Philadelphia Reflections

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

1 Volumes

European Common Market and the American Constitution Compared
It is an interesting question how similar the constitutions of the European Union and the United States are, while reaching dissimilar outcomes. A real question arises whether further small modification might trigger major changes, or whether Constitutions are just less important than our Founding Fathers believed. If we expect different outcomes, It can be an important question.

Quakerism

New topic 2019-05-07 00:25:40 description

A Quaker Carillon

{carillon bells}
Carillon Bells

A bell in a belfry tolls the same note, over and over. A carillon is a collection of bells, each a different size and shape, producing a different note. If they all toll together, they make a jangling noise. If tolled in a certain sequence, with a certain timing -- they play a tune.

Carillons were first and best devised in the low countries of Holland and Belgium. The oldest one, and the finest ones are found there, perhaps because some were re-used. When wars approached, they were taken down and melted into cannons. When the war was over, the cannons could be melted into an improved carillon. Those who hate war-- can sometimes go forward, even from war.

Like a tuning fork, a large bell sounds its tone for several seconds. When a second note follows closely, it must be in the same key or register, harmonious, or it will clash. But a second note which waits its turn -- is a companion, and the two then stand together, inviting a third to join them.

Small bells last longer than big ones. Big ones must be struck harder, eventually wearing a flat spot, which produces a flatter tone. In time, the off-key vibration causes the bell to crack -- right at the place that once began as its sweet spot.

Quaker Carillon

{Toilet}
Carillon Bells

A carillon is a graded series of bells in a belfry, to play tunes. Quakers avoid bells and belfreys, but instinctively grasp the concept of a carillon. Why is that so?

Spoken messages at an unprogrammed meeting, like ringtones of a carillon, are followed by persisting vibrations of varying intensity. Care must be taken, no matter how pure the next message may be, to preserve harmony with the ring decay of the tone it has just followed. Not too soon, not too unrelated.

Overly long delays between messages may be discordant, breaking up the tune unless the message is harmonious. Lacking a tune, the messages fall apart. A silence of even longer length may restore the tune for a gathered meeting, or the next speaker may gently rebuke the interrupter. Sometimes the difference is distinguishable only when you know the personalities. A meeting without a tune is a disappointment, pointing toward individual experience instead of group unity. But death or other catastrophes can have its message destroyed by trite commentary. Rising above triteness can be one way a "weighty" meeting rises above its rank to demonstrate the fearlessness of leadership; failing to rise to an occasion is a way of demonstrating ordinariness.

