Philadelphia Reflections

The musings of a physician who has served the community for over six decades

367 Topics

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)
DelawareOriginally 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.

Tourist Walk in Olde Philadelphia
Colonial Philadelphia can be seen in a hard day's walk, if you stick to the center of town.

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

Independence HallMillions 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.

Benjamin Franklin Parkway
Benjamin Franklin Parkway

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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The Heirs of William Penn

William Penn

Freedom of religion includes the right to join some other religion than the one your father founded; William Penn's descendants had every right to become members of the Anglican church. It may even have been a wise move for them, in view of their need to maintain good relations with the British Monarch. But religious conversion cost the Penn family the automatic political allegiance of the Quakers dominating their colony. Not much has come down to us showing the Pennsylvania Quakers bitterly resenting their desertion, but it would be remarkable if at least some ardent Quakers did not feel that way. It certainly confuses history students, when they read that the Quakers of Pennsylvania were often rebellious about the rule of the Penn family.


Such resentments probably accelerated but do not completely explain the growing restlessness between the tenants and the landlords. The terms of the Charter gave the Penns ownership of the land from the Delaware River to five degrees west of the river -- providing they could maintain order there. King Charles was happy to be freed of the expense of policing this wilderness, and to be paid for it, to be freed of obligation to Admiral Penn who greatly assisted his return to the throne, and to have a place to be rid of a large number of English Dissenters. The Penns were, in effect, vassal kings of a subkingdom larger than England itself. However, they behaved in what would now be considered an entirely businesslike arrangement. They bought their land, fair and square, purchased it a second or even third time from the local Indians, and refused to permit settlement until the Indians were satisfied. They skillfully negotiated border disputes with their neighbors without resorting to armed force, while employing great skill in the English Court on behalf of the settlers on their land. They provided benign oversight of the influx of huge numbers of settlers from various regions and nations, wisely and shrewdly managing a host of petty problems with the demonstration that peace led to prosperity, and that reasonableness could cope with ignorance and violence. When revolution changed the government and all the rules, they coped with the difficulties as well as anyone in history had done, and better than most. In retrospect, most of the violent criticism they engendered at the time, seems pretty unfair.

John Penn

They wanted to sell off their land as fast as they could at a fair price. They did not seek power, and in fact surrendered the right to govern the colony to the purchasers of the first five million acres, in return for being allowed to become private citizens selling off the remaining twenty-five million. Ultimately in 1789, they were forced to accept the sacrifice price of fifteen cents an acre. Aside from a few serious mistakes at the Council of Albany by a rather young John Penn, they treated the settlers honorably and did not deserve the treatment or the epithets they received in return. The main accusation made against them was that they were only interested in selling their land. Their main defense was they were only interested in selling their land.

As time has passed, their reputation has repaired itself, and they bask in the universal gratitude which is directed to their grandfather and father, William Penn. Statues and nameplates abound. Nobody who attacked them at the time appears to have been really serious about it, except one. Except for Benjamin Franklin, who turned from being their close friend to being their bitter enemy. Franklin tried to destroy the Penns, traveled to England to do it, and after twenty years seemed just as bitter as ever. Something really bad happened between them in 1754, and neither the Penns nor Franklin has been open about what it was.

Franklin Declares Independence a Year Early

Joseph Priestly became a close friend of Benjamin Franklin almost as soon as they met. Priestly was an Anglican clergyman who broke loose and formed the Unitarian Church, and meanwhile, his scientific discoveries also entitle him to be called the Father of Chemistry. Franklin, of course, was the discoverer of electricity; it would be hard to be sure which of the two was more brilliant. In July, 1775, Franklin wrote the following letter to Priestly, which makes a trenchant case that the American colonies should, and would, break away from England. Since some legal authorities, following Lincoln's lead, maintain that Jefferson's manifesto "informs" the United States Constitution, it might be well to begin referring to this letter as an even clearer statement of the mindset of America's founding leaders.

