The musings of a physician who served the community for over six decades
367 Topics
Downtown A discussion about downtown area in Philadelphia and connections from today with its historical past.
West of Broad A collection of articles about the area west of Broad Street, Philadelphia, Pennsylvania.
Delaware (State of) Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Religious Philadelphia William Penn wanted a colony with religious freedom. A considerable number, if not the majority, of American religious denominations were founded in this city. The main misconception about religious Philadelphia is that it is Quaker-dominated. But the broader misconception is that it is not Quaker-dominated.
Particular Sights to See:Center City Taxi drivers tell tourists that Center City is a "shining city on a hill". During the Industrial Era, the city almost urbanized out to the county line, and then retreated. Right now, the urban center is surrounded by a semi-deserted ring of former factories.
Philadelphia's Middle Urban Ring Philadelphia grew rapidly for seventy years after the Civil War, then gradually lost population. Skyscrapers drain population upwards, suburbs beckon outwards. The result: a ring around center city, mixed prosperous and dilapidated. Future in doubt.
Historical Motor Excursion North of Philadelphia The narrow waist of New Jersey was the upper border of William Penn's vast land holdings, and the outer edge of Quaker influence. In 1776-77, Lord Howe made this strip the main highway of his attempt to subjugate the Colonies.
Land Tour Around Delaware Bay Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Tourist Trips Around Philadelphia and the Quaker Colonies The states of Pennsylvania, Delaware, and southern New Jersey all belonged to William Penn the Quaker. He was the largest private landholder in American history. Using explicit directions, comprehensive touring of the Quaker Colonies takes seven full days. Local residents would need a couple dozen one-day trips to get up to speed.
Touring Philadelphia's Western Regions Philadelpia County had two hundred farms in 1950, but is now thickly settled in all directions. Western regions along the Schuylkill are still spread out somewhat; with many historic estates.
Up the King's High Way New Jersey has a narrow waistline, with New York harbor at one end, and Delaware Bay on the other. Traffic and history travelled the Kings Highway along this path between New York and Philadelphia.
Arch Street: from Sixth to Second When the large meeting house at Fourth and Arch was built, many Quakers moved their houses to the area. At that time, "North of Market" implied the Quaker region of town.
Up Market Street to Sixth and Walnut Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
Sixth and Walnut over to Broad and Sansom In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Montgomery and Bucks Counties The Philadelphia metropolitan region has five Pennsylvania counties, four New Jersey counties, one northern county in the state of Delaware. Here are the four Pennsylvania suburban ones.
Northern Overland Escape Path of the Philadelphia Tories 1 of 1 (16) Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
City Hall to Chestnut Hill There are lots of ways to go from City Hall to Chestnut Hill, including the train from Suburban Station, or from 11th and Market. This tour imagines your driving your car out the Ben Franklin Parkway to Kelly Drive, and then up the Wissahickon.
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Philadelphia Revelations
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George R. Fisher, III, M.D.
Obituary
George R. Fisher, III, M.D.
Age: 97 of Philadelphia, formerly of Haddonfield
Dr. George Ross Fisher of Philadelphia died on March 9, 2023, surrounded by his loving family.
Born in 1925 in Erie, Pennsylvania, to two teachers, George and Margaret Fisher, he grew up in Pittsburgh, later attending The Lawrenceville School and Yale University (graduating early because of the war). He was very proud of the fact that he was the only person who ever graduated from Yale with a Bachelor of Science in English Literature. He attended Columbia University’s College of Physicians and Surgeons where he met the love of his life, fellow medical student, and future renowned Philadelphia radiologist Mary Stuart Blakely. While dating, they entertained themselves by dressing up in evening attire and crashing fancy Manhattan weddings. They married in 1950 and were each other’s true loves, mutual admirers, and life partners until Mary Stuart passed away in 2006. A Columbia faculty member wrote of him, “This young man’s personality is way off the beaten track, and cannot be evaluated by the customary methods.”
After training at the Pennsylvania Hospital in Philadelphia where he was Chief Resident in Medicine, and spending a year at the NIH, he opened a practice in Endocrinology on Spruce Street where he practiced for sixty years. He also consulted regularly for the employees of Strawbridge and Clothier as well as the Hospital for the Mentally Retarded at Stockley, Delaware. He was beloved by his patients, his guiding philosophy being the adage, “Listen to your patient – he’s telling you his diagnosis.” His patients also told him their stories which gave him an education in all things Philadelphia, the city he passionately loved and which he went on to chronicle in this online blog. Many of these blogs were adapted into a history-oriented tour book, Philadelphia Revelations: Twenty Tours of the Delaware Valley.
He was a true Renaissance Man, interested in everything and everyone, remembering everything he read or heard in complete detail, and endowed with a penetrating intellect which cut to the heart of whatever was being discussed, whether it be medicine, history, literature, economics, investments, politics, science or even lawn care for his home in Haddonfield, NJ where he and his wife raised their four children. He was an “early adopter.” Memories of his children from the 1960s include being taken to visit his colleagues working on the UNIVAC computer at Penn; the air-mail version of the London Economist on the dining room table; and his work on developing a proprietary medical office software using Fortran. His dedication to patients and to his profession extended to his many years representing Pennsylvania to the American Medical Association.
After retiring from his practice in 2003, he started his pioneering “just-in-time” Ross & Perry publishing company, which printed more than 300 new and reprint titles, ranging from Flight Manual for the SR-71 Blackbird Spy Plane (his best seller!) to Terse Verse, a collection of a hundred mostly humorous haikus. He authored four books. In 2013 at age 88, he ran as a Republican for New Jersey Assemblyman for the 6th district (he lost).
A gregarious extrovert, he loved meeting his fellow Philadelphians well into his nineties at the Shakespeare Society, the Global Interdependence Center, the College of Physicians, the Right Angle Club, the Union League, the Haddonfield 65 Club, and the Franklin Inn. He faithfully attended Quaker Meeting in Haddonfield NJ for over 60 years. Later in life he was fortunate to be joined in his life, travels, and adventures by his dear friend Dr. Janice Gordon.
He passed away peacefully, held in the Light and surrounded by his family as they sang to him and read aloud the love letters that he and his wife penned throughout their courtship. In addition to his children – George, Miriam, Margaret, and Stuart – he leaves his three children-in-law, eight grandchildren, three great-grandchildren, and his younger brother, John.
