his courage and suggested a price to the trustees, of fifty million. The prompt answer was, done, you've got your medical school.

In due course, Kern found himself on the platform at the inaugural ceremonies of the school, sitting next to the guest of honor, that man who had made such an instant decision. Chatting amiably, Kern mentioned that he had always wondered how high the Hershey Foundation would have been willing to go. The answer was just as prompt as the original one. "Hundred-twenty."

Inscrutable Chinese Click Title To Read Comments (1)

Chinese Symbols

The main square in Beijing (once called Peking) is pretty big, but the surrounding Chinese buildings are also big, so the size of the square no longer strikes American visitors as terribly unusual. Tiananmen Square has hosted periodic riots and demonstrations for a long time, with four or five notable ones taking place in recent memory during the past hundred years, many more, of course, in the last thousand years, after each of which it settles down to its usual resemblance to a deserted parking lot in a large shopping center. The most recent riot took place on June 4, 1989. Something like a million students from forty universities demonstrated, provoked military retaliation, and ended up with uncountable thousands of them killed, imprisoned, and mistreated. We are told the demonstration was in support of a national leader who had just died, but who had previously been ousted because of his support for greater personal liberty. The students wanted his name restored to a place of honor. In retrospect, we can see that although the Tianenmen massacre was followed by a period of harsh repression, in time the Chinese nation moved in the direction of greater personal and economic freedom. So, the face-saving description of this matter could be that it was a defeat, a punishment, or a victory, hard to say.

Although there was enough modern technology around so almost every American watched this horrible event on television, read about it the next day in their newspapers, or had at least seen several pictures of the scene. Eye-witness news, we call it. There may have been a number of Philadelphians at the scene, but they have not made themselves known in fifteen years, except for the Sundermans. Doctor Sunderman was emeritus professor of Medicine at Thomas Jefferson University, and because of his notable scientific career had been able to visit many Chinese friends in the Chinese medical community. His prolonged tour in 1989 ended up in Beijing, and he had arranged that he would give a report on his tour when he got back.

It happens that Jefferson has the tradition of a weekly staff meeting at 8 AM. Because of jet lag most travelers have no interest in sleep when they land. So, Dr. Sunderman get in a cab at the airport, and arrived to sit in the front row of the crowded conference room, just as it began. Every person in the room, of course, knew about the Tianenmen massacre, and there was a good deal of interest in hearing from someone who had just got off the plane from there. The medical part of the meeting was shortened a few minutes, and Sunderman was called on to give his impressions of the current state of Chinese medicine.

Everyone in the room knew about the massacre, except Dr. Sunderman. As he began to talk, praising the Chinese for their progress and humanity, and particularly praising the glories of Beijing and its famous Tianenmen Square,it slowly began to dawn on the audience what had happened. In his last day or two in China, the authorities had isolated the foreigners from the news, hustled them aboard airplanes, and kept them away from newspapers. The chairman of the Jefferson meeting was not up to coping with this unanticipated awkwardness, and simply let the speaker run on, increasingly puzzled by inappropriate squirming and muttering of his audience. He was finally thanked, and allowed to leave the room, to find out about the matter however he might.

Victor Rambo, Indian Eye Surgeon Click Title To Read Comments (1)

Rambo

There have been at least twelve documented generations of the Rambo family in Philadelphia. Historical justification can be found for the idea that this was the first family to settle within what are now the city limits. Victor Clough Rambo MD was an unpaid intern at the Pennsylvania Hospital in 1927; you will find his nameplate on the wall.

Victor early made up his mind that he was going to go where he could do the most good. Considerable thought led him to learn how to extract cataracts, and go to India to extract as many as he could. From time to time, he would return to America to visit family, and to give some speeches to raise money for his project.

The builders of our enormously costly hospital castles might give some thought to the fact that Victor did most of his surgery in tents. His system was to send out teams to the next two villages, wherever he was, with the news, "Bring in your blind people, the eye doctor is coming." When he then arrived, he set about operating on cataracts from dawn to dusk, in a country where the supply of cataracts was essentially unlimited. There was no time to operate on the comparatively minor visual disturbances so commonly treated in America today; he had to concentrate on people who were really blind, and in both eyes.

He wrote a book about his experiences, Apostle of Sight: The Story of Victor Rambo, Surgeon to India's Blind" and perhaps there you could find the data to calculate the number of people who were restored to a useful existence by his efforts. Surely, it was thousands. He just kept going at it, and when he died he was a very old man.

A Toast To J. William White, MD Click Title To Read Comments (1)

JWilliam White left a legacy to the Franklin Inn, the income from which was to pay for an annual dinner, with all the trimmings. Good as its word, the Inn holds the J. William White dinner every year on Benjamin Franklin's birthday, although inflation and fluctuations of the stock market require it to make a modest charge for attendance. White also created the J. William White Professorship in Surgery at the University of Pennsylvania, a chair which was once occupied by Jonathan Rhoads.

William J White MD

These trust-fund memorials do little to convey the wild and glamorous image of Bill White. White was a member of the First City Troop, and fought the last known honest-to-goodness duel on Philadelphia's field of honor (the center of Rittenhouse Square). The right and wrong of the argument are in dispute, but the details boiled down to White at the critical moment raising his gun to the sky and firing at the stars. That it was not a meaningless gesture was then brought out by his opponent taking slow and deadly aim -- but missing him.

