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.
The Pharmacy Example. It would seem, a natural place to introduce computing to medical care delivery would be the drug store. Almost everyone is familiar with the process of the doctor writing out a prescription and giving it it the patient. And it's likewise familiar how a patient takes the prescription to the store, gets the bottle of pills, and pays for it. The drugstore seems to be a single link in the chain between doctor and patient, with only the prescription adding input, only the bottle of pills generated as output. So let's begin there, watching an example of how simple things rapidly become complicated. The pills are standard, the inventory is already digitized, insurance can be made to enforce a standard number of pills in a refill, the pharmacist can then be replaced by a high school girl. You give the patient 30 pills, and 30 days later he needs another 30, right? Well, not exactly.
The computers are in the drugstore all right; usually five or six of them. What's missing is the professional latitude of the former owner-pharmacist, replaced by an automated assembly line. Druggists, as we knew them, began to disappear around 1970, and computers probably had a lot to do with that first step of moving from corner drugstore toward pharmaceutical ATMs. Prior to World War II, most pharmacists could even compound capsules from powders, and mix various-colored liquids in a bottle. That is to emphasize, the corner drugstore and its friendly owner-operator were well on the way to disappearance, quite a while before outpatient prescribing was overwhelmed by health insurance. It must not be imagined that disentangling insurance from outpatient prescribing would automatically take us back to a system which allows more professional latitude between ancient professions. That might well be desirable, but opportunity is fading fast.
The drug stores by 1970 had already automated most of their process to a point where insurance designers could easily imagine substituting insurance billing for patient billing; and linking that combined payment system to a pill fulfillment system. If only a way could be found to substitute bottles of pills for twenty-dollar bills, the drugstore would already be on its way to becoming a cash-dispenser, or at the very least, a candy-dispensing machine. Technology had only been waiting for someone to pass a law.
Shortages. Very probably the concepts of centralized control began with the Pharmacopeia. Originally, this term referred to a list of drugs the store kept in stock; an inventory list. When supplies got low, they were re-ordered in an amount judged sufficient until the next delivery. Certain drugs and certain supply houses were preferred, so once a decision has been made, the stores and the suppliers kept themselves ready for business. Hospitals maintained a more elaborate Pharmacopeia, usually with a committee appointed to oversee the list. Until the Second World War, most of the patients were in the indigent wards, so custom evolved into the idea that private patients could have anything the doctor ordered, often ordered from the pharmacy across the street. The Pharmacopeia was for indigent patients, taking the view that the committee was to decide matters of quality, and the hospital pharmacist had the latitude to order the cheapest generic version available. This didn't always suit the doctors with private patients, so there was a tendency to extend it to all drugs, quickly jerked back into line by the private physician giving a prescription to the patient's family, to be filled in the drug store across the street from the hospital. When insurance came along, this sort of thing lost its point, so peace was restored by converting everybody's drugs to the more expensive variety, essentially disbanding the committee. It was an important turning point: the conflict between quality and cost was almost instantly resolved by letting insurance just pay for the best. When the pharmaceutical companies saw what was happening, inclusion on the favored list began to revert to the quiet preferences arranged between the companies and the hospitals. In time, drug prices began to go up, insurance companies noticed, and the committees had to be restored in order to assure that quality was preserved. Around 2012, shortages of vital drugs began to appear; up to that point, shortages were unheard-of. But Philadelphia was somewhat quicker to recognize what was happening because it had all happened in Philadelphia in 1778. Price inflation invariably provokes rationing, and rationing provokes shortages. And shortages soon lead to rioting, when it is discovered that shortages have appeared, in spite of hoarded abundance. American pharmaceutical firms found that generic drugs were unprofitable compared with drugs under patent, so they stopped making generics. Third-world countries continued to make generics, but only when it was profitable and free of probing inspectors. Shortages are a likely sign of government intrusion; shortages in the midst of abundance are a certain sign of it.
Regimentation. Once hospital nursing systems got around to individually recording drug use, it was only a matter of time before someone got the idea of devising a set of "best practices", matching them with what had actually been prescribed, and identifying which doctors complied best with the best practices. That's where reality sets in.
