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
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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.
In 1963 the Studebaker automobile company went bankrupt, leaving half its employees without anyone to pay the promised pension benefits. Congress soon resolved such things should never occur again and convened a Congressional task force to devise a law which would make employee benefits survive, even after the parent company went under. Negotiations took almost ten years and were said to craft a law that could not be amended, thus assuring employees their pensions would be independent of the fortunes of the company itself. Somewhere near the end of this long process, someone asked why it could not extend from pensions to health insurance as well. Almost as an afterthought, health insurance acquired some new features which had never really been considered in the past. ERISA (Employee Retirement Income Security Act) was enacted, signed by President Ford in 1974 and almost immediately began to change the whole discussion of health insurance. The suggestion I would make is that this legislation takes care of interstate health insurance, and seems to have created very little dissension. It might, therefore, contain some features which peacefully solve the same problem of reconciling a mobile and itinerant population with the Tenth Amendment.
Interstate Commerce Commission Seal
Because the Constitution provided for only a limited set of powers for the Federal Government, and the Tenth Amendment repeated the point for strong emphasis, every power not expressly given to the Federal, and not expressly forbidden to the States, was to be a power of the States. And that included health insurance. The Court-packing uproar of 1937 considerably strengthened the power of the Federal Government to extend its ability to regulate commerce. Indeed, advocates of this movement have been at pains to describe the Interstate Commerce Clause as merely "the Commerce Clause", as if to pretend it had never said anything else. However, the authors of ERISA (the Employee Retirement Insurance Security Act) expressly included pre-emption clauses which rather unnecessarily provide that Federal Law and Regulation should supersede state powers in that area.
There was a conflict here, in which ERISA apparently had to behave as though the Tenth Amendment did not exist. The conflict was never resolved by the Supreme Court, probably because it was so evident that business was delighted to have a thousand mandated benefits in state laws undermined by Federal pre-emptions. Concerted efforts by labor lobbyists had succeeded in putting everything they could imagine into health benefits packages, which were then exempted from income tax. Health insurance became "first dollar coverage", greatly increasing its scope. Because it included many low-cost items, its insurance administrative costs were unduly high; and because it included birth control, it was even a welcome respite for the Court system from the excited lobbyists on both sides of that inflammable issue.
Unfortunately, much of the behavior in the health insurance world is political rather than economic. Consequently, big businesses were mainly interested in is having one fifty-state insurance umbrella rather than in winning arguments in public. The use of federal regulation allowed them to have nation-wide insurance with uniform benefits, and it probably allowed them a wider set of insurance choices at lower prices. Moreover, it helped the Human Resources departments of the major corporations to have their way unhampered, and get rid of such nuisances as obstetrics for male employees. In the original negotiations, labor unions were bought off by allowing them to run their own "independent" health plans, but eventually, they went back to searching law books for loopholes. And the conflict between the "supremacy clause" and the Tenth Amendment was certainly a logical one to pursue because one mandated Federal regulation, and the other precluded it. Twenty-six states place taxes on provider institutions and most of them use the tax money to draw down federal matching money at anywhere from 1:1 to 1:4 levels, which is then returned to hospitals as "disproportionate share hospital" reimbursement. Other states use tax incentives to force third-party administrators to restructure benefits in a way that mirrors regulation.
By far the commonest set of dodges take advantage of judicial opinions that the states could regulate what was insurance, whereas the Federal regulation mostly applied to "self-insurance". The feeble distinction was whether lump sums were paid to an insurance company to distribute, or whether the parent employer distributed the money directly. By extension of this principle, reinsurance was taxed, payments to hospitals were federally regulated. The principle of risk-sharing was dragged into discussions which relegate state regulation of stop-loss arrangements, especially those with low attachment points, as indistinguishable from pure insurance; while self-insurance and experience rating are state regulated. What to do about "pure" insurance with a high deductible is less clear. (This may be one subtle reason why first-dollar coverage, in some ways the least desirable insurance form, is treated as a default, while Catastrophic coverage, which ought to be the basic protection, is relegated to a status bordering on outlandish. By treating huge costs as the responsibility of local charity, this arrangement tends to make them remain so.) That is, by inserting a fictitious intermediary, the regulation supposedly changes from federal to state. The model for this would seem to be one-bank holding companies. Consequently, trial lawyers have taken to suing the fiduciaries of trustees, leading to the comment that "You would have to be a lunatic to agree to be a fiduciary." The longer all of this goes on, the more tangled it will probably become, so the Supreme Court is probably under heavy pressure to pick a suitable case, and decide it.
