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.
Philadelphia Reflections is a history of the area around Philadelphia, PA
... William Penn's Quaker Colonies
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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.
On the eve of the Constitutional Convention, the nation was unhappy, confused, and dissatisfied; this wasn't what a victory was supposed to feel like. George Washington wanted a country to be proud of, big enough to discourage enemies, otherwise free of policing, regulation, or monarchy. Eight years of war had taught him it wasn't easy to have both liberty and discipline at the same time. Perhaps America was more unusually blessed, however, defended from invasion by oceans and wilderness, and from greed by a continent of natural resources. If order and justice could be organized, perhaps this by itself would enlist the loyalty of that mixture of classes and nationalities then flocking to our shores. Several important writers were having a strong influence on the era we now call the Enlightenment; David Hume and Adam Smith in Scotland, Edward Gibbon in England, Voltaire and Diderot in France, even Catherine the Great of Russia, with a thousand others including Benjamin Franklin and Robert Morris. Although Washington probably hadn't read them, Adam Smith's The Wealth of Nations showed unvarnished new ways of looking at commerce and politics, while Gibbon's The Decline and Fall of the Roman Empire showed what could happen if idealism gets neglected. Both books were published in the portentous year of 1776, describing many difficulties, but always suggesting problems could somehow be solved. There were plenty of ideas in circulation, but there was no plan.
It must have become obvious to Washington well before the Battle of Yorktown, that the Revolutionary War would not leave us with our problems solved. There was one brief moment as the British Army was withdrawing from Philadelphia in 1778 which seemingly justified boasts our troops had licked 'em. Just after the surrender of a whole British Army at the Battle of Saratoga, the British were also retreating from Philadelphia, and the Lord North offered generous peace terms through the Earl of Carlisle. No doubt the British public was restless after the Burgoyne defeat and the French alliance with America. Because the Carlisle episode is much more familiar in England than in America, perhaps it was a feint or a maneuver to embarrass the Earl of Carlisle or possibly just an exploration of the true state of affairs which were rumored about across a wide ocean. At any event, Gouverneur Morris was the visible American actor in this puzzling episode, but he must have been acting in concert with others. Lord North offered to give us our own elected parliament within a commonwealth; taxation with representation, no less. Morris seems to have dismissed this offer with contempt. But six more years of devastation ensued, surely convincing Washington that bitter defeat was still possible. That reality was concealed behind the graciousness of the French in allowing us to claim American troops had defeated the British at Yorktown. In fact, the preponderance of troop casualties, naval vessels and strategy had been French. The money had been mostly French as well. If that debt nearly bankrupted France, what might it have done to America?
Washington had been an outstanding athlete, soldier, and farmer, but his many travels about the colonies convinced him something more than leadership was needed. You just can't defeat a powerful enemy with short enlistments which give soldiers a legal right to go home on the eve of battle, and no way for the central command to extend the enlistments. To this, Robert Morris added that you can't buy gunpowder without the central power to levy taxes to pay for them. Morris warned him more was needed than a confederation so big others would leave it alone. Even temporary power wasn't enough. National disorganization had been just as bad after the Revolution as before. By 1787, Washington concluded the states just would not surrender power to a central national government unless the people forced them to give it up, and after a brief patriotic fervor, the people mostly wanted to go home for spring plowing. Peacetime also demonstrated another discouraging truth: meaningful improvement of the existing order meant the whole previous leadership class might leave public service to less qualified leaders, watching peace attract mediocrity to political office. Prominent men in the community gathered in a Constitutional Convention recognized the advantages of Union and devising peaceful ways to maintain it. After that transient moment when the memory of the war was fresh, politics could return to the mediocrities of a political class. That's not exactly what is now meant by "We, the People", but it might have to serve. In Washington's view, the voice of the people usually echoed along the lines of Tell us what good it would do to upset the Articles of Confederation, otherwise leave them alone. If you propose the general shape of a new central government, first tell us what it can do better than the states. And then show us how to make dubious state politicians agree to it. The accents of hesitation and defeat echo powerfully.
The hideous French Revolution was soon to demonstrate how unwise it was to look for short-cuts; we need a republic, not a stampeded democracy. George Washington was unsure just what was needed, but he knew a few basic things with certainty. America needed a bargain which everyone was expected to keep. A stronger central government should be provided for, and make it difficult to dissolve.
COMPUTER war games now consume a great deal of time which teenaged boys ought to be spending on homework, but study of the underlying principles of commanding an army is a major part of the serious curriculum at West Point. To be good in this course means promotion in the officer corps, and putting principles into successful action creates a few famous heroes for the history books. Lawrence E. Swesey, the founder and president of American Military Heritage Experiences, recently fascinated the Right Angle Club with an analysis of Generals Lee and Grant, both West Point graduates, putting the principles to work in the Civil War. Conclusion: Grant was the better general. It was Henry Adams, the manic-depressive historian, who diverted attention away from the principles of war, to such issues as Grant's short stature, taste for whiskey, and poor performance as an Ohio farmer. To be snide about it, a case can be made that Grant was a better writer of history than Adams, as well as a better general than Lee. However, probably neither Ulysses Grant nor Julius Caesar would be considered great historians if either had lost the wars they so famously described.