General Thomas Gage

" Dear Friend (wrote Franklin),

"The Congress met at a time when all minds were so exasperated by the perfidy of General Gage, and his attack on the country people (i.e. Of Lexington and Concord), that propositions of attempting an accommodation were not much relished; and it has been with difficulty that we have carried another humble petition to the crown, to give Britain one more chance, one opportunity more of recovering the friendship of the colonies; which however I think she has not sense enough to embrace, and so I conclude she has lost them forever.

"She has begun to burn our seaport towns; secure, I suppose, that we shall never be able to return the outrage in kind. She may doubtless destroy them all; but if she wishes to recover our commerce, are these the probable means? She must certainly be distracted; for no tradesman out of Bedlam ever thought of increasing the number of his customers by knocking them on the head; or of enabling them to pay their debts by burning their houses.

"If she wishes to have us subjects and that we should submit to her as our compound sovereign, she is now giving us such miserable specimens of her government, that we shall ever detest and avoid it, as a complication of robbery, murder, famine, fire, and pestilence.

"You will have heard before this reaches you, of the treacherous conduct to the remaining people in Boston, in detaining their goods, after stipulating to let them go out with their effects; on pretence that merchants goods were not effects; -- the defeat of a great body of his troops by the country people at Lexington; some other small advantages gained in skirmishes with their troops; and the action at Bunker's-hill, in which they were twice repulsed, and the third time gained a dear victory. Enough has happened, one would think, to convince your ministers that the Americans will fight and that this is a harder nut to crack than they imagined.

"We have not yet applied to any foreign power for assistance; nor offered our commerce for their friendship. Perhaps we never may: Yet it is natural to think of it if we are pressed.

"We have now an army on our establishment which still holds yours besieged.

"My time was never more fully employed. In the morning at 6, I am at the committee of safety, appointed by the assembly to put the province in a state of defense; which committee holds till near 9, when I am at the Congress, and that sits till after 4 in the afternoon. Both these bodies proceed with the greatest unanimity, and their meetings are well attended. It will scarce be credited in Britain that men can be as diligent with us from zeal for the public good, as with you for thousands per annum. -- Such is the difference between uncorrupted new states and corrupted old ones.

"Great frugality and great industry now become fashionable here: Gentlemen who used to entertain with two or three courses, pride themselves now in treating with simple beef and pudding. By these means, and the stoppage of our consumptive trade with Britain, we shall be better able to pay our voluntary taxes for the support of our troops. Our savings in the article of trade amount to near five million sterling per annum.

"I shall communicate your letter to Mr. Winthrop, but the camp is at Cambridge, and he has as little leisure for philosophy as myself. * * * Believe me ever, with sincere esteem, my dear friend, Yours most affectionately."

[Philadelphia, 7th July, 1775.]


The Invention of Air: A Story of Science, Faith, Revolution,and The Birth of America, Steven Johnson ISBN: 978-1-59448-852-8 Amazon

SHAKSPERE SOCIETY February 5, 2003


Dean Wagner in the chair. Other members present: Bartlett, Binnion, Bornemann, Cramer, Di Stefano, Dupee, Fallon, Fisher, Frye, Griffin, Hopkinson, Ingersoll, Lehmann, Madeira, O' Malley, Peck, Warden, Wheeler.

Members are grateful to Messrs. Friedman, Pope, and Madeira for hosting the 2003 Annual Dinner on the Bard's birthday, Wednesday, April 23 The probable site will be the Awbury Arboretum in Germantown.