White was an academic in the sense that he was the first, unpaid, Professor of Physical Culture at the University of Pennsylvania. Active in the Mask and Wig Club, he was chief surgeon at Philadelphia General Hospital, chief surgeon to the Philadelphia Police, and chief surgeon to the Pennsylvania Rail Road. He was Chairman of the Fairmount Park Commission, and numerous other positions where political contact was more important than surgical skill. When World War I came along, he was off to France with the University of Pennsylvania Hospital Unit, writing two books with Theodore Roosevelt. Although his friendship with Henry James suggests greater literary talent, Roosevelt published more than thirty books. What emerges from the history of Bill White is flamboyance and lots and lots of unfettered energy. He might feel a little out of place at one of his endowed dinners today, but he was probably always a little out of place in any company -- and didn't care a whit.

A Toast To Silas Weir Mitchell, MD Click Title To Read Comments (1)

Silas Weir Mitchell

Silas Weir Mitchell lived to be an old man during the Nineteenth Century, when it was unusual to get very old. He was an important part of both the Philadelphia medical scene, and the literary one. He became known as the Father of American Neurology as a published studies of nerve injuries caused by the Civil War. He published about 150 scientific papers, including famous investigations of the neurological effects of rattlesnake venom. His most famous medical treatment was the "rest cure" for hysteria, while his most enduring scientific discovery was the phenomenon of causalgia. He despised Freud, and psychonanalysis. No doubt the feeling was mutual, but the passage of time has tended to favor Mitchell more than Freud. The central role of sex is the essence of Freud's viewpoint, while Mitchell's is summarized in the remark that, "those who do not know sick women, do not know women."Struggling medical students can take heart from the well-documented fact that Mitchell applied to the Pennsylvania Hospital for an internship, and was rejected. Upset by the experience, he toured Europe for a year and applied again. He was again rejected. He later applied for the faculty at Jefferson, and was rejected, but his reaction to that was one of rage and vengeance. Just what these two episodes out of Philadelphia medical politics really mean, remains to be clarified by Mitchell's biographers.

Franklin Inn

Mitchell's second career was literary, publishing 12 novels and 5 books of poetry. He is honored as the founder of the Franklin Inn Club, for a century home to every important literary figure in Philadelphia. It is striking that he selected Benjamin Franklin as the guiding star of the Inn, since Franklin similarly was eminent in both science and culture, and an ornament to conversation and society. In a pacifist Quaker City, both men approved of combat, and his novel about Hugh Wynne stresses that his hero was a "Free Quaker, meaning one who fought in the Revolution. Because of his strong Republican views, he was never made a professor at the local medical school.

College of Physicians

Mitchell's patient Andrew Carnegie donated the funds to build a new building for the College of Physicians when Mitchell was its President. When Mitchell was president of the Franklin Inn, Carnegie wrote him, asking for suggestions about donating a small sum, say five or ten million, and asking where it should go. That was the Inn's big chance, all right, but somehow it failed the test. Mitchell suggested that the money be given to raise the salaries of college professors, thus perhaps suggesting that this veteran of many academic revolts did eventually soften his views.

Old Blockley (P.G.H.) Click Title To Read Comments (1)

Blockley

For a long time, the Philadelphia General Hospital was the largest hospital in town, even growing briefly to seven thousand patients during the Civil War, but leveling off at about three thousand at the beginning of the Twentieth Century. There were 26,000 hospital beds set up in Philadelphia during the Civil War, and it is estimated that over 150,000 war casualties were treated in various Philadelphia hospitals. At the end of World War II PGH had shrunk to about 1500 beds, but it was Medicare and Medicaid in 1965 which finally did it in. By 1977 it was costing the City of Philadelphia about five million dollars a year beyond its revenues to run the place with only 300 patients, while the running expenses of the local private hospitals were actually less per patient because of maintaining 18 acres of largely unused capacity. Titles XVIII and XVIII of the Social Security act constituted Lyndon Johnson's Great Society, and in effect they made every patient at PGH resemble a walking government check in the mind of hospital administrators. The local hospital association made the argument to then Mayor Rizzo that everybody would be better off if the hospital closed and those government checks were directed to the local voluntary institutions. After a few years, the federal government inevitably squeezed the generosity out of the entitlement programs, and the voluntary hospitals saw they had made a bargain they would like to abandon. But that's the way it goes. PGH is gone and it isn't coming back. The eighteen acres in Blockley Township, now West Philadelphia, were given to the Bellevue in New York, Charity in New Orleans, or Cook County Hospital in Chicago. Of these hospitals, PGH had surely been the best, and at the turn of the Twentieth Century a Mayor's Commission issued a report on the place which began, "Philadelphia can surely be proud...." Having worked in Bellevue and having visited most of the rest, I can testify that was likely true. When PGH was finally torn down, the walls and floors had such substantial construction that changing the wiring and plumbing had become almost impossible. The PGH nurses were famous for running. Although the alcoholic and drug addicted patients might be called the dregs of society, the alacrity of the student nurses in running them bedpans or answering other calls, was spectacular to watch. When a doctor came on the floor, they jumped to their feet, and were usually ready with the patient's chart, unasked. Unlike Bellevue, where new equipment was occasionally bought but never maintained, and where the floors were creaky and wooden, the open wards were spacious, clean, and equipped. At Bellevue the forty bed wards were crowded with sixty or seventy patients, so close together you could almost roll from one end of the room to the other without touching the floor. I can remember seeing one seventeen year-old Bellevue student nurse tending such a ward at night alone, the Internet sharpening needles, and the medical resident developing electrocardiograms in the darkroom. None of this would have seemed acceptable at PGH.