Carl von Clausewitz
The nine principles of war used by the American military derive from the Prussian officer Carl von Clausewitz, and are also used by the British, who add Flexibility as a tenth. The Chinese and Russians go on to add Annihilation to their list, a thought worth pondering. French military schools base their training on 115 principles laid out by Napoleon, which are presumably ten times more difficult to remember in the heat of battle if indeed anyone can remember anything when the enemy starts taking aim. In any event, the first universally agreed principle is to have an objective that is both effective and achievable. The second is deciding to take offensive or defensive action, the third is to apply sufficient combat mass at one critical time and place. Maneuver is the last of the four main principles. The economy of force, Unity of command, Surprise, Security, and Simplicity are five lesser principles, used to achieve the four main ones. Using these lines on the scorecard, how did Robert E. Lee and Ulysses S. Grant score on the fifteen major battles of the Civil War?
To compare the two generals, there is the difficulty that they only opposed each other in five battles, and each was the clear winner in two of them. In the battles where they faced other generals, both Lee and Grant won some, mainly because the opposing general did the wrong thing and lost the battle. The score comes out roughly even and gets complicated when giving more weight to winning bigger battles, less weight to smaller ones. Lee gets more glamor, because his style was to attack, even attacking just after he seemed to be losing. Lee won one battle when he was outnumbered, two to one.
But Grant won the war, and that should count for something. Both Lee and Grant knew the superior resources of the North would ultimately overcome the South unless the North made some mistakes, or just got tired and quit. Apparently Lincoln also understood this, and immediately offered the top job to Grant after an interview in which Grant came right out and said so.
Apparently, there is one more principle of war that isn't on the list. You play the hand you are dealt, after counting your cards carefully. In contract bridge, the game is always played with fifty-two cards. It isn't that simple in a war, where you stack the deck if you possibly can.
It's been sixty-three years since I last sat in a classroom as a student. For an additional fifty-five years, I was a teacher; in the absence of any correspondence to the contrary, I believe I am still listed on the faculty of two medical schools. Socratic teaching is now nearly universal, but I only got a smattering of it as a student. I hated it then, and I grumble about it, still.
Just about the only thing I remember about my experience in fourth grade is the following question by the teacher: "Argentina grows wheat. Now, class, what does Argentina grow?" I refused to answer such a question.
It would be another ten years before I had a chance to read some Socratic dialogues, finally recognizing that many of the questions Socrates asked of his students were sarcastic, and even a few of his answers were mocking. After all, Socrates was judged a rebel and executed for promoting subversive thoughts among young and therefore impressionable students. The dialogues are not demonstrations of how to teach a class, they are semi-theatrical depictions of Plato's recollections of Socrates, heavily edited for the purpose of defending his reputation. The main modern criticism of Socrates is not that he made students squirm, but that he relied so exclusively on logic and reasoning. The truth of his teaching was based on plausibility, not testing and proof. Such pontification today would be viewed with skepticism; at most, it would be described as relying too heavily upon secondary sources, because there could certainly be no reference to primary ones. How would I know what Argentina grows? Or, for that matter, how do you know? One really has to pity that poor tormented teacher.
Method
One has less sympathy with current medical school faculties of New York City, who have largely taken up a denatured version of what they imagine was the Socratic Method, and which their students openly refer to as teaching by coercion. One swaggering professor ended his dialogue with one of my classmates, who in fact later won the Nobel Prize in Medicine, with the finale, "You won't forget that, will you?" To which the future Nobel laureate replied, "Sir, I won't forget you." And another somewhat less distinguished classmate was cringed beside the locked door of the examination room, studying notes right up to the last moment before a final exam. "Well, Levy," boomed the same professor, "Do you know everything about Rheumatic Fever?" To which was made the immortal response, "Sir, no one knows everything about rheumatic fever." By the time they get to be seniors, medical students are famously independent-minded, and they can give back as good as they get. So, one pities that professor less than that fourth-grade teacher, but questions the methodology more. One other mocking description the irreverent medical students give of it is: "Well, what am I thinking, today?"
Let's change the scene to cable television, to a continuous live presentation of current history called C-Span. Once a week, some famous teacher from anywhere in the country is depicted giving a real college seminar. One can easily imagine the editor of this program, with essentially unlimited budget, seeking out the best teachers in the best educational system in the world. On the evening in question, one charmingly pert young lady was performing on a topic I now do not recollect; it was, however, perfect Socratic dialogue. No matter how preposterous the answer, no student was ever wrong about anything. Encouraging smiles urged the student to try again, or stand aside for a classmate eager to recite. Like Molly Bloom, the teacher's responses were, "Yes, yes, yes".