The Origins of Haddonfield

{Haddonfield's Dragon}
Haddonfield's Dragon

Haddonfield, New Jersey is named after Elizabeth Haddon, a teenaged Quaker girl who came alone to the proprietorship of West Jersey in 1701 to look after some land which her father had bought from William Penn. Geographically, the land was on what later came to be called the Cooper River, and it must have been a scary place among the woods and Indians for a single girl to set up housekeeping. It was related in the "Tales of a Wayside Inn" that Elizabeth proposed to another young Quaker named John Estaugh. Because no children resulted, she sent to her sister in Ireland to send one of her kids, a girl who proved unsatisfactory. So the kid was sent back, and Ebenezer Hopkins was sent in her place. Thus we have Hopkins pond, and lots of Hopkins in the neighborhood ever since. Eventually, the first dinosaur skeleton was discovered in the blue clay around Hopkins Pond, and now can be seen in the American Museum of Natural History, so you know for sure that Haddonfield is an old place. Eventually, the Kings Highway was built from Philadelphia to New York (actually Salem to Burlington at first) and it crosses the Cooper Creek near the old firehouse in Haddonfield, which claims to house the oldest volunteer fire company in America, but not without some argument about what was first, what is continuous, and therefore what is oldest. Haddonfield is, in short, where the Kings Highway crosses the Cooper, about seven miles east of City Hall in Philadelphia. The presence of the Delaware River in between makes a powerful difference since at exactly the same distance to the west of City Hall, is the crowded shopping and transportation hub at 69th and Market Street. Fifty years ago, Haddonfield was a little country town surrounded by pastures, and seventy years ago the streets were mostly unpaved. The isolation of Haddonfield was created by the river and was ended by the building of the Benjamin Franklin Bridge in 1926. If you go way back to the Revolutionary War, the river created a military barrier, and many famous patriots like Marquis de Lafayette, Dolley Madison, Anthony Wayne and others met in comparative safety from the British in the Indian King Tavern. In a famous escapade, "Mad" Anthony Wayne drove some cattle from South Jersey around Haddonfield to the falls (rapids) at Trenton, and then over the back roads to Washington's encampment at Valley Forge. In retaliation, the British under Col John Simcoe rode into nearby Salem County and massacred the farmers at Hancock's Bridge who had provided the cattle. At another time, the Hessians were dispatched through Haddonfield to come upon the Delaware River fortifications at Red Bluff from the rear. Unfortunately for them, they encamped in Haddonfield overnight, and a runner took off through the woods to warn the rebels at Red Bank to turn their cannons around to ambush the attackers from the rear, who were therefore repulsed with great losses. These stories are told with great relish, but my mother in law found out some background truths. Seeking to join the Daughters of the Revolution in Haddonfield, she was privately told that the really preferable ladies' the club was the Colonial Dames. Quaker Haddonfield, you see, had been mostly Tory.

{Alfred Driscoll}
Alfred Driscoll

A local boy named Alfred Driscoll became Governor of New Jersey, but before he did that he was mayor of Haddonfield. He had gone to Princeton and wanted to know why Haddonfield couldn't look like Princeton. All it seemed to take was a few zoning ordinances, and today it might fairly be claimed that Haddonfield is at least as charming and beautiful as Princeton, maybe nicer. At the very least, it has less auto traffic. Al Driscoll went on to be CEO of a Fortune 500 pharmaceutical corporation, and everyone agrees he was the world's nicest guy. The other necessary component of beautiful colonial Haddonfield was a fierce old lady who was married to a lawyer. Any infraction of Al's zoning ordinances was met with an instant attack, legal, verbal, and physical. A street-side hot dog vendor set up his cart on Kings Highway at one time, and the lady came out and kicked it over. If you didn't think she meant business, there was always her lawyer husband to explain things to you. She probably carried things a little too far, and one resident was driven to the point of painting his whole house a brilliant lavender, just to demonstrate the concept of freedom. Now that she and her husband are gone, the town continues to be authentic and pretty, probably because dozens of other citizens stand quietly ready to employ some of her techniques if the need arises.

Camden NJ: The Third, or Irish, Tenth

{Camden in 1662}
Camden in 1662

The early Swedish and Dutch settlers tended to sail up the Delaware Bay, and settle on the right-hand bank, which we now call New Jersey. In time, Seventeenth-century settlers, even William Penn, switched over to the left, or Pennsylvania, side. The Dutch, who had experience with dikes on the Zuider Zee, knew that it was quicker and easier to drain the lowlands than to chop down big trees and dig up the roots. Although the Dutch were more interested in fur trading than agriculture, they had to eat. Fish, crabs, oysters and truck gardens were enough for that purpose. After establishing a Fort Nassau at what is now the town of Gloucester, on the south edge of Camden, fur trading on the New Jersey side began to fall off, and the Dutch settlement was moved across the river as Fort Casimir, next to the mouth of the hidden river, the Schuylkill, just south of what is now the international airport. That was fine for the Dutch to stay close to their ships, but the Indians on the far side of the swamp resisted coming down the swampy river and held back to do their fur trading at Gray's Landing, on the high ground between Bartram's Gardens and the University of Pennsylvania. For the Dutch it was a pleasant paddle up from the mouth of the river at Fort Casimir, and anyway you never know about strangers.