Affordable Care Act
Shortly after the Affordable Care Act was passed, big business employers were given a one-year deferral of mandated coverage. The tangle with insurance exchanges for small employers (fewer than 50 employees) does somewhat justify getting that part straightened out, before taking on the much larger issue of employees in the large groups. But there is probably much more to it than that since large employers have the ability to hire assistance in the technicalities, and could probably quickly do many things small employers could not contemplate. Since it was elected to do the more difficult job first, this explanation is unconvincing. We are left uncertain: whether a big business has walked out, is bluffing its intention to walk out later, or has some other use for the extra delay. A secret Republican promise to offer more favorable terms, in exchange for help in the 2014 elections, would probably not be difficult to obtain. Meanwhile, uncertainty whether state mandates for low-cost medical items apply or not hangs over the surprisingly high deductibles being placed on insurance plans in the exchanges. For Catholic voters, it is critical whether they will be compelled to include birth control pills; for Health Savings Accounts, eliminating low-cost state-mandated benefits is important for high-deductibles to work. And for Obamacare, if state-mandated low-cost issues must be covered, it is hard to see how high deductible policies could work, how alternative co-payments can be avoided, and therefore how lowered costs can be imagined.
Henry Kaiser
Pre-empting state-mandated benefits is not the only issue that could be used for trade. Everybody has been curiously silent about the egregious unfairness of the Henry Kaiser tax exemption for employee benefits, with no deduction at all for the self-employed. The solution seems quite simple: preserve tax neutrality by lowering the tax exemption for employees by about a quarter, but extend the result to everyone. There are so many more employees than self-employed, that the exemption for self-employed could be paid for with quite a small downward adjustment of the exemption for employees. For this tax inequity to persist for seventy years, somebody is being pretty stubborn.
Note: Later in this book we discuss investment returns, and ERISA regulates huge dollar amounts of employee pensions, many of which are in trouble because they are underfunded. Most of the investment is subject to 1-2% fees of one sort or another, which would disappear if the investment switched to index fund investment without fees of more than 0.25%. Rather than let the City of Detroit, or the States of New Jersey and Rhode Island, go bankrupt because of unfunded pensions, it would seem worth-while for some politician to sweep out the investment advisors and purchase index funds. If it seems like a lot of trouble, just imagine what might happen if your political opponent in the next election, suggested it first.
There are now reported to be 15 million subscribers to Health Savings Accounts, growing at about a million new subscribers a year, with hardly any advertising. It' s really a very simple concept, consisting of two parts. The Savings Account is pretty much like any other savings account, and I understand one New York Bank has 700,000 accounts. You are allowed to make deposits up to $2350 a year, terminating when Medicare begins, at age 66. At that point, any balance in the account is turned into an IRA, and may be used for any purpose after paying income tax. When you make withdrawals for other purposes there is a penalty tax of 20%. They may be used for legitimate healthcare purposes, without taxation. The statutory basis for this is that deposits are tax-deductible, and withdrawals for health are tax-sheltered; the rest of the rules are regulation. Most accounts are linked to a debit card for medical purchases.
Two working parts:(1) Tax-exempt savings fund (2) Catastrophic (high deductible) health insurance.
HSA in Essence
In order to make deposits, the subscriber must link the account to a high-deductible health insurance policy. It is often difficult to obtain a public quote on price, which must mean the price is highly competitive and variable. Changes in the environment make for price changes which are almost not worth printing in a pamphlet. Many account managers insist on linking to a specific brokerage account, either subsidiaries, or linked by fee arrangements; such details are to be frowned upon. The new investor should be aware that most index funds of the entire domestic market return slightly less than 12%, but the manager of a fund subtracts overhead and passes on a variable amount to the customer. The amount of this return on investment is critical, and the ability to move accounts to a new manager if dissatisfied is an important feature but an optional one. It is also important for the catastrophic insurer to have made price arrangements with local hospitals which are competitive. A price of one and a quarter times the Medicare rate is on the high end.
Most investment manager are not fiduciaries, they are brokers. That is, they have no legal obligation to put the customer's interest ahead of their own. It is reported that most new subscribers are between the age of 30 and 45. That is, old enough to have some savings, young enough to gather meaningful income before being used. Actuaries report the average yearly cost is about 30% less than conventional health insurance, but price quotes are difficult to get on anything but an individual basis, and there may be some tacit underwriting.