Socratic Diagram
Within a few minutes, two seemingly unrelated mysteries got clarified somewhat. A possible explanation of the self-assurance of the "x" generation began to suggest itself. Those children of silent, withdrawn parents had been encouraged to believe their spontaneous instincts were oracular, as a way of encouraging the shy to assert themselves. Ten or twelve years of Socratic, "Yes, yes, yes" had half-convinced a sizable minority that their views were those of unsullied vestals, clearly to be preferred to those who relied on that famously undependable source, experience. It can take four or five years to recover. And watching TV another mystery seemed to expose some of its roots. For some years I have marveled at the manner of academics in charge of a meeting of peers. Ever since Thomas Jefferson presided over the unruly Senate at Sixth Street in Philadelphia, the Parliamentary rules have been strict: the chairman only votes to break a tie, and absolutely never engages in partisan debate. Yet repeatedly one watches these lovely people, often close friends, riding rough-shod over colleagues in a debate. Suddenly while watching TV focus on the best of them, some glimmering of understanding begins to emerge. The teacher states the proposition, asks the question of the audience, and hunts for someone to give the right answer. If the question is amended, it is referred to a committee which will think about it. If someone voices the right answer, it is cheered as having closed the topic to further discussion. Very few votes are ever taken.
It's impossible to crawl inside the heads of people, even your friends, and pick out their motives. But now, the Socratic skeptics at least have some idea where all this is coming from.
I soon persuaded the American Medical Association to endorse the plan, John Goodman of Texas wrote a popular book about HSA, which persuaded Bill Archer, the chairman of the House Ways and Means Subcommittee on Health to push a law through, enabling a pilot program. Today, the nonprofit Employee Benefits Association reports 11.8 million people to have Health Savings Accounts, mostly in states without mandatory small-cost coverage laws to hamper the use and pricing of deductibles. Others report a third more. One clarifying example would be mandatory birth control pill coverage, which not only undercuts the purpose of a large deductible but is politically inflammatory as well. Health Savings Accounts are popular in Indiana where Patrick J. Rooney was a heavy early supporter, but HSAs until lately were almost unknown in New York and California, which had extensive mandatory small-benefit laws , sometimes dozens of them. Today, to my amazement, California leads the fifty states in HSA enrollment, and JP Morgan Chase services 700,000 policies.
1. Temporarily forget about retirement funding, just finance healthcare. A smaller sum is easier to handle. I certainly hope this is merely a transition expedient.
2. Forget about death. Just keep re-investing the remaining money until its debts are paid off, and then have it terminate. The model is a trust fund.
3. Forget about childbirth. Start a trust fund in anticipation of having at least one child, and if you don't, provide for a legal contingency. The model is a "Bride's Hope Chest", which sometimes ends in funding spinsterhood.
4. Forget about living trusts. If you anticipate or even want to anticipate, having children, start financing for it by saving money, investing it, and transferring it to its purpose without taxation of the transfer. But since we recoil at government ownership of the means of production, the model is a trust fund, not Socialism. Lawyers are puzzled about trust funds without living owners, so there must be a legislative approval of whatever we do that hasn't been done, before.
5. At present, we do all of our post-graduate medical education as "residencies" in hospitals. The consequence is twin silos with impaired communication. And then, our graduates (except surgeons) spend the rest of their lives working out of their offices. The consequence is the greatest flaw in the system comes from "hand-overs" of the patients from hospital to office practitioners who can't know what happened in the hospitals. The reverse is also true, from office to hospital, although it makes some sense to do a complete work-up when the patient is sick enough to warrant admission -- as long as you also make it available to the referring physician. The reason behind this is the desire of hospitals to maintain a monopoly silo for the transfer of information, lest they lose control of the patient himself. In Switzerland, almost all medicine is practiced in 15-25 bed "clinics", but that goes too far in the opposite direction.
If doctors get good at typing, they are spending too much time at it.
One solution to this is to use retirement villages as half-way houses, with a resident in charge, under supervision, in an attached medical shopping center which also serves the retirement facility better. Naturally, the retirement villages resist that hospital control feature. A great deal could be done with telemedicine that is not being done, but the idea flounders because of equipment start-up costs. However, when you see thirty billion dollars spent to patch this over with "meaningful use" of electronic medical records, you have to wonder how sincere the objections are. Because we don't have retirement villages well integrated into such a system, the extensive use of demonstration projects is advised, before the whole system is converted. In fact, it may make more sense to start with small rural areas than with large urban ones. Let a hundred flowers bloom.
6. My suspicion is the electronic record would make more progress if it were limited to laboratory, etc. data, and deliberately excluded doctor communication in favor of tape-recorded communications or even video recordings. But not composition or typing. If doctors get good at typing, they are spending too much time at it.
In time, of course, this is a technical issue which will be solved. However, it exaggerates the time spent reading the stuff, so a major project of automatic periodic summarization is urgently needed. Presumably, that should grow out of an expanded search and retrieval system, which records whatever doctors have been interested in seeing, in similar cases, and at what stage. The basic fact is that if no doctor ever looks at it, it isn't worth including in the archive. Conversely, if doctors go after it like a dog after a bone, it should be highlighted.
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.