A memorial service, followed by a reception, will be held at the Friends Meeting in Haddonfield New Jersey on April 1 at one in the afternoon. Memorial contributions may be sent to Haddonfield Friends Meeting, 47 Friends Avenue, Haddonfield, NJ 08033.
The U.S. House of Representatives will soon consider a medical malpractice reform (limiting awards for pain and suffering to $250.000) which it adopted seven times in the last ten years. Following almost certain House passage, the proposal will then confront the Senate,
cartoon malpractice
where it has failed seven times. The politics of the two chambers are not chief concerns of this paper, which strongly advocates passage. The paper contends that unwise incentives for patients to bring suit are important causes of present difficulty, and reducing such incentives offers a comparatively simple opportunity to bring the complex issue to quick stability. Stability is essential before more sweeping changes can be examined. The collection of data in certain areas would reduce the scope for vituperation and ideology, another important step toward a solution. Full recognition must eventually be given to the intertwined complexity of industrial product liability, the McCarran Ferguson Act, hospital and corporate governance in general, the tort system, pass-through of Medicare and Medicaid overhead reimbursement to malpractice premiums, even universal health insurance. Some small step must begin such an interlocked rearrangement, and a cap on pain and suffering has the major advantage of being successfully tested by twenty-five years of experience in California and Indiana.
This paper makes no claim of identifying all the root causes or predicting all the calamitous consequences of inaction. Advocating passage of national laws to reduce plaintiff incentive to sue, it chiefly focuses on the chief arguments historically made against the present proposal, offers some comparatively novel insights in favor, and makes suggestions for collecting data to reduce the latitude for disagreement.
Congress will again take up malpractice tort reform (MICRA) in 2005. perhaps successfully. The 2004 outcome was close. Since the Republicans subsequently made electoral gains in both House and Senate, the leadership is considered likely to re-introduce the same bill and try to hammer it through. The bill's medical essence is to limit awards for "pain and suffering" to $250,000, contrasting strongly with recent escalating awards which have sometimes reached $100 million. Newcomers to the issue may be surprised that so much emphasis gets placed on this point, but thirty years of wrangling experiences in state legislatures have produced this reform alone with proven effectiveness. In the course and semi-jocular language of politics, "nothing helps the malpractice problem unless it involves on
A breezy summary of European geopolitics, including many rough inaccuracies, will probably irritate residents of that region but may help Americans understand the history and composition of the Germantown area of Philadelphia.
The Western World was long defined as a province of Rome, and all roads led there. At the top of the Italian boot can be found the Swiss Alps, forcing Romans to go around through what is now Provence in France. An old jingle defines the river system of Switzerland as " The Rhine, the Rhone, Danube, and Poa rise in the Alps, and away they go!"
So northward-bound Romans, Caesar and all, went West around the Alps up to the Rhone Valley, and eventually came upon the Rhine River flowing north to Rotterdam, just across the English channel from London, or Londinium as they called it. The crossover between the Rhone and the Rhine was at Strassbourg where the European Parliament now meets. For two thousand years, the main highway from Rome to London was the Rhine River.
Essentially, everybody to the West of the Rhine was Roman Catholic, and everybody to the East of the river was Protestant. At least, that was true in the Sixteenth Century. The head of the river in Switzerland was Calvinist Protestant, and the mouth of the river in Holland was Reform Protestant. Along the main part of the river, Alsace, Lorraine, Palatine, Luxembourg, divided East and West but for centuries pieces of land shifted control back and forth. The reformation movement started by Martin Luther ended up as the Thirty Years War, from which the region took another hundred years to recover, and more hundreds of years to forget and forgive. You might call it a religious Mason-Dixon line, remembering of course that the American Civil War was mostly fought on the Potomac, not the Mason Dixon.
Professional soldiers teach Military students that there is no war worse than a religious war. Lots of people, probably thousands, were burned at the stake during the religious wars along the Rhineland. Rape and pillage were common Partee. And so, if you lived in a little farming village in this region, and some Englishman named William Penn came around with an offer to emigrate to his peaceful kingdom in America, it sounded wonderful. Religious toleration was an important part of the attractiveness, and nowhere to be found in Europe.
William Penn's mother was Dutch. It is likely he spoke the local languages. For a number of years he had traveled in the Low Countries and the Rhineland, preaching the ideas of George Fox the Quaker. And then, one day he arrived with a new idea. The King of England had given him a huge stretch of uninhabited land in the New World, no doubt influenced by the idea that Quakers were a nuisance and this was a good way to get rid of them. Whatever. Penn was selling land grants, and he could be trusted. Why not give it a try?
Germantown Before 1730
In 1730, there was a great influx of German peasantry to America, stimulated by the English government giving bounties to ship captains who would help fill the country with settlers. Protestants only, of course, so the ships were forced to land in England on the way, so Catholics on board could be returned to Europe. The majority of these ships landed in Philadelphia, but one group of thirty families did land in New York where they found the Dutch inhabitants had maintained their dislike of those sects from upriver on the Rhine. Both the Calvinists and the Dutch Reformed were interested in religious freedom, but both were uninterested in religious toleration. The thirty German families then went up to the Hudson to Albany, were treated badly there, too, and eventually cut their way through eighty miles of forest to the headwaters of the Susquehanna at Coopertown, New York. From there they floated down that river to the backwoods of Pennsylvania and started a colony in what is now called the Pennsylvania Dutch country.
The flood of German immigrants into Philadelphia after 1730 soon made Germantown German. From 1683 to 1730, however, Germantown had been settled by Dutch Quakers and some Swiss ones. These earlier immigrants were townspeople of the artisan and business class, rapidly establishing Germantown as the intellectual capital of Germans throughout America. This eminence was promoted further by the establishment by the Rittenhouse family (Rittinghuysen, Rittenhausen) of the first paper mill in America. Rittenhousetown is a little collection of houses still readily seen on the north side of the Wissahickon Creek, with Wissahickon Avenue nestled behind it. The road which now runs along the Wissahickon is so narrow and windy, and the traffic goes at such dangerous pace, that many people who travel it daily have never paid adequate attention to the Rittenhousetown museum area. It's well worth a visit, although the entrance is hard to find (try coming down Wissahickon Avenue).