William Osler

Old Blockley was the place where modern systems of medical education originated. Up until William Osler came to Philadelphia, medical education mostly consisted of attending eight hours of lectures a day. Osler had an electrifying personality, and wandered among the sick at PGH with a train of students following him. He is much quoted, and once suggested his obituary ought to read, Here lies the man who took the students into the wards. A somewhat more elegant statement of the value of practical experience was included in his dedication speech at the Boston Library:To treat patients without books is to sail an uncharted sea. To read books without seeing patients is never to go to sea at all. Osler was somewhat under-appreciated in Philadelphia, and went on to found the medical school at Johns Hopkins in Baltimore. Nevertheless, the main reason he later left Johns Hopkins for a professorship at Oxford was his disillusionment with the idea of salaried practice of medicine, which he felt severed the responsiveness of a doctor to his patients' wishes. When asked about it, he passed his departure off as having other causes.

The disappearance of old Blockley now ends a controversy, even something of a mystery, about just which one was the oldest hospital in America, PGH or The Pennsylvania Hospital. There had been an infirmary in the Old almshouse at Eleventh Street, and there is no doubt the almshouse was there first. PGH grew out of the almshouse. However, there were many comments at the time of the founding of the Pennsylvania Hospital that it was now the first; that's a strange thing to say when the almshouse was three blocks away. Social historians need to look into the mindset of colonial America, which seems to have included a distinction between the worthy poor and the unworthy poor. Somehow, the founding principle of the Pennsylvania Hospital was to get people back to work who were capable of productive work, possibly even paying for itself in that way. In their minds, just giving solace and help to those who were down and out was not quite the same thing.

The First and Oldest Hospital in America Click Title To Read Comments (1)

Pennsylvania Hospital

There is a painting of the region around 8th and Spruce Streets in the 1750s, depicting a pasture, with cows, and three or four buildings between 8th and 13th Streets. When the Pennsylvania Hospital moved there in 1755 from its temporary location in a house located a block from Independence Hall, there were complaints that it was now located so far out in the woods that it was difficult and dangerous to go there. Still another description of the area is evoked by the provision which the Penn family placed in the deed of gift of the land, strictly forbidding the use of the land as a tannery. Tanneries have always been notorious for giving off noxious odors, so most people wanted them to be somewhere else, anywhere else. In any event, the main activity of Penn's "green country town" at that time was concentrated closer to the Delaware River, and the nation's first hospital was definitely placed in the outskirts. Two blocks further West the almshouse was already in place, but not much else. We are told that Benjamin Franklin had flown his Famous Kite at 9th and Chestnut, using a barn there to store his materials. It might be recalled that the population of Philadelphia, although the second largest English-speaking city in the world, was only about twenty-five thousand inhabitants at the time of the Revolution, and in 1751 was even smaller.

In any event, the first and oldest hospital in America was built on 8th Street between Spruce and Pine, and the Eighteenth Century buildings on Pine Street still present a breathtaking view at any season, but particularly in May when the azaleas are in bloom, and fragrance from the flowering magnolias fills the evening atmosphere for blocks around. Although some people today mistake the Pennsylvania Hospital for a state hospital, it was founded in the reign of George II, decades before there was such a thing as a State of Pennsylvania. The Cornerstone was laid by Benjamin Franklin, with full Masonic rites. Most doctors regard a hospital as a mere workshop, but the affection with which many Pennsylvania physicians regarded their special hospital is indicated by the number who have requested that their ashes be buried in the garden.