William Penn followed the same path, buying and reselling farmland in New Jersey for a decade before he asked for, and King Charles gave him, Pennsylvania. Skipping many of the details, northern New Jersey, called East Jersey, was given to Scottish Quakers, while what we call South Jersey and they called West Jersey, was divided into ten parts among the English Quakers. The Third Tenth around the Cooper River roughly corresponds to Camden County, and was mainly purchased by Irish Quakers and for a while was called the "Irish Tenth". In time, Gloucester County was split off from Camden County, which was mainly known originally as Newton Township. After a century, the Irish origins of the local inhabitants of Newton and Haddonfield were largely forgotten. The town of Gloucester, however, was situated on the river next to what was to be the vast shipyards of New York Shipbuilding Corp.(1899-1967). First addressing the oak forests of West Jersey for the masts of sailing ships, sailing ships were built with lumber logs floated down the Susquehanna River in rafts during the Nineteenth century. This industry attracted later Irish immigrants during the time of the great Irish migrations, and still more were attracted when World War I made Camden a major steamship building center. The experience was repeated during World War II, reaching its eventual high point when the nuclear Aircraft carrier Eisenhower could be seen under construction by commuters going over the Walt Whitman Bridge.

Shipbuilding, like other heavy industry of the rust belt, moved abroad seeking cheaper labor, and what little remained on American soil moved to Norfolk, Virginia. The response of protectionist legislation made America even less attractive for unionized industry. The wiser workers saw what was happening and sought jobs in other industries, elsewhere. But Gloucester City, underneath the bridge girders and surrounded by winding creeks, held out as an oasis of working-class Irish as the southern anchor of crumbling, decaying Camden. About a thousand homes had been built by the federal government during the labor shortages of World War I, as Fairview. These two little Irish enclaves, 97% Caucasian, continue to hold out for a day that will likely never return, gathering in their taverns to sing songs about old martyrs, fighting to maintain control of the industrial unions, and dominating the Democrat politics of the county. There was a time when leverage might have established political control of South Jersey, and through that to the domination of the whole state, but that gets progressively less likely. Tough politics essentially met more than its match in the river towns of North Jersey, other groups learned to play the ethnic game, and the recent uproar about child molestation has loosened the hold of their church on young adherents with school children. The same pattern seems to be emerging on the Pennsylvania side of the river in Delaware County, where however the political machine has historically been Republican.

Meanwhile, just a little to the north, the city of Camden steadily decays and deteriorates. Now only half the size of its 125,000 "Citadel of Republicanism" in 1950, the title of America's poorest city is applied to an average income of $18,000, and various statistics of violent crime make it the first or second most dangerous place in America to live. The City is 53% black, 29% of Puerto Rican origin, and 44% below the official poverty level. In 2001, its Mayor was sent to jail as an affiliate of the Mafia, and the state took over the running of the city. In 2009, a state auditor reported that the books were in such chaotic condition that it was impossible to say where they stood, financially. Along the way to this sorry state, RCA Victor (1901-1986) finally moved out, after decades of watching its employees migrate to the suburbs, taking their tax revenue with them. Although Campbell Soup loyally maintains and is even expanding its national headquarters in Camden, the soup is made elsewhere. Frozen chicken dinners are made by the hundreds of thousands in Delaware, assembling the tinfoil, chickens, and peas from hundreds of miles to the moment when it is packaged mechanically in a manner that would shame the Japanese. There was a time in living memory when truckloads of Jersey tomatoes were lined up at the Camden soup factory for miles, but all that has moved to California. Jersey tomatoes ripened sequentially throughout the season, requiring human tomato pickers to tell green ones from red ones. A new form of hybrid tomato ripens all the fruit simultaneously, allowing it to be mechanically harvested, and taking advantage of three crops a year in California. The Golden State on our western coast seems to be having labor and tax trouble, too; but that is small comfort to Camden.