Even today, printing businesses usually locate near their source of paper to reduce transportation costs. North Carolina is the present pulp paper source, before that it was Michigan. In the Seventeenth and Eighteenth centuries, a paper came from Germantown, so the printing and publishing industry centered here, too. When Pastorius was describing the new German settlement to prospective immigrants, he said, " Es ist nur Wald" -- it's just a forest. A forest near a source of abundant water. Some of the surly remarks of Benjamin Franklin about German immigrants may have grown out of the competition from Christoper Sower (Saur), the largest printer in America.
Francis Daniel Pastorius was sort of a local European flack for William Penn, assembling in the Rhineland town of Krefeld a group of Dutch Quaker investors called the Frankford Company. When the time came for the group to emigrate, however, Pastorius alone actually crossed the ocean; so he had to return the 16,000 acres of Germantown, Roxborough and Chestnut Hill he had been ceded. Another group, half Dutch and half Swiss, came from Krisheim (Cresheim) to a 6000-acre land grant in the high ground between the Schuylkill and Delaware. The time was 1683. They were soon joined by Mennonites, followers of Menno Simons, a reform group similar to Quakers but a hundred years older. The truly Dutch origins of these original settlers give an additional flavor to the term " Pennsylvania Dutch".
Where the Wissahickon crosses Germantown Avenue, a group of Rosicrucian hermits created a settlement, one of considerable musical and literary attainment. The leader was John Kelpius, and upon his death the group broke up, many of them going further west to the cloister at Ephrata. From 1683 to 1730 Germantown was small wooden houses and muddy roads, but there was nevertheless found the center of Germanic intellectual and religious ferment. Several protestant denominations have their founding mother church on Germantown Avenue, Sower spread bibles and prayer books up and down the Appalachians, and even the hermits put a defining Germantown stamp on the sects which were to arrive after 1730. The hermits apparently invented the hex signs, which was carried westward by the more agrarian later German peasant immigration, passing through on the way to the deep topsoil of Lancaster County.
Germantown After 1730
The early settlers of Germantown were Dutch or German-speaking Quakers; they were also of the craftsman class. Consequently, they were rather poor subsistence farmers. With a whole continent stretching beyond them, professional farmers would not likely choose to settle on a stony hilltop, two hours away from Philadelphia. Their future lay in a religious congregation, in papermaking, textile manufacture, publishing, printing, and newspapers. Plenty of stones were lying around, so stone houses soon replaced the early wooden ones. Since Philadelphia in 1776 had only twenty or so thousand inhabitants, and only thirty wheeled vehicles other than wagons, it was not too difficult for Germantown to imagine it might eventually eclipse the nearby English seaport. Two wars and two epidemics brought those dreams to an end, but in a sense, those calamities were stimulants to the town, as well.
In 1730 the German peasants began to arrive in large numbers from the Palatinate section of the Rhine Valley. While it is true they arrived as survivors of a horrendous ocean sailing experience, packed in such density that it was not unusual to find dead bodies in the hold that had only been supposed to have wandered into a different part of the ship. Quite often, they paid for their passage by selling themselves into what amounted to limited-time slavery, and the usual pattern was for parents to sell an adolescent child into slavery for eight or ten years in order to pay for the voyage of the family. They were uneducated, even ignorant, and often were proponents of small new religious sects. But they were professional farmers, and good at it. They knew, and a quick tour of Lancaster County today confirms their belief, that if you had a reasonable amount of very good land, you could live a life that approached the craftsmen in comfort and usually far exceeded them in personal assets. They have taken a long time to rise from farm to sophistication, but the already sophisticated craftsmen in Germantown wasted no time in abandoning farming. The newcomers arrived in Philadelphia, made their way to the nearby town of Germantown, learned a little about the new country and the refinements of their Protestant culture, and then pressed on to the great fertile valley to the West. Some of them, of course, stayed on permanently in the steadily growing little metropolis on the hill.
During this period, Germantown also invented the Suburb. Benjamin Chew, the Chief Justice, built a magnificent stone mansion on Germantown Avenue. Present-day visitors are still impressed with the immensity and sturdy mass of his home. Grumblethorpe, Stenton and a score of other country homes were placed there. Germantown still wasn't a very big town, but it was plenty comfortable, quiet, safe, intellectual and affluent. The first disruption came from the French and Indian War.
Germantown and the French and Indian War
Present-day interest in the Constitution, the Declaration of Independence, and related issues tend to drown out what was once a lively interest in the French and Indian War (1754-1760) as the pivot of American colonial history. Benjamin Franklin was so important in the French and Indian War that he could have died in 1761 at the age of 48 and still be remembered as one of our most far-sighted and influential statesmen. He was, however, not a plaster saint. Little Germantown was peripheral to events in those days, little interested in what was happening in Quebec or Albany. Like Hamlet's schoolmates Rosencrantz and Guildenstern, however, the Germantowners got drawn into events they did not entirely understand and played an unwilling part in history.
The French and Indian War was mainly about control over the Ohio Valley. Having established a communications system running out of Quebec, and carefully placing forts in the area beyond the Allegheny Mountains from which to trade with and possibly convert the Indians, the French had a rather elegant strategy for controlling the center of the continent. It involved urging their Indian allies to attack and harass the English-speaking settlements along the frontier. It was a nasty business. The survivors of General Braddock's defeated army at what is now Pittsburgh reported hearing screams for several days as the prisoners were burned at the stake. Rape, scalping and kidnapping children were standard practice, intended to intimidate the enemy. The Scotch-Irish settlers beyond the Susquehanna, which was then the frontier, were never terribly congenial with the pacifism of the Eastern Quaker-dominated legislature. The fact is, they liked to fight, and gouging of eyes was almost their ultimate goal in a moral dispute. They had an unattractive habit of inflicting what they called the "fishhook" involving thrusting fingers down an enemy's throat and tearing out his tonsils. As might be imagined, the English Quakers in Philadelphia and the German Quakers in Germantown were instinctively hesitant to take the side of every white man in every dispute with a red one. For their part, the frontiersmen were infuriated at what they believed was an unwillingness of the Quaker-dominated legislature to come to their defense. Meanwhile, the French pushed Eastward across Pennsylvania, almost coming to the edge of Lancaster County before they were pushed back and ultimately defeated by the British.