The designers of pharmacy systems have assumed that directing the computer to record what ought to be done, is the same as describing what has actually been done. Unfortunately, in an outpatient environment, the patient is generally acting as his own nurse and is almost always somewhat sick. He is also paying at least a portion of his bill. When the cost of a cheap generic is a penny a pill, slack can be created in the system by throwing in a few extra pills. However, when an expensive brand name drug, say one costing ten dollars a tablet, is authorized by the insurance, great care is taken to dispense precisely 30 tablets every 30 days, regardless of Christmas or Sunday, Hell or high water. When a pill accidentally goes down the drain, or gets forgotten, or wasn't in the bottle to begin with, the situation is exaggerated that the patient is short of the expensive pill, but has a surplus of cheap ones. He tends to wait until they match up, but the computer clock is running and usually won't allow the slack to catch up with itself. At this point, often a relative -- let's say the daughter flew in from California -- discovers that the patient hasn't been taking pills which are fearfully expensive, and therefore vital to survival. It is very likely a fact that the expensive pill being skipped is indeed the one most likely to be critical to his condition. The dilemma almost always reaches crisis proportions at a time when there is no one available to over-ride the computer. The rest of this little scene is best left to the imagination.
There is nothing the matter with Bill Archer's law to enable Health Savings Accounts, except one thing: it forbids payment of health insurance premiums via the Accounts. Probably, that provision was a necessary compromise, to get the bill passed. But just imagine what would happen if it were amended to permit such payments: money legitimately passing through the accounts gets an income tax deduction.
Henry J Kaiser
Anybody can start an HSA, so with a small amendment, anyone could get an income tax deduction for health insurance, by writing a check from the Account to pay the premium on his present health insurance, or even just notifying his bank's Bill-Pay to do it automatically. By this simple maneuver, everyone would be eligible for the Henry Kaiser tax exemption now limited to employer-paid insurance. This simple change would eliminate a festering sore of unequal treatment under the law which has been allowed to persist for eighty years. Except possibly for those who don't want a tax exemption or don't want to take the trouble to use the HSA. It's hard to imagine anyone taking that attitude, so a powerful incentive to create HSAs would leap into place. As we have said in many places, if the tax cost of the universal exemption to the government is an objection, it could easily be paid for by lowering the exemption for employer-based insurance. The number with the exemption at present so greatly outnumbers the population excluded from it, that the reduction in tax exemption making it equal is surely less than 25%. It will nevertheless be resisted, not because of the small tax cost, but because the present inequality drives people toward employer basing. Even employers would not lose much because all the business competitors would be treated equally. The main resistance would come from insurance companies which specialize in the weird forms of health insurance specially designed to adjust to existing law. Perhaps they should be compensated for their loss, although that sort of thing is seldom done in our system of government. Rather, they would be expected to accommodate the new rules of business or go out of the business. That's traditional, and it is traditional for their stockholders to insist that they resist it, leading to the eternal struggles of "creative destruction," which is universally praised as an ornament of our culture, except when it applies to yourself.
Conversely, insurance companies which provide Health Savings Accounts will flourish with new customers, so existing health insurance companies are urged to add a new form of business and prosper. Any change of the rules requires time to re-adjust, so there will be room for both kinds of health insurance, for a long transition period, perhaps permanently. Let a hundred flowers bloom. In fact, all of the current plans being offered under Obamacare contain deductibles of at least $6000, so the designers of that Act have grasped the right idea, which includes tacit phasing out co-payments. A copayment of 20% is well demonstrated not to be enough to influence patient behavior, and a copayment of 50% is seen by the public as no insurance at all. Copayment has always been a way of making the premium cost appear smaller than it really is, and it's very simple to calculate in a bargaining negotiation. A twenty percent copayment reduces the premium by twenty percent, and that's about all there is to it. Total costs are largely unaffected, except they trigger the invention of another layer of insurance to cover them.
Obamacare
It presently is difficult to know how many people will have health insurance after Obamacare settles down, and how much it will cost. But the Wall Street Journal reports that all of the plans being offered by the Insurance Exchanges have at least $6000 deductibles, and the various approved insurance plans cost between $187 and $590 a month. The Obama administration seems to have grasped the idea that paying small claims with three layers of insurance is a pretty expensive way to pay your bills. Therefore, it is possible to imagine an agreement between the Democratic Senate and the Republican House of Representatives, for reasons of cost, alone. Later in this book, we propose that all small claims by everyone be paid out of Health Savings Accounts, and all hospital claims are paid by diagnosis since the bedfast patient has no opportunity to bargain in the marketplace. Getting the hospitals to charge everyone the same, is an entirely different issue. The concern about such a rule is that it may contain an incentive to perform elective surgery as an inpatient when a vast number of small surgeries are adequately managed as less expensive outpatient procedures. Special accommodating adjustments such as patient discounts will probably prove necessary to prevent such an unwise migration of the locus of care. Indeed, the small but irritating local monopolies of ambulances may need to be addressed, as well, since a patient may be well enough to recover at home, but not well enough to drive himself home.