As factories close, people abandon their homes, slums result. The schools deteriorate, migration and crime increase. Most people would say it is a mess. A recent sociological study, called Camden After the Fall describes in painful detail how every idea anyone has ever had about how to turn Camden around -- has been tried, amply funded and found to be an utter and discouraging failure. The highway system has been modernized, only to allow commuters to buzz through Camden somewhat faster. Public buildings have been built, only to underline the fact that no new construction has taken place with private money in decades. Building a prison in the center of town created jobs, and now more jobs are being created to tear it down. Rutgers, the state university, has a branch under the shadow of the Ben Franklin Bridge. The battleship New Jersey is at anchor in a lovely riverside park, there's a nice little minor league baseball park. Anything you can build with tax money has been built. There's just no private industry, or business, or profession. Anyone who has a bright idea is welcome to read Camden After the Fall . It's just possible something to try has been overlooked, though it isn't very likely. Except for law, order and good schools.

After decades of watching Camden get steadily worse as I commuted hastily through it, I would say there actually is sort of a plan visible. As houses decay, they are torn down, and the grass is planted. It seems likely that the plan is to wait until a large enough plot of land is cleared and planted to grass, so it eventually becomes attractive to a developer. And then the developer will make tons of money with raw land that even the Indians in 1640 could see was very well situated.

The Empire Visits Haddonfield, Briefly

{The Holy Roman Empire}
The Holy Roman Empire

When William Penn extended an invitation to all religions to come to a place of religious freedom, he really meant it. All religions were welcomed and tolerated, but the English government was deathly fearful of French Catholics in Canada, and Spanish Catholics in Florida. The Stuart kings were Catholic, sort of, but the important issue was protecting colonial real estate more than protecting doctrinal purity. When they picked up immigrants at European ports, the ships had to make a stop in England, and any Catholics aboard were removed.

So one very large and important cultural group never had much influence in America, particularly in Philadelphia. The Holy Roman Empire, that large loyally powerful European Catholic group in central Europe and southern Germany, just never got here in any great number. Americans eventually came to hear there was an important culture of some sort centered in Vienna, full of fat jolly folks who danced waltzes, but these apparitions were seldom seen in person and were never much thought about. The steel mills of western Pennsylvania drew in large numbers of Hungarians, and they told of Vienna's rival capital in Budapest, but that rivalry was apparently like Penn and Cornell or maybe Harvard and Yale, and what difference. Occasional visitors from those regions would grow strangely hostile upon encountering this indifference to what seemed pretty important back home. But one must remember to be more polite when around guests, that's all.

It took the Second World War and its attendant cultural struggles to bring a real wave of immigrants to America from Vienna. And these people were neither poor nor uneducated. They quickly moved into the classical music world and assumed roles that were not only important but culturally more advanced than we were accustomed to. They entered the universities and quickly rose to the academic peaks. Many of them could out-sing, out-dance, out-conversationalize any little group of provincial folk who happened to encounter them. Their names began to appear in the social pages, marrying debutantes. To a large degree, this singular immigration movement came to an end when the Cold War did. And that's rather a pity; we could really use more people like that.

{Marie Therese, the Austrian Queen of Louis XIV}
Marie Therese, Austrian Queen of Louis XIV

One unusual exile from that movement lived for a long time next to the Haddonfield Quaker Meeting, or at least just down a little wooded lane to the rear. The occupant of that house was John Waite, a Quaker who really looked like a Quaker.

Geckos: Academy of Natural Sciences brings Mini Dinosaurs

{Gecko}
Gecko

FRIENDS who spent time in Vietnam have a lasting memory of lizards stuck to the ceiling, catching flies with their tongues. Those animals are named geckos, one of the oldest and probably most varied families of reptiles, but confined to the Southern hemisphere. Fossils have been found containing geckos from fifty million years ago, so they were here before the big dinosaurs were wiped out, when the Yucatan was probably struck by an asteroid.