In December 1763, once the French and Iroquois were safely out of range, a group of settlers from Paxtang Township in Dauphin County attacked the peaceable local Conestoga Indian tribe and totally exterminated them. Fourteen Indian survivors took refuge in the Lancaster jail, but the Paxtang Boys searched them out and killed them, too. Then, they marched to Philadelphia to demand greater protection for the settlers. Benjamin Franklin was one of the leaders who came to meet them and promised that he would persuade the legislature to give frontiersmen greater representation, and would pay a bounty on Indian scalps.
Meanwhile, Franklin was active in raising troops and serving as a soldier. He recognized that thirteen divided colonies could not easily mount a coordinated defense against the well-organized French strategy, and called a meeting in Albany to propose a united confederation. The Albany Convention agreed with Franklin, but not a single colony ratified the plan, and Franklin was disgusted with them. Out of all this, Franklin emerged strongly anti-French, strongly pro-British, and not a little skeptical of colonial self-rule. As a leader of a political party the Pennsylvania Legislature, he was very familiar with the tendency of the German Pennsylvanians to vote in harmony with the Philadelphia Quakers. It must be noticed that Franklin's main competitor in the printing and publishing business was the Sower family in Germantown. Franklin persuaded a number of leading English non-Quakers that the Germans were a coarse and brutish lot, ignorant and illiterate. If they could be sent to English-speaking schools, perhaps they could gradually be won over to a different form of politics.
Since the Germans of Germantown was supremely proud of their intelligence community, they were infuriated. Their response was almost a classic episode of Quaker warfare. They organized, off Market Square, the Union School, which was eventually to become Germantown Academy. Its instruction and curriculum were sufficiently outstanding to justify the claim that it was the finest school in America. Later on, George Washington was to send his adopted son (Parke Custis) to school there. In 1958 the Academy moved to Fort Washington, but needless to say, the idea of forcing the local ignorant Germans to go to a proper English school was rapidly shelved.
The Battle of Germantown: Oct. 3, 1777
After its brief commotion from the unwelcome reverberations of the French and Indian War, Germantown settled down to a period of colonial prosperity and quite vigorous growth. Most of the surviving hundred historical houses of the area date from this period, and it might even be contended that the starting of the Union School had been a beneficial stimulus.
Almost two decades passed. What we now call the American Revolution started rumbling in far-off Lexington and Concord, soon moved to New York and New Jersey. General William Howe, the illegitimate uncle of King George III, then decided to occupy the largest city in the colonies, considered getting his brother's Navy up Delaware but decided against a naval attack on the chain barrier blocking the narrow mudflats of the river at what is now The International Airport. Instead, he sent the navy down to Norfolk and back up te Chesapeake, landing the troops at the head of the Elk River. Washington was soon defeated at the Battle of the Brandywine Creek trying to head him off. So Howe invested Philadelphia, organizing his main defensive position in the center of Germantown against an attack by Washington that was soon to come. His headquarters were in Stenton and Morris House, General James Agnew was at Grumblethorpe The Center of British defense was at set up at Market Square where Germantown Avenue crosses Schoolhouse Lane. With Washington holed up in Valley Forge, that should take care of that. Raggedy rebels were unlikely to attack a prepared hilltop position with a river on either side, defended by a large number of British regulars.
Washington did not look at things that way, at all. He had watched General Braddock conduct an arrogant suicide mission in the woods near Ft. Duquesne, and also knew the British didn't like to get too many yards away from their navy. His plan was to attack frontally down the Skippack Pike with the troops under his direct command, while Armstrong would come down Ridge Avenue and up from the side. General Greene would attack along Limekiln Road, while General Smallwood and Foreman would come down Old York Road. In the foggy morning of October 3, the main body of American troops reached Benjamin Chew's massive stone house, now occupied by determined British troops, and General Knox decided this was too strong a pocket to leave behind in his rear. Precious time was lost with an artillery bombardment, and unfortunately, the flanking troops down the lateral roads were late or did not arrive at all. The forward movement stopped, then the British counter-attacked. Washington was therefore forced to retreat, but he did so in good order. The battle was over, the British had won again.
But maybe not. Washington had not routed the British Army or forced them to leave Philadelphia. They did leave the following year, however, and there was meanwhile no great desertion from the Colonial cause. Washington's troops suffered terrible privation and discouragement at Valley Forge, but the crowned heads of Europe didn't know that. For reasons of their own, the French and German monarchs were pondering whether the American rebellion was worth supporting, or whether it would soon collapse in a round of public hangings. From their perspective, the Americans didn't have to win, in fact, it might be useful if they didn't. But if they were spirited and determined, led by a man who was courageous and resolute, their damage to the British interests might be worth what it would cost to support them. The Battle of Germantown can thus be reasonably argued to have been a victory for Washington, even if he had to retreat in an orderly withdrawal.
In Germantown itself, the process of turning a defeat into a victory soon began, with the alienation of the German inhabitants against the inevitably destructive experiences of British military occupation. Germantown would never again see itself as the capital city of a large German hinterland. It was on its way to becoming part of the city of Philadelphia.
1793: Germantown Nurses the Yellow Fever
The French Revolution continued from 1789 to 1799 and created the opportunity for a second revolution in the colonies which an overstretched mother 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 was bad in 1793, came back for three more years, and flared up badly in 1798. It could easily be seen that it was worse in the lowlands, absent in the hills. It reached a peak in October, disappeared after the first frost. In the early fall, people died a horrible death, jaundiced and bilious.
The Yellow Fever epidemic had a profound effect on many things. It was one of the major reasons the nation's capital did not remain in Philadelphia. It made the reputation of Dr. Benjamin Rush who announced the highly unfortunate treatment of bleeding the victims, thus provoking numerous anti-scientific medical doctrines which were essentially based on the comparative value of doing nothing at all. It took a full century for American scientific medicine to recover from this blow to its reputation. One very good thing the epidemic did was put an 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 him for it, and this class warfare movement would likely have got much worse if suddenly everyone had not dropped tools, and headed for the 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 capital. Meanwhile, a great many rich, powerful and important people had come to see what a nice place it was. Germantown then entered the 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.
Contemporary Germantown
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.