Dr. Orville "Pete" Horwitz, a longtime member of this Society, died on January 28 at the age of 93. A memorial service will be held on February 7 at eleven AM at the Church of the Redeemer in Bryn Mawr. Senior members recalled that Dr. Horwitz had loved the Society and had attended meetings faithfully for many years. He was a veteran of the Battle of Midway, and during his Navy service in World War Two, he was awarded the Bronze Star with two oak leaf clusters. He went on to a distinguished career as a cardiologist and medical scholar in Philadelphia. He is survived by his wife of almost seventy years, Natalie, a niece of John Foster Dulles. Members grinned at memories of Dr. Horwitz's vigorous role in an annual competition among men's clubs from New York, Boston, and Philadelphia to decide whose members could tell the funniest off-color stories. Dr. Horwitz starred in this competition, borrowing stories from his Trenton barber.

Mr. Dupee recently visited our senior member, Mr. Foulke, in Florida, and brings Mr. Foulke's cordial greetings to all Society members. Mr. Dupee also reported that he has arranged, on behalf of the annual Shakspere competition among local high schools students, for Society members Fallon and Peck to play a role this year. All twenty-eight of the young people competing will be presented with copies of Dr. Fallon's recently published reader's guide to Shakspere's plays. Dr. Peck will be one of the judges of this year's contest, to be held at the Walnut Street Theater on President's Day, February 17, from 9:00 AM through the afternoon. Each of the young people, winners of contests at their respective schools, will recite a passage of some twenty lines from one of the Bard's plays, and one of Shakspere's sonnets. The winner here goes on to competition among regional winners in New York City.

Members voted on whether they favored allowing women to be eligible for membership in the Society. Several members not present had already expressed their opinions to the Secretary or the Dean. Dean Wagner announced that the final tally was eighteen votes in the affirmative, thirteen in the negative, and nine active members not voting. The motion was therefore defeated since it did not receive the support of three-quarters of those voting. Women guests are of course always welcome. A couple of members commented that we have no rules either welcoming or rejecting the candidacy of women to be members of the Society. Presumably, anyone proposed as a member, according to whatever criteria we decide on following in the future, is eligible for election. The Bartlett Committee will shortly make recommendations as to what these criteria should be.

We elected to membership in the Society Mr. Jonathan Schmalzbach, proposed as a candidate by Mr. Lehmann. We will welcome another dinner visit in the near future by Mr. Ake's friend Michael Mabry, who visited us twice in October.

We completed our reading of The Two Gentlemen of Verona in short order. We noted in Act Four that the disguised Julia analyzes her feelings about her perfidious lover Proteus at some length; she prefigures articulate psychologists of love in Shakspere's later and better romantic plays. Julia and Silvia are by far the most vigorous and strong-minded characters in this weak play, suggesting Rosalind and Juliet and Viola and Olivia, and even, perhaps, Desdemona, in later masterpieces about conflicted love. In Act Five, we visit the forest, so often a symbolically important setting for scenes in the Bard's plays of love, as in Midsummer Night's Dream and As You Like It. Strong emotions cause turmoil but are reordered after threats to lovers' happiness.


Respectfully submitted Robert G. Peck Secretary

Gazela Primeiro

{The Gazela Primeiro}
The Gazela Primeiro

The Portuguese sailing ship Gazelo Primeiro is parked at the foot of Market Street, where it can be reached by going down 45 steps of a winding staircase. It would be well to remember that you will have to climb 45 steps to get home if you go that way, and so there are attractions to parking your car on the lot which is right next to the ship. No one seems to be sure why it is the Primeiro, but the best guess is that there were several issues of this model, and this was the first. If you overlook the history of the ship largely carrying a cargo of dead fish in its commercial days, it's a beautiful tall ship, with a cheerful helpful crew.

The Franklin Inn Club held its 2009 annual summer picnic aboard, and everybody dressed suitably nautical, the food was good, the breeze was steady, and the weather generally outstanding.