For two hundred years, beginning with the first American resident physician Jacob Ehrenzeller, the interns and residents were paid no salary, so they had to live on the grounds. An Interne was just that, interned within the four walls for at least two years. Because the resident physicians had no money, they stayed in the hospital at night and on weekends, playing cards and swapping stories. The hospital was home for them, as it was for the student nurses, likewise unpaid but more strictly confined and supervised. This penury seemed acceptable because the patients were mostly charity ward patients, otherwise unable to pay for their own care. Ehrenzeller finished his medical apprenticeship and went to practice for many decades in the farm country of Chester County, but gradually upper-class Philadelphia moved from 4th Street westward to and beyond the hospital, and two of the richest men in American history, Morris and Biddle, had houses within a block of the hospital, although Morris never lived in his house, having more pressing matters in debtor's prison. Therefore, later resident physicians at the hospital had the potential of setting up private practice in the area and becoming society doctors as well as academically prominent ones. Being a charity hospital in a rich neighborhood created the potential for volunteer work by the town aristocrats, and large bequests for charity. The British housed their wounded in the hospital during the Revolutionary War, and shot deserters against the red brick wall of the small cemetery to the north. A century later, there were a couple dozen rooms for private patients in the hospital for the convenience of the doctors and the neighbors, but everyone else was a charity patient. And a century after that, the hospital still did not have an accounting department to collect bills, and tended to regard people who asked for a bill as a nuisance. Benjamin Franklin is regarded as the Founder of the hospital, and his autobiography famously describes how he fast-talked the legislature into matching the donations of the public, not mentioning to them that he had already collected enough promises to see the project through. This seems in character; Franklin's biographer Edmond Morgan summed up that,"Franklin doesn't tell us everything, but what he does tell us, is straight." The idea for the hospital was that of Dr. Thomas Bond, whose house is now a bed and breakfast on Second Street, , but it was characteristic of Franklin to be the secretary of the first board of managers of the hospital. In Quaker tradition, the clerk of a meeting is the person who really runs the show. It thus comes about that the minutes of the founding board were recorded in Franklin's own handwriting, among them the purpose of the institution, which is to care for the Sick Poor, and if there is room, for Those Who can pay. This tradition and this method of operation continued until the advent in 1965 of Medicare, when charity care was displaced by concepts which the nation had decided were better. The Pennsylvania Hospital was not only the first hospital, but for many decades it was the only hospital in America. Its traditions, sometimes quaint and sometimes glorious, cast a long shadow on American medicine.

Dinner With Hoffa Click Title To Read Comments (1)

Hoffa

Although she lived for more than twenty more years, in 1975 my mother was eighty years old. Nevertheless, she did not display the slightest surprise, or hesitation in answering, "Sure", when asked if she would like to have dinner with Jimmy Hoffa. One of her constant pleasures was to be doing things that other women couldn't match.

Jimmy Hoffa

The Philadelphia County Medical Society's Center City branch was having a dinner, and the program chairman had the main goal in life of attracting speakers who would bring an overflow audience. Jimmy Hoffa, the former president of the Teamsters Union, recently released from prison, certainly filled that description; one of the members of the branch had a patient who was a teamster official who happened to know that Jimmy would love to speak to the doctors about medical care in prisons. Not only was he willing, he paid his own expenses to fly up from Florida to give the speech. As by far the oldest lady present, my mother was not to be denied when she demanded to be seated at the head table.

disappeared, and there have been hundreds of books and articles written about his probable murder by the Mafia, the latest of which is called I Heard You Paint Houses, in which one Frank Sheeran is quoted as claiming to have been the hit man. I wouldn't know. The title, however, is reliably known to refer to all the blood which is found splattered about, following a mob rub-out.

The reawakening of this topic does raise some old questions of the highest rank. Reviewing the evidence, it is possible to believe he was not guilty of precisely what Bobby Kennedy was accusing him of. At least, the prosecution failed to convince one jury of it. The FBI records do seem to indicate that J. Edgar Hoover offered him evidence of the questionable Kennedy private lives, which he refused to use. And there seems to be little doubt that he worked hard to elect Richard Nixon, or that Nixon later commuted his sentence. Generally speaking, he was on the side of opposition to Mafia influence in the Teamsters Union. But his relationship to the Kennedy family is quite another matter.

Philadelphia in 1976: Legionaire's Disease Click Title To Read Comments (1)

The Yellow Fever

No other city in America is remembered for an epidemic; Philadelphia is remembered for two of them. The Yellow Fever epidemic, for one, that finished any Philadelphia's hopes for a re-run as the nation's capital. And Legionnaire's Disease, that ruined the 1976 bicentennial celebration. One is a virus disease spread by mosquitoes, the other a bacterial disease spread by water cooled air conditioners. Neither epidemic was the worst in the world of its kind, neither disease is particularly characteristic of Philadelphia. Both of them particularly affected groups of people who were guests of the city at the time; French refugees from Haiti and attendees at an American Legion convention.

In 1976, dozens of conventions and national celebrations were scheduled to take place in Philadelphia as part of a hoped-for repeat of the hugely successful centennial of a century earlier. Suddenly, an epidemic of respiratory disease of unknown cause struck 231 people within a short time, and 34 of them died. Every known antibiotic was tried, mostly unsuccessfully, although erythromycin seemed to help somewhat. The victims were predominantly male, members of the American Legion of a certain age, somewhat inclined to drink excessively, and staying in the Bellevue Stratford Hotel, one of the last of the grand hotels. Within weeks, it was identified that a new bacterium was evidently the source of the disease, and it was named Legionella Pneumophila. Pneumophila means "love of the lungs" just as Philadelphia means "city of brotherly love", but still that foreign name seemed to imply that someone was trying to hang it on us. Eventually, the epidemic went away, but so did all of those out-of-town visitors. The bicentennial was an entertainment flop and a financial disaster.

Since that time, we have learned a little. A blood test was devised, which detected signs of previous Legionella infection. One third of the residents of Australia who were systematically tested were found to have evidence of previous Legionella infection. A far worse epidemic apparently occurred in the Netherlands, at the flower exhibition. Lots of smaller outbreaks in other cities were eventually recognized and reported. It becomes clear that Legionnaire's disease has been around for a very long time, but because the bacteria are "fastidious", growing poorly on the usual culture media, had been unrecognized. And, although the bacteria were fastidious, they were found in great abundance in the water-cooled air conditioning pipes of the Bellevue Stratford Hotel. Even though the air conditioning was promptly replaced, everybody avoided the hotel and it went bankrupt. When it reopened, 560 rooms had shrunk to 170, and it still struggled. Although there is little question that lots of other water-cooled air conditioning systems were quietly ripped out and replaced, all over the world, the image remains that it was the Bellevue, not its type of plumbing, that was a haunted house. There is even a website devoted to its hauntedness.