This is the reason that Henry Bockus and Jonathan Rhoads were sitting at the same table, sometime 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 gastroenterology. 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 remember 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 provosts 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 shoveling food.
"Hey, Rhoads, wherrseriland?". Jonathan's eyes rose to the questioner, but he kept his head bowed over his plate.
"Rhoads, Westland?" 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.
Academic economists make a useful distinction between "money" and "credit" when they point out that real money is always and everywhere created by governments and governments alone. To sustain this argument, it can be argued that banks only appear to double the money in circulation when they issued "credit" to the borrower, but simultaneously allow the depositors to retain the right to withdraw the same amount of "money". It's a little artificial, but it helps to clarify the next idea, which is fractional reserve banking.
Federal Reserve Bank of Philadelphia
Self-reserved banking, to coin an otherwise unnecessary phrase, would be to insist that a bank limit its total loans to the amount of money in its vaults, which is what private individuals do when they loan to friends. Since the volume of bank withdrawals is ordinarily quite stable and amounts to only a small fraction of reserves, self reserving would unnecessarily limit the bank's ability to lend, thus constraining the economy in general. Only in the event of a bank panic, or "run" on the bank, would the bulk of the reserves be useful, and this rare risk can be covered by creating reserve banks who guarantee to come to the rescue. Since the federal government alone can create "real" money out of thin air, a federal reserve bank is a logical arrangement to establish. Its existence makes possible the concept of fractional reserves at the local level, which any reserve bank can then control by declaring what numerator it will tolerate before it prefers to infuse money into the denominator of the equation.
And from all this comes the "multiplier effect", where a bank can loan several times as much money as it has in reserves, so long as the federal reserve permits it. When those loans get deposited in other banks, they serve as reserves for a second (or third, or fourth) bank, and the multiplier effect can get quite dizzying. In our system, the Federal Reserve can thus control the inflation or deflation in the general economy by adjusting reserve requirements of the banks it governs. It does so by increasing or decreasing the "money in circulation", which is not really money, but credit, which feels exactly the same to those who can get it.
We're playing with words a little, but that's the general idea.
For the past 14 years, LaSalle University has featured an economics meeting at the Union League in January, usually with an economist predicting the local outlook for the year. Increasingly, the luncheon in Lincoln Hall has been packed and sponsored by some local firm. This year, the speaker was Stuart A. Hoffman, the chief economist of PNC Bank, who turns out to be quite a witty fellow. The lunch itself was gourmet, although a little on the feminine side for a mostly male audience. And because the place was filled with an audience, the waitresses of the League were taking it away faster than the eaters could eat it. It's hard to say what the audience might have felt about that, because most of them could afford to lose a few pounds, just like the Chef himself.
Dr. Hoffman feels the big news this year is OIL. It sort of fell out of heaven at the right moment, but even the politicians who opposed it are forced to acknowledge it was a very good thing, indeed. Its international effect, in creating oil independence, was especially powerful and undeniable. However, there are winners and losers. Our North American neighbors in Canada and Mexico may feel some painful effects, for example. In any event, the discovery and exploitation of fracking seem very likely to bring the recession to an end, sooner than we deserve, at least.
So the prediction for the year is rather bright for wages, unemployment, and housing, perhaps even banking. The relevant parts of the stock and bond market will prosper -- undeservedly, as always. But at the end of the year, we are likely to see that recovery as historical only, as we begin to see the long term gloom inherent in health care and educational costs, and the rest of the world begins to affect us more than we affect them. How's that for a January prediction, largely revolving around unexpected events in OIL. We'll try to remember to compare this January prediction with the subsequent December retrospective realities, later in this volume. We'll even see if Dr. Hoffman has to eat his words since today he had very little time to eat his lunch.
Mario Draghi
Chairman of the European Bank
In the Question period, it was particularly interesting to hear a short description of what recently happened to the Swiss franc. The Swiss never joined the monetary union, but they did peg their currency to the Euro. As time went on, it was increasingly painful for Swiss exporters to have the franc suppressed by the lagging Euro, and when the Chairman of the European Bank announced his intention to start buying bonds, the Swiss bank capitulated and cut the tie of the Swiss franc to the Euro. The franc promptly rose, and that's all there is to the matter. Except if it isn't. The Germans are in much the same position within the Eurozone, and the English are restless, outside of it. So, if the prosperous parts of Europe decide to follow the Swiss example, the whole European monetary scheme may be in trouble. And if Europe has a monetary convulsion, it is trading partners in Africa and South America may follow, dragging in China, and -- who would be so brave as to suggest the USA could remain unaffected? Especially if Putin and the Arabs misbehave, pulverizing Israel in the process. When all you have is a hammer, you treat everything as a nail. Central Asia used to have two things, oil, and ruffians. And now they have apparently lost their dominance in oil.
Andy Mellon
Well, that's about the size of it, from Pittsburgh. Pittsburgh was largely settled by going West on the Erie Canal, so they never liked being attached to the Quaker end of the state. Philadelphia dominated with its banks, to Andy Mellon's great distaste, and largely controlled the shift of steel production from Eastern anthracite to Western bituminous coal. So now, Philadelphia scarcely has a bank to its name and has to hear the News of the World in Review -- from the other end of the state.
Hospital-Phyiscians Relationships: Case Student and Commentaries on Medical Staff Problems, edited by Nathan Hersey, 239pp, 823.50, Rockville, Md, Aspen systems Corp, 1982
Relations between the medical and legal professions are so strained by malpractice litigation that it often goes unnoticed that most mainstream lawyers do not belong to, indeed may even harbor reservations about the trial bar. Consequently, we may inadequately acknowledge the legal professions as a useful and honorable one, with much to teach us about handling our affairs. The goal of his book although Nathan Hershey states it somewhat differently is to dramatize the range of awkward situations that plausibly could arise in any hospital and that should, therefore, be anticipated in the drafting of any hospital's medical staff bylaws. The medical staff, writing its bylaws, resembles the man writing his will, who must be diplomatically persuaded to include "boilerplate" provision against eventualities he refuses to take seriously but that does, nevertheless, litter the landscape of human affairs
In this book, a series of fictionalized episodes parade before us the respected staff physician in whom a drug or alcohol problem develops, the emotionally overwrought house officers who gets carried away by misguided sympathy, the fully qualified applicant for staff privileges who is, nevertheless, unwanted, the surgical super salesman or other "big admitter" whose business is more welcome than his behavior, the feuds that can spill over into hospital affairs when medical partnerships disrupt, and other marionettes.