Under auspices of the Kiwanis Club for the
Binghamton Academy of Medicine
By Dr. S.B. Blakley
The medical supervision of the expectant mother during pregnancy is called prenatal or antenatal care. Broadly speaking it includes much more than just those few months. For example, as a child, the expectant mother may have had rickets which caused a bony deformity which in turn may seriously interfere with her labor. Again, she may have had scarlet fever which left a latent kidney trouble which in turn may be so lightened up by pregnancy as to threaten her health or life. Many other examples might be given showing how important all the years that go before, as well as the immediately preceding nine months, are to the patient under discussion tonight.
The expectant mother is the most important member of any social group whether of the city, state or nation. The number, health, and character of future citizens depend largely on her. Without her home with all that it means to us is rarely maintained. Anything that affects her health or usefulness or threatens her life is of deepest general concern. The mother of the family having a baby is infinitely more important to a community than the father of the family having his appendix out. All this would seem to be self-evident, but curiously enough is only within a comparatively recent time that its truth has been at all widely appreciated or recognized. In our present vaunted civilization which after all is but a thin veneer over an ancient and eternal paganism the following is a common picture with the following persons of the play an expectant mother, rarely even partially relieved of her household duties even up to the day of her trail; a preparation for this day most dread and important if her first experience often most completely inadequate for a situation that may demand more skill and assistance than any major surgical operation, a so-called experienced neighbor women, usually of the best intentions but entirely incompetent to act as nurse and housekeeper; any accident regarded as the inscrutable act of an all-wise Providence; and finally, the new mother again taking up her increased burdens after a totally insufficient period of rest. Soviet Russia is today the only country that gives and finances a period of rest before and after labor. It is to our shame that both state and church encourage, even demand, a high birth rate, while neither offer much aid in solving the problems involved which are largely educational and economic.
But there is evidence that the expectant mother and her child are being viewed in changing light. Much of the ignorance, superstitions, and taboos about sex are being swept away. Women are being emancipated in body and mind from the slavery of a dead past. Both the medical profession and the laity have come to realize that pregnancy is often, yes even usually, NOT a normal process whatever it may have been in ages gone and that the line between health and illness during that period is very narrow. The dictum that in obstetrics nature should be allowed to take her course is but the manifestation or colossal ignorance. Maternity hospitals and pavilions are being established, and both doctors and nurses are receiving better training in this branch or the healing art. The importance of the expectant mother is being recognized. She has become something more than just a "confinement case".
What should the expectant mother do? First, she should visit the physician of her choices as soon as the need for his future services is known. If she is not able to pay a private physician, the charity department of the city or county can make such service available to her. The physician then or later will, after taking her history, make a complete physical examination including the measurement of the bones of the pelvis and whatever special or laboratory tests are needed. the physician gives her advice and instruction, and instruction, and at stated intervals thereafter further examines and advises her. It is highly important that the patient follow the advice given to her, and carefully keep all appointments requested by the physician. It is not necessary here to enter into the details of prenatal care. The information was given by the physician may be and should be supplemented by reading. Every good library has books on the subject, many women's magazines have departments offering advice and pamphlets, and the Department of Labor at Washington and New York State Department of Health at Albany have excellent booklets on prenatal care, free for the asking. No women need to be ignorant on this subject that is of such vital interest to her and hers.
The average women should pass thru her pregnancy with a very small amount of discomfort and often with improved health and reach the end of the period with vigor or body and serenity of mind, ready to fulfill her biologic duty and realizes her dreams.
The universal exercise of proper antenatal care will enormously reduce the incidence of miscarriages and stillbirths, will almost entirely abolish the convulsions of pregnancy, and go a long way toward solving the problem of the type of infection formerly known as childbed fever. It can be possible only through an enlightened public opinion. It is no idle dreams, but a perfectly practicable achievement. In the whole realm of preventive medicine, there is no more promising field than prenatal care.
IV. MEDICARE PREVAILING CHARGES (LEVEL II) 1984- PENNSYLVANIA
V. ADJOURNMENT
Influence of HCFA Regulations on Cross-Over Billing
Definition: Cross-over billing is a process by which a provider bills the primary insurance carrier, and the primary carrier then sends an electronic notification to the secondary insurance carrier. This process reduces duplicate billing, prevents errors, reduces key-entry costs, speeds the claims flow, and produces administrative savings to both insurance carriers as well as to the provider. All parties are consequently anxious to promote cross-over billing.