Discipline for the Disciple Click Title To Read Comments (1)

I.S.Ravdin was President Eisenhower's surgeon; Chick Koop was President Reagan's Surgeon General. Both of them were overshadowed by Jonathan Rhoads. Even in a physical sense, this was true. Rhoads was a foot taller than almost anyone. Big bones, too.

During the Second World War, Ravdin led almost every doctor in the University of Pennsylvania off to some military hospital unit or other, and in fact the 900 bed hospital in Philadelphia was left with only two surgeons, Koop and Rhoads, ineligible for military service because of previous tuberculosis. Koop was a first year resident in training, so for practical purposes Rhoads was the only surgeon. Even after eliminating purely elective or optional surgery, the work load was staggering, and the number of operations was prodigious.

Rhoads devised a system. The young trainee, Koop, would do the time-consuming work of opening the belly wall and Rhoads would then do the internal surgery, following which Koop would close the wound while Rhoads was operating on another patient. As Koop told the story at Rhoads' 90th birthday celebration, one day a patient was to have his gall bladder removed. Rhoads told him to open the wound, first the skin, then the fascial layer, then the peritoneum, while he was finishing up with another patient in another room. At that point, Rhoads felt he would be able to come in and remove the gall bladder. Most gall blabbers are firmly attached to the nearby liver, and must be shaved loose before it is possible to put a clamp around the base to remove them.

On this day, two things were different. Rhoads was delayed in the other room because of some complication, and Koop was just standing around waiting. The other thing that was different was that this particular gall bladder was not attached to the liver at all, but was just flopping around in the belly. When Rhoads continued to be delayed, Koop just went ahead and clipped off the gall bladder; more time elapsed. So he carefully sewed up the peritoneal layer, then the fascial layer, then the skin, stitch by stitch. He was standing there pretty pleased with himself when the doors finally banged open and Rhoads came charging into the operating room.

Koop offered some explanation in a faltering way, but Rhoads did not say a word. A large elbow on a huge arm silently but forcefully brushed Koop off to one side in a single movement. Rhoads then took out each stitch in the skin, then the stitches in the fascia, then the stitches in the peritoneum. He peered into the cavity, inspected the former bed of the gall bladder. Finding things in good order, he then resutured the peritoneum, then the fascia, then the skin. Without a word, he then strode from the room, leaving the future Surgeon General never to forget the lesson he had been taught.

Nobel Prize: Michael Brown, MD Click Title To Read Comments (1)

Michael Brown

The College of Physicians of Philadelphia annually sponsors a lecture by a winner of the Nobel Prize in Medicine or Physiology. There is never any question of the high quality of the lecture, but it does add an element of local pride whenever the Nobel Laureate comes from Philadelphia, as he did this year. Michael S. Brown, MD graduated from Cheltenham high school in 1958, received a B.A. from the University of Pennsylvania in 1962, and his M.D. degree in 1966. Nineteen years later, he was awarded the Nobel Prize in Medicine for his work in describing the cholesterol pathways, and the human defects in it which lead to heart attacks, strokes and other consequences of atherosclerosis. Almost immediately, Japanese investigators found the so-called stain drugs being produced by relatives of the penicillin mold for no particularly obvious purpose. The patents have not yet expired on most of these drugs, but many millions of people have already been spared death or disability from hardening of the arteries, the commonest killer in modern life.

The speaker, now a gastroenterologist practicing in Texas, chose to organize his talk around the manner in which biochemical discoveries are currently being made. Physicians in medical research endure news media presentations, usually in silence, of scientific research performed by basic scientists with PhD degrees, with physicians then merely dispensing the drugs. It sometimes happens that way, but in general the basic scientist is too highly focused on the techniques of the scientific cutting edge to be well positioned to see the direction that should be taken next. The physician scientist, on the other hand, is aching to find a solution to current problems, but often lacks the necessary technical skills to perform the experiment. James Shannon, one of the early directors of the National Institutes of Health, recognized this mutual deficiency was impairing progress and set about establishing training programs for cross-fertilization between the scientific approaches. Dr. Brown was one of the early trainees of that program, and now describes its glories, going from the patient bedside to the scientific laboratory bench, and then back to bedside to test the results. Competition has morphed into collaboration.

Some day, someone will conduct a study of Nobel Laureates, seeking out the traits which characterize them. The next step after that would probably be cloning them, although public opinion will first have to catch up with that thought. From an observers point of view, they all seem gifted with the ability to give a logical, entertaining and succinct description of a complicated matter. Almost all of them are located in very large research environments, where news of small scientific discoveries in obscure scientific journals is quickly picked up by a hundred eyeballs, filtered for the benefit of the local enthusiast of the topic, and fitted together with something that enthusiast has discovered but not published, or published too recently to be well known. Research is not just expert marksmanship, it is marksmanship within a boiling cauldron of undigested facts. One other thing about Nobel Laureates: as a group, they tend to drive over the speed limit, even when going to the local supermarket.