Following each vignette is a brief commentary, but the real message lies in the depiction of messes that result from (characteristic?) failure to follow"due process." Like any advocate, Nathan Hershey attempts to show that following a well-defined, fair procedure saves the client money and trouble in the long run. But one gains the distinct impression that, to his great credit, Mr. Hershey is genuinely dismayed at some disorderly processes he has observed, occasionally seeming to have given rise to unjust and unwise behavior by hospital trustees who seemed to think almost any behavior was tolerable as long as it provoked no bad publicity, physicians who seemed to think any methods of approach was justified by a well-motivated goal, and hospital administrators who seemed to think anything was acceptable as long as they didn't get caught. Presumably, the caricatures in the book are unusual instances of poor behavior, offered to suggest what must be avoided rather than to imply what is typical. However, one gets a distinct impression that these examples are disguised but not fanciful. The message comes through that how the Establishment behaves under provocation does matter, that behaving well need not be inconsistent with righteous motives, desirable outcomes, or respectable public image. Indeed, whenever society perceives that its arrangement is leading to the emergence of inappropriate elites, society promptly contemplates new arrangements. The subliminal message in this book is a very creditable one.
This reviewer recommends the book for wide circulation but does reserve a right to criticize a bit. To continue the analogy with writing a will, most of us see that our 40-page wills were largely produced by an automatic typewriter producing standard paragraphs; hospital staff bylaws will mostly be the same. This book would be a more important statement if it risked a set of proposed model bylaws that could be measured against those of the Joint Commission on the Accreditation of Hospitals, which are sneered at on page 89. Since there will be comparatively few decision branches that tailor standard boilerplate to the individual situation, it would have been helpful to have these points identified and discussed in detail.
Possibly Mr. Hershey regrets as much as this reviewer does that the hospital lawyer is not fully in a position to appreciate the major scientific and sociological forces that are causing novel dissension to arise. For example, the spreading migration of specialists to the suburbs and rural areas was bound to cause commotion in organizations that were stabilized by different anticipations. The malpractice liability muddle has undermined confidence in the judicial system at the same time that it has coerced more involvement with it. The 1965 Social Security Administration Amendments have created an unwelcome allegiance of hospital trustees to the regulations of the Department of Health and Human Services, thereby creating the true legal basis for what now masquerades as antitrust theory, consumer protection, and fair trade. If the courts carry this public utility idea much further, there will be no need for medical staff bylaws at all because we shall have open staffing. At least, the logic would be that if you can't exclude non-physicians from a hospital medical staff, it is hard to see how you could justify excluding any physician.
George RossFisher,MD
Philadelphia
Cardiothoracic Surgery
A Practice of Cardiothoracic Surgery, by M.P. Holden, 432 pp, with illus,$49.50, Littleton, Mass, John Wright-PSG, 1962.
Any writing about this evolving field rapidly becomes a compromise with impossibilities. No one agrees, for example, on when to operate for aortic regurgitation. The author quotes Lord Brock, saying that most of our answers about when to operate are still too empiric. Nevertheless, in giving some provisional replies, this book represents one surgeon's assimilation of disparate opinion, how he thinks, and how he acts in detail.
Senior readers may disagree about initial conservative treatment of postinfarction ventricular septal defects or grafting only the anterior descending branch for left main coronary disease. (MOst US surgeons graft the circumflex also.) . The author underestimates some mortality, eg. 2% for mitral valve replacement. Similarly, few believe that 95% of patients who have undergone coronary bypass will stay symptom-free.
Despite his enthusiasm, Holden's invigorating style and English perspective offer a worthwhile reading experience. After learning that transthoracic reoperations are now being performed to cure myasthenia that was unsuccessfully first treated by cervical thymectomy or that the author's waiting list for coronary bypass surgery is now 18 months long, the reader emerges wiser and more thankful to be part of the American healthcare system. The chapters on the esophageal disease will also sharpen our perceptions.
By writing a condensed book rather than a vast, encyclopedic tome, the author has wisely chosen between "the alternatives of Plinius: either of writing what deserves to be written or of writing what deserves to be read".
Alan T. Marty, MD
Evansville, Ind
Neurology, Psychiatry
Psychiatric Aspects of Neurologic Disease, vol.2, edited by D. Frank Benson and Dietrich Blumer (Seminars in Psychiatry, Milton Greenblatt, ed), 325 pp. with ilus, $24.50. New York, Grune & Stratton Inc., 1982
Volume 1 of this series appeared in 1975; volume 2 has been written by 13 authors, all of whom are different from those who wrote for volume 1, with the exception of the editors. The epilepsies, the dementias, and certain movement disorders are topics discussed in both volumes.
A survey of the contents will indicate the range of coverage of the borderland between neurology and psychiatry, for which the term neurobehavioral is suggested. Richard L. Strub opens with a review of the acute confusional state, a behavioral response to widespread disruption of cerebral metabolism to literally thousands of agents or metabolic imbalances.
In a chapter by the editors on the psychiatric manifestations of epilepsy, the behavioral change during the prodromal state, during the fetus, postictally and intellectually (epileptic psychoses), is described, as well as the psychological response to the seizure disorder itself. Michael R. Trimble, writing on the interictal psychosis of epilepsy, considers among other things the relationship between psychosis, epilepsy, and dopamine, which may increase the seizure threshold but provoke or exacerbate psychosis.
A chapter by Kenneth C. Rickler is concerned with episodic dyscontrol, states of explosive behavior of wide-ranging etiology. The nature of this complex condition invokes the ancient controversy as to whether innate or acquired factors are responsible. Psychotherapy plus medical therapy has been more helpful than either alone.
The midsection of the volume (four chapters, one each by Cummings, Benson, Cutting, and Wells) addressed the diagnosis and treatment of a variety of dementias. A chapter by Blumer considers the problem of chronic pain based on the analysis by George Engel of more than two decades ago. Blumer describes the variant of the depressive disease that is represented by the pain-prone disorder and notes the high incidence of shortened rapid eye movement latency in sleep and of nonsuppression in the dexamethasone suppression test. At the time of writing, these were considered to be biologic markers of depressive disease.