For the moment, let's not get down into the weeds of this thing. Let's just pass it, and immediately.
The public is vaguely aware there is a problem with Medicare indebtedness, but for the most part, this issue is swept aside, for fear agitation might injure the chances of funding healthcare for those of working age. The size of this debt is not well known but can be guessed at by realizing Medicare costs are 50% borrowed. The current CMS data show a line for contributions from the general fund, equalling 50% of the total. Because cost accounting for government accounts has its special features, inter-agency transfers are referred to as assets. It's a debt, all right, and a large part of it is owed to the Chinese. For whatever reason, Treasury debt is entirely "general obligation", so it is not usually possible to tell from Treasury debt, how much is assigned to particular debts. They would have to be totaled from Medicare annual reports, which are not generally available for much of the past. So we don't -- right now -- know how much we owe foreigners for Medicare debts, but it is considerable, very likely going back to the days when deficits began to appear. That gives me a choice: I can keep quiet about the subject, or I can conjecture. I choose to conjecture.
Some, maybe all, of the transfer from general taxes in the latest year to Medicare, was borrowed. Medicare started in 1965, but during the early years, the receipts from payroll deductions were larger than the expenses of the Medicare program. But when the program was fully underway, it ran a deficit. For how many years, and for what amounts, is only a guess. But I assume guessing the debt to be equal to a full year of Medicare expense, is large enough to make the point I wish to make, but may well be larger. For present purposes, let us assume the existing debt is equal to a full year's cost of Medicare, which we do know is 549.1 billion dollars. This guess is selected for illustration because it is large enough to cause alarm, but is probably on the small side. I hope it will provoke some official figure to be released, and sincerely hope my own proves to be too large..
Because, if it proves close to the guess, it presents a future problem for paying off the debt, which would actually be worse than the healthcare cost now under such heavy debate. The past indebtedness is currently not under debate and is still getting worse. The public, including my colleagues in the medical profession, often point to Medicare with admiration. Since everybody likes a dollar for fifty cents, that's perfectly natural. And so it is also perfectly natural for elected officials to treat the matter of replacing Medicare as if it were the "third rail of politics." Just touch it and you'll be dead. That's also fair play until it is proposed the whole medical system of the country be covered with a "Single Payer System", which is a fancy way of proposing everything should be funded like Medicare; and that's just too much.
So I propose, discomfiting friend and foe alike, that we buy our way out of this problem by allowing the public to buy its way out of Medicare. One by one, as they approach the 65th birthday, they should have the opportunity to relinquish Medicare, by depositing $80,000 in a Health Savings Account. Assuming 10% compound income return (see Chapter Four), $40,000 should generate $433,000 by the age of 91, which I assume to be the average longevity in a few years. By taking a guess at the size of the debt, the remaining $40,000 would throw off an additional $433,000 for paying it off. With 25 million Medicare recipients paying that much, let's hope it is more than adequate right now, although it will clearly become inadequate if we delay. These numbers ought to seem like a bargain to the public, and they certainly would seem like a bargain to the government. If there is any other proposal for managing this debt, we have yet to hear it. That's probably because of "third rail" concern, but unfortunately, it may also reflect there is no other solution to talk about.
Issues and Problems In the first place, $40,000 at 10% will only yield $202,000 by age 83, the present average longevity. It will slowly grow, as will the medical expenses from 83 to 91. The debt is already too conjectural to justify more precision, but a decade or so is not unusual for oriental negotiations. Sooner or later, we must expect this progressive longevity to flatten out, and make the problem harder to solve.
In the second place for a long time to come, people arriving at their 65th birthday will have a history of payroll deductions when they were young. This will eventually dwindle down, but it begins as a quarter of Medicare costs and must be returned as part of the buy-out. Meanwhile, persons older than 65 will have fulfilled their payroll deduction, and are paying annual premiums, which also equal a quarter of Medicare costs. This seems to be approximately prorated, so only the payroll deduction is owed these people during the transition.