Anyway, it's real nice to take the statin drug and watch your cholesterol go down, secure in the knowledge that invisibly your longevity is improved. There's just nothing more attractive than having more longevity. At least, it's hard to imagine what could replace it in attractiveness.

Goat Head Merchant Click Title To Read Comments (1)

Bellvue Hospital

In 1948, one of the Internet physicians at Bellevue Hospital contracted tuberculosis. The senior medical students at Columbia were asked to volunteer to take his place, and for a month I did so. Since I knew I was soon going to Philadelphia to Internet at the Pennsylvania Hospital, my interest was particularly taken by an old Bowery bum who was talking about untaxed liquor. In New York at that time, it was common for Skid Row denizens to drink the wood alcohol in Sterno, called "squeeze" because it could be extracted from the waxy contents of a Sterno can by wrapping it in cheesecloth or a handkerchief and squeezing out the juice. Another favorite was "Smoke", which was typically a mixture of automobile radiator fluid and other sundry handy ingredients. My new best friend at Bellevue was just recovering from the effects of such recreation, and was in a mood of "never again". He observed that "When I get out of the Bell View, I'm going to get on a bus and go down to Philly. They've got a drink there called Goat Head, and, man, is it ever smooth."

Pine Barrens

The Chief Resident of the Pennsylvania Hospital was happy to tell me what Goat Head was. It was bootleg liquor, made in the Pine Barrens of New Jersey. Bags of cane sugar were fermented and distilled through coils of copper tubing, obtained from old hot-water heaters. The smooth stuff that so intrigued the bums of Bellevue was what was otherwise known as "White Lightning". It was then sold in the alleys near South Street by "Goat Head Merchants", who carried a suitcase full of small bottles, sold for about 25 cents a bottle. They say that during the Depression, Goat Head was sold out of an open bucket, at 10 cents a dipperful. One of the Goat Head Merchants used the Accident Room of the hospital as his family doctor, let us call him Walter Apple.

One day, Walter had a heart attack and was brought in on a stretcher, in considerable pain. I had just completed an electrocardiogram on him, when the pain disappeared. A few weeks later, he had completely recovered, and was going home. Every time I came anywhere near him, he announced to everyone in the vicinity that I was the best doctor in the world, having cured his heart attack by giving him the "wire treatment".

As he gathered up his belongings to go home, he apologized that he was not going to be able to pay his bill. He had once known Dillinger and all those other big shots, wore a diamond stick-pin, and drove a Dusenberg car. But now he was broke.

But grateful, too. So, if ever there came a time when I encountered someone unpleasant, who needed "pushing' around" -- just you call on Walter Apple, and Walter would be glad to pay off his debt.

College of Physicians of Philadelphia Click Title To Read Comments (1)

College of Physicians of Philadelphia

The College of Physicians of Philadelphia is the oldest medical organization in America, or even the Western Hemisphere, having been founded in 1787, the year of the Constitutional Convention. The CPP, located on 22nd Street near Market, is not to be confused with the American College of Physicians (a much more recent organization, formed in 1923 and located at Fifth and Arch Streets). The term "Physician" was then much more specific, and Philip Syng Physick, now known as the father of American Surgery was not considered eligible for membership because he was a surgeon, not a physician.

The general idea of the founding of the College seems to have been to focus on the physicians who had attended medical school (usually in Edinburgh), as distinguished from the general run of physician at the time, who had merely served an apprenticeship. The first medical school, at the University of Pennsylvania (then at Ninth and Walnut Streets, but now at 36th and Spruce) caused the College of Physicians to turn away from pedagogy to the direction of setting standards and providing a forum for the "better sort" of the profession to be self-governing. At one point, there was even a real possibility that the College of Physicians of Philadelphia would become the credentialing agency for the whole country, but licensing took the direction of state boards during the Nineteenth Century. Every book and journal must have a Library of Congress number. The Transactions of the College of Physicians of Philadelphia has a Library of Congress number, all right. Number one. Jonathan Rhoads, the giant of 20th Century surgery and the only person to be president of the College twice, once remarked that being first may not be terribly important in the greater scheme of things, but -- it's awfully hard to imitate.

The College was a very strong guiding force in the development of a system of medical ethics for the profession. A curious false turn was taken in the direction of Lambda Chi, a secret society of physicians for the purpose of invisibly policing medical conduct, but the College soon recognized this was the wrong direction to take, and eventually it assumed the lead in forming the American Medical Association in 1848. The portrait of Chapman, the first President of the AMA, hangs above the mantle in the fellows' reception room, the original minutes and rolls of the delegates are found in the library. Half a dozen presidents of the College were also presidents of the AMA, but for some curious reason the College never became the local branch of the AMA, reserving that for the State and Pennsylvania County Medical Societies.

Mutter Museum

Every year a number of the most distinguished physicians in the world address the College, and an annual lecture by a Nobel Prize winner has been established. The College had the largest medical library in the country until recently, and it is still one of the largest. The present building is a Carnegie Library, in a sense. Andrew Carnegie was a patient of S. Weir Mitchell at the time Mitchell was president of the College, and donated a large sum for a new building. The present elegant marble and walnut paneled structure was built in 1905, fairly recent by Philadelphia standards but nevertheless a national landmark.