Healthcare's Growing List of Indebtedness

Extensive premium changes in health insurance followed the introduction of the Affordable Care Act. Most changes involved an increase in patient participation in the costs, either deductibles or coinsurance, coupled with a "cap" on total patient payments. Almost all insurance seemed to grasp the futility of co-payment as a purchasing restraint, substituting fairly high deductibles for the old 20% co-pay. As election day nears, we are seeing a rash of articles about the hardships of front-end deductibles, during the first year of their introduction, and the largest patient group with this kind of experience are holders of Health Savings Accounts. A sudden media clamor about one point generally suggests some political stirring-up is taking place, but perhaps it is fast-breaking news that someone with a torn fingernail decided to bandage it herself rather than go to the accident room, all because of the shocking discovery that the days of first-dollar coverage are fast receding. The lady in the article didn't mention any other medical debts, but that is surely coming in the news.

After Medicare was introduced in 1965, I had already been in practice for fifteen years, and it did not surprise me how many patients, indigent and otherwise, had snaggly teeth, perforated eardrums, amazingly big hernias, gall stones, extensive varicose veins, and gigantic prostate glands. It was just the way things were, and doctors set about treating 'em as they appeared. What amazed me, six or seven years later, was the supply of these things had greatly diminished. Only then did I realize that people had been holding back on elective surgery because of finances. This backlog was a reasonably good measure of the benefit which Medicare was having, by giving elective surgery away free.

But that was only true if you consider every single remediable condition to be a disgrace of some sort. The people who had these conditions had weighed the costs against the benefits and had often simply declined. You could argue if you must, that poor folks just couldn't afford to get essential treatment, and that anyone who denied them this essential human right was an ogre; but that didn't appear to be the case in large measure. What was true was that the threshold for offering charity care was set to match the judgment of the decliners, rather than the level of physical perfection of an ancient Greek god. Folks just didn't think the surgery was worth the money, but when it became free, a new standard was set and they might as well get it fixed like a dent in an auto fender. Nevertheless, there's a strange fact about surgical scarcity and abundance. If you are planning on having any of these procedures, I would advise getting a surgeon with training during that catch-up period of the nineteen-seventies, because he had a lot of practice. In fact, my granddaughter flew to Nashville to have a perforated eardrum repaired by a famous expert during that period. When she recently needed a second operation after forty years, she had trouble finding a surgeon who could do it, even with half a dozen doctors in her family.

Surely a front-end deductible won't get us back to the same state of affairs, even if deductibles continue another forty years. But to some degree, it will happen, and what we once called a backlog will resurface as a debt from one time period to the next, with the threshold reset. Since we definitely need deductibles, it seems we apparently also need a small backlog of untreated elective (non-fatal) conditions, whether they do better than that in France or Sweden, or not. Since it can be safely predicted this will happen, we need to devise a way of managing the issue without provoking unsustainable costs. In the meantime, known but untreated, treatable conditions will become an accounting entry, which can fairly be attributed to the solving of our health cost issues. It's a debt, but I'm not sure total bodily perfection is the best standard of it.

Foreign debts for Medicare. For some time, Medicare has been 50% subsidized by federal borrowing. At the very beginning in 1965, it was 100% federally subsidized, and gradually payroll deductions, premiums and new programs with better funding arrangements took over. So far as is easily determinable, no one has dug out all of the subsidies and repayments, to be able to tell us what the accumulated unpaid debt for the Lyndon Johnson entitlement programs has been. What it has accomplished is harder to measure, since it must include a share of the improved longevity during the interval. Nevertheless, we could make an effort to see what the book cost has been. Surely it has been greater than just the cost of elective surgeries. At first, the creditors were all American citizens, most taxpayers, but at least it kept the money within the domestic budget. Since we started to borrow the money from the Chinese government, it assumes a different character, one which any creditor would feel entitled to evaluate. To know what to do about this debt is above my pay grade, as they say, but at least it would seem to be responsible stewardship to make a formal accounting of where we stand, and what we plan to do about it.