The topic of tardive dyskinesia is authoritatively reviewed by Christopher G. Goetz and Harold L. Klawans. Michael P. Alexander reviews thoroughly the common problem of traumatic brain injury. A study of amnesia as a clinical approach to understanding memory is the work of the editors, Benson and Blumer.
Michael R. Trimble and Igor Grant discuss the psychiatric aspects of multiple sclerosis and conclude that there is no evidence of a predisposing personality.
The volume closes with David B. Rosenfield's consideration of stuttering, which like all the other chapters, is interesting and informative.
This excellent volume makes for fascinating reading about a burgeoning field, transcending the classical discipline of neurology and psychiatry. There is no limit to need for scientific material oriented toward understanding these and other borderland problems. One can think of additional topics for succeeding volumes, for example, the sleep disorders, including narcolepsy, cataplexy and sleep paralysis, and those depressive disorders that are tending toward the neurological side, if indeed sides are to be drawn.
What of causal implications, which, if approached in this volume, are done so diffidently? Do or do not the emotions have access generally to neural structures, and may they be acting over time, encouraging a spectrum of neurobehavior from tranquility to abject disequilibrium, depending on their nature, in a process perhaps skin to kindling? Parenthetically, kindling as currently understood is discussed in this volume by Trimble (pp 85 and 86) under the heading of the interictal psychoses of epilepsy.
It has been argued by Ashley Montagu that experience organizes neural systems in a fashion that permits expression of aggressive behavior. If this is so, may "evasive action" taken in formative years become an aspect of prevention?
The chapters are pleasingly coordinated from one to the next by concise and graceful interspersed commentary. An index of 11 pages appears adequate. Checking in our medical library reveals that volume 1 has been under consistent demand since 1975; I would expect volume 2 to fare likewise. It is a well-planned and thoughtful clinical treatise, which those concerned with neurobehavior would do well to have accessible.
Charles D. Aring, MD
University of Cincinnati
College of Medicine
Nutrition
Parenterals an Enteral Nutrition for the Hospitalized Patient, by Howard Silberman and Daniel Eisenberg, 306 pp, with illus, @27.50, Norwalk, Conn, Appleton-Century Crofts, 1982.
Therapeutic nutrition is barely in its second decade as an established medical discipline. Its intricate methodology, based on complex biochemical and physiological phenomena, makes it abstruse and somewhat unappreciated by the practitioner at large. Books on the subject are either encyclopedic in scope, aimed at the specialist or too superficial to be of any value as a reference for the clinician. The authors of this work have succeeded where many others have failed. They have written a concise yet comprehensive text on the definitive current information on therapeutic nutrition, backed by extensive and recent references.
The text is divided into ten chapters. Each is organized into subsections and has a summary and bibliography at its end. The first chapter details the consequences of malnutrition on the body as a whole and on the different organ systems. The next chapter deals with the evaluation of nutritional status, with emphasis on the practical, clinical, and laboratory methods. The following chapter describes the nutritional requirements of the patient and the different routes of nutrients administration. The fourth chapter details enteral nutrition, including indications, nutrient formulation, techniques of feeding, patient monitoring, and complications. The fifth through the eighth chapters cover the general principles of parenteral nutrition as well as historical background , formulation, composition and preparation of nutrient as well as historical background, formulation, composition and preparation of nutrient solutions, vascular access, administration monitoring, dosage, metabolic effects, adverse reactions, and complications both in general and on individual systems and body organs. The ninth chapter compares the efficacy and effectiveness of the different methods of nutritional support. The last chapter is dedicated to the clinical application of therapeutic nutrition for the condition such as gastrointestinal fistulas, burns, and liver disease.
The book has accomplished its goal of being concise and practical. Controversial opinions are objectively presented without bias. The precise, crisp text, supplemented by comprehensive tables and good, realistic photographs, makes it a reference as well as a handy how-to book. This is enhanced by its manageable size and attractive format.
The book should be a welcome addition to the library of medical students, residents, and practitioners and will surely become a classic.
Alexander E. Medme, MD
Hurley Medical Center
Michigan State University
Flint
The Human Body
The Human Body, by the editors of US News Books, Blood: The River of Life, by Jake Page: The Eye Window to the World , by Last Wertenbaker; The Heart: The Living Pump, by Goods P. Davis, Jr. and Edwards Park; Reproduction: The Cycle of Life, by Karen Jensen; The Skeleton: Fantastic Framework, by Kathy E. Goldberg, 163, 159,165,and 165,pp, with illus, $15.95 each, Washington, DC. US News Books, 1961 and 1962.
US News Books is providing an excellent science resource library for the general reading public (including persons trained in the medical arts and teachers and students of the psychological and biological sciences) through the publication of its series The Human Body. This service has already been acknowledging by the American Heart Association, which only recently awarded its Blakeslee Prize for "outstanding achievement in the area of educating the public on the heart, its functions and dysfunctions," to the publisher for its book The Heart.
Other volumes currently available are The Skeleton, Blood, Reproduction, The Eye, The Brain, Muscles, and Skin,. The books are published approximately every three to four months. Some 20 are anticipated in the complete set, and future titles will include The Cell, Digestive System, Genetic and Heredity, and Wonders of the Ear.
A historical survey, coverage the particular subject at hand, begins each approximately 165-page text. This is followed by a cultural resume as background for current medical knowledge and practice. Ensuing chapters provide a physiological and electrochemical tour of the organ system and how it functions. Studies unique to the particular topic are reviewed (eg, creativity and sleep in The Brain, color in The Eye, and paleontology in The Skeleton). Finally, each book closes with a chapter on current research and investigations of future interest. All this, however, is a basic format. The uniqueness of the books lies in their extensive use of colorful photo essays and other visuals, which complement an easy-to-read text, as well as the employment of an impressive cadre of experts, including such notables as Lewis Thomas from Sloan-Kettering Institute, Rye, NY, Eugene Braunwald from Harvard, Cambridge, Mass, and Solomon Snyder from Johns Hopkins, Baltimore, in addition to specialist consultants for individual subjects, to assure authoritative current material.