Problem: In the case of cross-over billing between Medicare and Medicaid, a problem is created when the provider number for group providers or assignment accounts is used since these provider number usually differ from those of the individual provider himself. HCFA rules permit Medicare to utilize group and assignment-account provider numbers, but HCFA insists that Medicaid utilize only individual provider numbers.
Proposal: That HCFA reconciles the rules for the two programs so that a uniform system is employed. The Pennsylvania Medical Society has no position as to position as to which system is superior and limits its petition to the creation of uniform rules for provider numbers.
The following is an executive skeleton of Revised Health Savings Accounts. Expansions grew from 1980 concepts discovered by John McClaughry and me, among them that combining an IRA for Health, with Catastrophic (High deductible) Health Insurance, transforms simple interest into extended compound interest. That maneuver usually reduces administrative costs of both, particularly when the two age groups come to face retirement. After all, retirement insurance is just health insurance which doesn't specify the cause or location of death, and its risk is nearly 100%. Young people usually have small health costs, while old folks often have bigger costs; for both age groups health is a gamble they can"t control. But it's still a cost.
Since 1980 we added five new features building on the first two, depending on luck and inclination. That's seven in all.
1.-2. In 1980 we started by combining "the HSA for Health" with "catastrophic health insurance", canceling out some costs of both by unifying them. Young people don't have much health expense, so the HSA provides extra retirement income to the person who earned it, with the appropriate tax deduction. An older employee can spend the surplus on retirement, which he surely can use, plus a surprise tax deduction for the accumulation. Or he can just spend the money if he happens to prefer it. It's like magic, and it's legal. For decades insurance companies have profited from improved longevity; this system shifts some profit to the patient.
3. These two points are reasonably familiar, so let's just skip to a third point. Let's add optional new insurance features as needed, like "Beads on a string." Supplemental co-payments and co-insurance, for example. Or not, if you prefer to spend the money on something else. The easiest option is to split and combine the two costs into Last year of life coverage . As much as half of lifetime Medicare costs fall into the last year of someone's life; the money is already spent. There's no point in quibbling, so just pay off and save much of the administrative cost by reducing it to sample monitoring. By a combination of saving costs and shifting them to Social Security, the burden on Medicare premiums is immediately reduced. By making it optional, you reduce the transition costs, which are mainly Rube Goldberg attempts to adjust for the inevitable age of death variation.
4. The fourth point is seemingly unrelated. We have gone off the gold standard, found no substitute. Inflation-targeting worked for a while, then quit working. Someday, economists will explain this, but the leading contestant at the moment is destruction of investing cost by index funds and other computer innovation. That adds five or more percent to investment earnings, triggering a virtuous deflationary cycle, probably more than canceling inflation. You don"t have to understand this to take advantage of it. We had a near-death experience with inflation and escaped by luck. Yes, it will "trickle down", and yes it will hurt some people.
5. For a fifth addition add compound interest, which Aristotle called the "Eighth wonder of the world". It means interest gets bigger with time. 'Way bigger, so it's usually bigger than you expect. By adding one insurance to the end of another, you extend the duration. Since compound interest curves upward at its far end, it's much more effective than you might guess. And it's tax-free until you spend it, so it's a more powerful stimulus to spendable income. Trust funds need useful alternatives, and HSA with Congressional sanction, could provide one, by a flexible extension of the duration of perpetuities over two generations, taking advantage of compound interest rising by increasing its length.
6. Let's be patient and try that first, to see how clever lawyers discover unsuspected loopholes. The American public clearly yearns for universal free medical care of the highest quality. But even if we could afford that, which we probably can't, most of us don't trust politicians to resist public pressure to borrow, then worry about ruinous costs after it's too late to fix them. Hasty legislation always creates loopholes, as Cyprus, Greece, and England discovered in one way, and a sudden cure for cancer or Alzheimers would create in another. It surely requires testing during several Congressional revisions to get it right, long after unmanageable sums slam the exits. Ours is the only Constitution to survive two hundred years, and we still don't entirely understand why it has. Don't change it suddenly.
7. A seventh feature is a warning. A flexible savings account is not a Health Savings Account. Anyone who deliberately tries to confuse the two is potentially a fraud trying to restore lost income. Lots of people have an FSA, believing they have an HSA. Avoid such people, dis-elect anyone of any party who proposes such a substitute, and don"t return to salesmen who propose it.
There's more, but these seven points are enough.
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.