With all this dignity, history and tradition, it likely comes as a surprise to learn that the College building has sixty thousand paid visitors each year. The source of this popularity is a combination of medical exhibits for the public, and the Mutter Museum. In the late Nineteenth Century Thomas Dent Mutter gave his large personal collection of anatomical specimens to the College for a museum in the style of the medieval European medical schools, where the students could learn from specimens on display because anatomical dissection was discouraged if not forbidden, and Kodachrome slides had not been invented. Mutter's collection is a combination of believe-it-or-not "freaks", anthropological studies of human variations, and a museum of medical history. The former curator, Gretchen Worden, has produced an illustrated book of the exhibits which quickly sold out and must be reprinted, and a yearly illustrated calendar which is quite popular. The doctors are a little bemused by the popularity of this material with the public, but tolerant.

Among the odd features of this collection is the brain of Sir William Osler, the giant of modern medical education. Osler belonged to a club of people who had such a high opinion of their own genius they pledged to donate their brains after death to the collection of specimens, in the hope that eventually science would be able to determine the anatomical source of their talents. Most people today are a little staggered at the arrogance of such an idea, so widely at variance with the concept that all men are created equal. Albert Einstein is another acknowledged genius whose brain is still floating in a pickle jar, waiting for its unique properties to be discerned. Presumably, time will eventually tell whether even the greatest intellects suffer from unconquerable hubris, or whether the envious rest of us must adapt to the consensus of political correctness, just to avoid facing the reality of our own inferiority.

Getaway Click Title To Read Comments (1)

Philadelphia General Hospital

Occasionally prisoners must be taken to the hospital, and that's a problem for the authorities. Philadelphia General Hospital had a special prison unit on the grounds, so the problem for the guards was merely to transport the prisoner to the locked hospital ward and bring him "home" after his medical problems were fixed. The State of Delaware doesn't have a prison unit in any hospital, so the security risk must be addressed by sending at least two guards, night and day, to some hospital, and securely manacle the prisoner to the bedstead. Nobody likes this situation, particularly the head nurses, but no one has a better solution to offer.

When a prisoner has to make an outpatient trip for an x-ray or similar, there is an iron rule: no one is to know about it in advance. In one particular case, however, a convicted Delaware murderer had to have an x-ray of his gallbladder, which in those days required giving him some large pills the night before. That was the tip-off.

On the specified morning, he was bundled into a patrol car with manacles and guards, and whisked off to the Delaware Hospital, now the Delaware Division of the Wilmington Medical Center. The x-ray department was at the end of a long corridor, with the diabetic clinic on the right and the bathrooms on the left side of that corridor. The entrance was on the side of this corridor, right next to the office for visiting consultants. Things were busy but peaceful that morning, when commotion arose. Three prison guards came marching through the door, surrounding their manacled prisoner. They turned left, and down the long hall to the x-ray department.

As they passed the men's room, the prisoner begged his guards to let him relieve himself, so they took him into the bathroom, removing the handcuffs. He washed his hands, dried them with a paper towel, pushed it into the waste container. Then quick as a flash he thrust his hand deeper into the crumpled waste paper, got the loaded revolver his accomplices had put there, and emerged from the waste basket -- shooting. The guards got down on the floor, a bullet went into the Diabetic Clinic where a very prominent society lady was working in a pink volunteer's uniform, and another bullet went into the consultants' office, which on other days I might have been using. The escapee was running hard, fired one final bullet into the ceiling at the door, and was out in a second to the waiting getaway car where his buddies were ready. He got away clean, as they say.

There's nothing like an episode of that sort to bring people together. We were survivors of an exhilarating experience, having something in common that no one could take away. For a couple of years afterwords, the bullet hole remained unobtrusively in the ceiling by the entrance. The nurses told me that workmen had arrived several times to patch it up, and the society lady, who was a trustee of the hospital, wouldn't let them fix it. That was our bullet hole.

Contemporary Germantown Click Title To Read Comments (1)

The Strittmatter Award is the most prestigious honor given by the Philadelphia County Medical Society, and is named after a famous and revered physician who was President of the society in the 1920s. There is usually a dinner given before the award ceremony, where all of the prior recipients of the award show up to welcome to this year's new honoree.

Bockus

This is the reason that Henry Bockus and Jonathan Rhoads were sitting at the same table, some time around 1975. Bockus had written a famous multi-volume textbook of gastroenterology which had an unusually long run because it was published before World War II and had no competition during the War or for several years afterward; to a generation of physicians, his name was almost synonymous with gastro-enterology. In addition, he was a gifted speaker, quite capable of keeping an audience on the edge of their chairs, even though after the speech it might be difficult to recall just what he had said. On this particular evening, the silver-haired oracle might have been just a wee bit tipsy.