The Human Body will, no doubt, be compared with the well-known Library of Health,published by Time life. It needn't be. The Time Life books are "designed to familiarize readers with the latest advances in medical science as a guide in maintaining their own health and fitness" .and are concerned with the discussion of specific health problems, such as Coping with the Common Cold, Dealing With Headaches, Exercising for Fitness, and The Prudent Use of Medicines.
Anatole France once said that "the whole art of teaching is only the art of awakening the natural curiosity of the mind for the purpose of satisfying it afterward." I can recommend US News Books series The Human Body as an aid such discovery in presenting a multi-level learning experience that is both inviting and effective.
Irwin M. Segel, MD
Plush-Prebytarin- St. Luke's
Medical Center
Chicago
Stoke Rehabilitation
Mossman's Problem-Oriented Approach to Stroke Rehabilitation, by John W. Sharpless, ed 2; 491 pp, with illus, $39.75 paper $32.50, Springfield III, Charles C. Thomas Publisher,1982.
This textbook has a unique quality in that it is suitable for all the allied health professionals as well as the physicians who make up a rehabilitation team. In other words, this is a good basic text for any stroke rehabilitation program, describing the various problems stroke patients have, by what means these problems are solved, and which allied health professional provides the solutions. Each one of the 25 chapters deals with a particular problem in detail, giving the methodology to relieve the problem not only with a concise and accurate text but also with man excellent illustrations.
There is nothing controversial in the book. It should be acceptable to any program that is interested in the rehabilitation of stroke. The book, therefore, is eminently suitable for physicians and residents who are interested in improving their expertise in stroke rehabilitation generally and knowing what can be done by the various allied health professionals.
However, there is only one major criticism I have with the book in this regard. It lacks a chapter on team management. Although it deals with the problems by describing the use of a team of allied health professionals, there is never a mention of how these professionals coordinate their services, how they interact, and how the term problems themselves are treated. Perhaps this could be added in a third edition. This does not detract from the value of the book, and I recommend it wholeheartedly as the main reference for any stroke program.
Henry H. Stomming,MD
Department of Physical Medicine and Rehabilitation
Mayo Clinic
Rochester, MInn
Obstetrics
Medical Complications During Pregnancy by Gerard N. Burrow and Thomas F. Ferris, ed 2: 583 pp, with illus, $49, Philadelphia, WB Saunders Co, 1982.
It is well known that every system in the body is affected by pregnancy to a greater or lesser extent. What is less well known is the manner in which the normal changes of pregnancy modify the course of almost every disease. Also, the drugs commonly used to treat such disease may or may or may not be suitable for use in pregnancy. Unfortunately, most textbooks of medicine give little or no consideration to pregnancy, contenting themselves with the observation that the effects of this or this or that drug in pregnancy are either harmful or unknown or that the risks must be weighed against the benefits.
This book is not designed as a complete text of general medicine, but it is an admirable and comprehensive survey of the manifestations of medical illnesses in pregnancy and the manner in which they should be dealt with. Virtually all system are considered. Each section is opened by a review of normal physiological changes of pregnancy and, for the specific disease itself and discussion of the manner in which the disease is modified by pregnancy. In each case, the diagnostic and therapeutic measures that are appropriate in pregnancy are discussed, and pointed reference is made to the measures ordinarily used that are to be avoided in pregnancy. Due attention is given to the effects of the disease on the fetus, the possible teratogenic effects of the drugs used to treat it, and in many cases, the preventive measures that may be taken to avoid the disease in the first place.
The text is written in uniformly crisp, strong prose by a group of authors who are actively engaged in teaching and are well known in the fields about which they write. The tabular and graphic materials are well selected and informative, as are the illustrations. The reference lists are appropriately categorized and extensive. Like virtually all books, the references lag behind by a year or two, but this does not detract from their value to the student who wishes to pursue a subject in greater depth.
This book makes for pleasant and highly instructive casual reading or study, but it should also be immediately available for reference by residents in training obstetricians, and medical specialists who have occasion to treat pregnant patients.
David M. Danforth, PhD, MD
Northwestern University Medical School
Chicago
Blood
The American Blood Supply, by Alvin W. Drake, Stann. Finklestein, and Harvey M. Sapolsky(MIT Press Series in Health and Public Policy, vol. 5, Jefferey E. Harris, ed). 161 pp. $20, Cambridge Mass, MIT Press 1982.
This small volume, part of a series being produced by the MIT Press, is an original and scholarly monograph authored by a group of individuals with diverse backgrounds. The text, directed toward those who have technical and administrative involvement with blood procurement and utilization in this country cover geostrophic that extend from the origination of the blood supply and blood procurement from the donor to a discussion o the organizations involved in that procurement.
It is apparent from the frank and factual discussion of the logistics and politics of blood providers that the authors are well acquainted with the diverse philosophies in practice in the United States. Supportive statements are made in regard to the American blood system hat it is envisioned to be better than it is occasionally described and that the quality of blood supply is high and carefully monitored. The nonprofit organization involved in blood collection are described as performing their duties of a collection with a great deal of efficacy and dedication. The authors point out with some concerns that the public is misinformed about the blood system and is likewise misinformed about blood policies. As blood banking in the United States becomes "cartelized," the authors encourage the public to create oversight mechanisms that are similar to those used in every other private monopoly presently serving the public
The text is adequately supported b\y clearly readable tables and is carefully divided by small headings in each chapter that guide the reader carefully through the authors' blunt but realistic group of topics, which bring clarity to the forefront some of the political problems that have inhibited redevelopment . of a national blood policy. In short, although not material of interest to a wide audience, this monograph deliberately and honestly discusses the problems of "The American Blood Supply."
Edgar H. Pierce Jr. MD
Nashville, Tenn
109 Volumes
Philadephia: America's Capital, 1774-1800 The Continental Congress met in Philadelphia from 1774 to 1788. Next, the new republic had its capital here from 1790 to 1800. Thoroughly Quaker Philadelphia was in the center of the founding twenty-five years when, and where, the enduring political institutions of America emerged.
Philadelphia: Decline and Fall (1900-2060) The world's richest industrial city in 1900, was defeated and dejected by 1950. Why? Digby Baltzell blamed it on the Quakers. Others blame the Erie Canal, and Andrew Jackson, or maybe Martin van Buren. Some say the city-county consolidation of 1858. Others blame the unions. We rather favor the decline of family business and the rise of the modern corporation in its place.
Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