Domestic Healthcare Debts. Without getting into a wrangle about the Tenth Amendment, it is fair to say that health care has long been thought to be a responsibility of the several states, so at the least, the fifty state budgets would have to be examined and aggregated, perhaps the municipal budgets as well. In Philadelphia, the deficit of PGH (Philadelphia General Hospital) was running eleven million dollars a year, when it closed in 1977. The nation's first hospital, the Pennsylvania Hospital, was created by a grant from the state legislature in 1755, at a time when Ben Franklin was active. Perhaps it is not necessary to go quite so far back to see how the books balance, but any adjustment for inflation would bring out the considerable taxpayer expenditure for health, ever since the nation was founded.

Sustainable Growth Factor. Every year since 1997, Congress has calculated the rate at which health costs should be growing, and when it exceeded that, has planned to reduce physician reimbursement to compensate. Every year Congress has relented at the last moment, but never put an end to the threat. Since the accumulation has reached a point where almost every physician in practice would have to stop the practice if Congress honored its threat, something must be done about it. Paying it all off at once would trigger a 26% drop in physician income since every physician carries a 50% gross overhead, collecting an additional 26% would be a disaster. Perhaps the two political parties each hope the other will get the blame and pay the bill. But the bill remains part of the debt hanging over the Federal Government for health entitlements, and like most of this debt, it is a question how to treat all of its inflation in the interval.

Healthcare Mortgages. Bill Dunkelberger the Philadelphia economist, recently remarked that real estate is where the rubber hits the road, the place where interest rates really matter, the place where equities collide with fixed income. For eight years past, our long term interest rates, net of inflation, have been close to zero. That allows the government to borrow free of charge, and in effect allows hospitals and universities to build buildings without much or any cost.

Unfortunately, our businessmen have not responded with a comparable spree of interest-free borrowing, because they see nothing worth borrowing to build for. Their unwillingness to spend leads to the appearance of growing earnings, which artificially supports the stock market. It's hard to imagine a stock crash just because prosperity returns, so it's hard to know what will happen if it does. Hospitals and universities think they have something to build which will generate a healthy return for them, so one builds out-patient facilities, and the other builds lavish dormitories. When interest rates return to normal (they haven't, in Japan, done so for seventeen years), it's a puzzle to know whether the economy and the stock market will tank, or will celebrate. In any event, there is a great deal of new real estate debt which must be added to the level of government indebtedness, due to health. Since nothing much could be done with such single-purpose structures, their disposal is also part of the consideration. When Jefferson University received a gift of a basic science building to house the first two years of its classes, they got a maintenance jolt. Just to heat, air condition and clean the building consumed the entire tuition of the first two years of classes.

Student Loans, broadly defined. To judge by Nineteenth-century plays and novels, medical students were traditionally impoverished. Today, students of all descriptions are carrying six-figure indebtedness, but medical students are a special case. They run up debts in order to stay in school, and the schools prosper. Then, they take jobs for several years as house officers in hospitals, who are paid by the government from Medicare funds which are used in large part to pay off their loans. And then, they go into practice, often reimbursed by salaries provided by government entitlement programs like Medicare and Medicaid. It's more than I am able to say whether these successive loans add to each other, or cancel each other out. In any event, a huge amount of money is being paid for what is described as medical education, but a certain amount of it is diverted to other university uses.

Future Entitlements. In many ways, the largest indebtedness to account for, are entitlements which have been conferred on future generations, many of whom are not yet American citizens. This is the problem most pension funds are now encountering, of whether such a future promise is a contract which must be honored, that is, whether it counts as a debt. Congress certainly acts as though it must say it is a contract, or else be dis-elected. But the rest of us would not regard that as much of a tragedy, so perhaps it isn't a debt. Whatever we end up calling it, it would surely be an improvement if we could hear it accounted for as if it were the debt of a corporation. Perhaps that wouldn't lead to improving the situation, but it would certainly feel a little better.

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.

Sociology: Philadelphia and the Quaker Colonies
The early Philadelphia had many faces, its people were varied and interesting; its history turbulent and of lasting importance.

Nineteenth Century Philadelphia 1801-1928 (III)
At the beginning of our country Philadelphia was the central city in America.

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.