Jonathan Rhoads had likewise written a textbook, about Surgery, and had similarly been president of dozens of national and international surgical societies. He devised a technique of feeding patients intravenously which has been the standard for many decades, and in his spare time had been a member of the Philadelphia School Board, a dominant trustee of Bryn Mawr and Haverford Colleges, and the provost of the University of Pennsylvania. Not the medical school, the whole university, and is said to have been one of the best provost of the University of Pennsylvania ever had. When he was President of of the American Philosophical Society, he engineered its endowment from three million to ten times that amount. For all these accomplishments, he was a man of few words, unusual courtesy -- and a huge appetite in keeping with his rather huge farmboy physical stature. On the evening in question, he was busy shovelling food.

"Hey, Rhoads, wherrseriland?". Jonathan's eyes rose to the questioner, but he kept his head bowed over his plate.

"HeyRhoads, werssiland?" The surgeon put down his fork and asked,"What are you talking about?"

"Well," said Bockus, "Every famous surgeon I know, has a house on an island, somewhere. Where's your island?

"Germantown," replied Rhoads, and returned attention to his dinner.

Kenneth Gordon, MD, Hero of Valley Forge Click Title To Read Comments (1)

Valley Forge

There's no statue of Ken Gordon at Valley Forge National Park, although it would be appropriate. No building is named after him; it's probable he isn't even eligible to be buried there. But there would be no park to visit at Valley Forge without his strenuous exertions.

Kenneth Gordon M.D.

One day, Ken's seventh grade daughter came home from school with the news that the father of one of her classmates said that Valley Forge Park was going to be turned into a high-rise development. That's known as hearsay, and lots of things you hear in seventh grade are best ignored. But this happened to be substantially true. At that time, the Park was owned by the Commonwealth of Pennsylvania, and Governor Shapp was finding the upkeep on the Park was an expense he needed to reduce. The historic area had two components, the headquarters area, and the encampment area. One part would become high-rise development and the other would become a Veteran's Administration cemetery. Although any form of rezoning has the familiar sound of politics to it, Dr. Gordon (a child psychiatrist) had the impression that Shapp was mostly interested in reducing state expenses, and had no particular objection to some better use of the historic area. At any rate, when Gordon went to see him, he said that he would agree to a historic park if Gordon could raise the money somehow. The Federal Government seemed a likely place to start.

Governor Milton Shapp

Well, the sympathetic civil servants at the National Park Service told him how it was going to be. You get the consent of the local Congressman (Dick Shulze) and it will happen. If you don't get his consent, it won't happen. It seemed a simple thing to visit that Congressman, persuade him of the value of the idea, and it would be all done; who could refuse? After the manner of politicians, Schulze never did refuse, but somehow never got around to agreeing, either. It takes a little time to learn the political game, but after a reasonable time the National Park employees told Gordon he was licked. Too bad, give up.

He didn't give up, he went to see his Senators, at that time Scott and Clark. They instantly thought it was a splendid idea, and instead of going pleasantly limp, they sent Citizen Gordon over to see Senator Johnson of Louisiana, the chairman of a relevant committee. Johnson also thought it was a great idea, and called out, "Get me a bill writer!" A bill writer is usually a government lawyer, tasked with listening to some citizen's idea and translating it into that strange language of laws -- section 8(34), sub-chapter X is hereby changed to, et cetera. Bill writers have to be pretty good at it, or otherwise they will misunderstand the intent of the original idea, modified by the personal spin of the committee chairman, the comments of the authorizing committee, and later bargains struck in the House-Senate conference committee. Having negotiated all those hurdles, a bill has to be written in such a prescribed manner that it won't be found to have multiple loopholes when it later reaches the courts in a dispute. A good deal of the time of our courts is taken up with making sense of some careless wording by bill writers. That's what is known as the "Intent of Congress", an ingredient that may or may not survive the whole process.

Dick Schulze

Ken Gordon had to go through this process, including testimony at hearings, for three separate congressional committees. To get everybody's attention, he organized several hundred supporters to write letters and get petitions signed by several thousand voters. These supporters in turn influenced the media, and started a lot of what is known as buzz. All of this is an awful lot of work, but there is one thing about this case that can make us all proud. Not once did a politician suggest a campaign contribution was essential in this matter.

In time, ownership of the Park did in fact migrate from the Commonwealth to the U.S. Department of the Interior, hence to the National Parks Service. Everyone agrees it has been well managed, and increasing droves of visitors come there every year. It is now clearly a national treasure. Unfortunately, the encampment area got away, and has been commercially developed, although not nearly as high-rise as originally contemplated. Along the way, many discouraging words were spoken about the futility of fighting against such odds. The outcome, however, is the embodiment of two slogans, the first by Ronald Reagan. "It's amazing what can be accomplished, if you don't care who gets the credit for it." The other slogan is older, and Quaker. All you need, to accomplish anything, is leadership. And leadership -- is one person.

One day Ken Gordon, the very busy doctor, was asked how much of his time was taken by this effort. His answer was, ten hours a week, every week for five years.

Dr. Cadwalader's Hat Click Title To Read Comments (1)

Dr. Thomas Cadwalader

The early Quakers disapproved of displaying your own picture, even refusing to have their names on their tombstones. Consequently, relatively few portraits of early Quakers can be found, and it is therefore surprising to see a picture of Dr. Thomas Cadwalader hanging on the wall at the Pennsylvania Hospital. A plaque relates that it was donated by a descendant in 1895. Dr. Cadwalader is still famous for his unvarying courtesy.

Pennsylvania Hospital

In one of the editions of