And to go on, there will surely be medical developments. Some of them may raise costs, some lower them, and all of them summarized by a hoped-for cure for cancer, which may raise costs or lower them, more likely raising them before eliminating them. Once the discovery is made and announced, its price will be known, and appropriate adjustments demanded. For this and a host of similar issues, only a scientific body with the power to adjust prices can be expected to make the appropriate response with mid-course corrections. Given the present affection of the public for subsidized Medicare, it appears likely, voluntary buy-outs will be a slow and protracted process. They should provide ample time for basing reasonable adjustments to what would be mainly favorable developments.
By far the hardest part of healthcare to find a way to pay for, is the newborn child. There is no opportunity for pre-funding, the cost is considerable, and the parents are in marginal financial shape, themselves. No one has proposed a satisfactory solution, except those who say the cost is negligible, which is not true at all. Accordingly, I have proposed we take advantage of another feature of increasing longevity.
The grandparents, who were little more than a theory in 1900, have aged to the point where they often overlap by a generation. I propose we overfund Medicare at birth so that it grows to the size of a considerable inheritance at death. We can then take advantage of the extra 21 years of longevity thus included in the family. Thus an extra $28,000 bequest can be generated from investment income and put in trust for a grandchild as a dwindling asset, sufficient to cover the first 21 years of life. This is the present limit of the statute of perpetuities, and need not disturb it.
Although the details are complex, they follow the pattern of the death benefit, and will not be repeated here, The estimated extra cost is $42 per child, which seems to bring it within the boundaries of what the average person can afford, and/or the government could subsidize, with a considerable margin for error.
Although it is possible to imagine many extensions of the ideas in this short paper, I would caution against going too far without some experience to support it. In fact, what is proposed here, should e tested in an incremental manner.
Let's do some simplified math. The ancient Greeks, possibly Aristotle, discovered that money at 7% interest will double in ten years. By remembering this simple accident, you can follow the math of Health Savings Account in your head, without writing anything down. If you remember that life expectancy is now 84 years, you have eight, going on nine, opportunities to double your money. Go ahead and do it: 2, 4, 8, 16, 32, 64, 128, 256, 512, 1024. At the rate things are going, a dollar at birth becomes 512 dollars at age 90, and it isn't unreasonable to hope for a thousand-fold increase in the future.
The current expectation is an average of $350,000 in lifetime healthcare costs per person. A gift to the newborn of $350 will almost pay for it. If he sets this aside for a lifetime, forgets he has it, or just doesn't spend it, it will cover his costs. Medicare is about half of the lifetime cost, so $175 at birth would pay for a buy-out. The individual is already paying a quarter of Medicare as payroll deduction, and another quarter as premiums. So, it would cost something like $87.50 at birth to pay for the rest. Whether it's a gift of his family or a government subsidy, that is manageable. It's close, but it's manageable.
How do we get 7% interest? We assume an index fund of the total stock market will produce 11% per year, because that's what it produced for the past century, in spite of wars and recessions. We assume 3% inflation, for the same reason, leaving 8% net return. Because every 28 years on average we have a "black swan" stock market crash of 30-50%, you have to ride it out. Therefore, the conventional advice is to invest 60% in stocks and 40% in bonds, reducing your net return to 5%. But unlike a college or a museum, we have no payroll to meet, so we only use 60/40 after the age of 50, when major illness costs begin. That brings us up to 6.5% overall after the HSA gets past its early transition costs. Since index fund investing is now readily available for less than a tenth of a percent management cost, we ignore the present fees of ten times that, which are customary. If you are forced to it, just put the certificate in your bank lockbox and have it opened when you die.
How much you actually invest at birth, or whether some other payment method is employed, are political decisions. The point to be made right now is that
passive investing of this sort is close to being feasible. It is close, but a cure for cancer or diabetes might make it a sure thing. The points to be made are two:
1. Adopting this approach with the Classical Health Savings Account, may or may not pay for the whole health system for everybody, but it would pay for a mighty big chunk of it.
2. The rest of this book attempts to find a few other improvements which really would pay for the whole system with some confidence. There's no way to prove it was successful except to conduct some pilot programs. I would expect that dozens if not hundreds of other people would try to find other refinements.
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.