{Anthony Geneva}
Anthony Geneva

There was a time when Africa, India, South America and Antarctica were united in one monstrously big continent, and the many varieties of gecko are scattered over the land masses which originally made that up. At least this is the way Anthony Geneva explains it to visitors to the Academy of Natural Sciences at 19th and Ben Franklin Parkway. There are no geckos to be found naturally in Philadelphia. Philadelphians hardly need reminding that the first dinosaur bones, ever, were discovered in Haddonfield NJ, and were soon taken to the Academy for permanent display. Ever since that time, the Academy's collection of dinosaurs has expanded, and are the things with the most impact on school-age visitors. The Academy is getting ready to celebrate its 200th anniversary in a few years, however, and contains much more than dinosaur bones, including extensive research facilities with world-famous scientists at work in them. In any event, the dinosaur image is a clear metaphor for the present display of little reptiles that look like dinosaurs, whatever the DNA trail may be. The main exhibition area is currently filled with dozens of glass display cases containing live geckos, and the little rascals are so good at camouflage that you have to hunt carefully for them before they suddenly seem to emerge from the shadows. There are white ones, black ones, bright green and bright orange ones, speckled in all sorts of weird patterns. They make sounds resembling bird songs, and the term gecko is a native word referring to such sounds. The Academy displays these gecko-noises for visitors who are invited to push twenty or so buttons. Geckos move, but suddenly, and probably for some predatory purpose. If you are really into geckos, you focus on their feet.

{Gecko}
Gecko

The variety of toe and foot shape is almost infinite and seems more so if you have a magnifying lens. The foot pads terminate in different kinds of extremely fine hairs, and that's their big secret. Those hairs are so fine the molecules of the foot and the molecules of the wall or ceiling attract each other magnetically. Since no energy is expended in the adherence, the gecko can remain attached to a wall or ceiling indefinitely, even after the gecko dies. But, by raising the angle of contact to thirty degrees, the foot detaches, and the little rascals can scoot along very rapidly, upside down. At present, there is a great deal of commercial and maybe military interest in clarifying the secrets of this adhesion. To be industrially useful, the footpad size would have to scale up to much larger dimensions, but just imagine gluing together the vessel ruptures and aneurysms inside the brain as we now do in a cumbersome manner with chicken-wire stents, just one example that quickly occurs to a visitor. If these little fellows figured out how to make these reversible adhesives fifty million years ago, our scientists ought to be able to imitate them.

Drop around to visit the Academy. It's filled with amazing things like this.

George Willoughby, 95, Peace Activist

{George Willoughby}
George Willoughby

Age was nothing but a number for 95-year-old peace activist George Willoughby of Deptford. His worldwide antiwar protests and nonviolent teachings started when he was in his mid-40s and continued until just weeks ago.

Mr. Willoughby was planning a six-week trip this month to India to meet friends he had made during visits to the birthplace of his idol, Mohandas K. Gandhi, and probably to give some of his trademark peace talks.

But Mr. Willoughby died at home of heart failure Jan. 5, a month short of the journey.

A Quaker who led local protests and famous treks from San Francisco to Moscow and from New Delhi to Beijing, Mr. Willoughby recruited many advocates for nonviolent conflict resolution, said a friend and member of the Central Philadelphia Meeting, Nicole Hackel.

"Once you experienced him, you didn't forget him," Hackel said, adding that she became a Quaker in the 1970s because of Mr. Willoughby's influence. "George would engage in conversation with anyone, even a 5-year-old who was attending a meeting for the first time."

Mr. Willoughby became a household name for area Quakers after he became director of the Central Committee of Conscientious Objectors in Philadelphia in 1954. He soon was a frequent presence in the news, mostly under headlines with the words peace, marchers, and protest.

In 1958, Mr. Willoughby was one of five crewmen on the sailboat Golden Rule who received 60-day jail sentences in Honolulu for trying to sail to the area of the Pacific Ocean where the U.S. government was testing nuclear bombs in the atmosphere.

That was Mr. Willoughby's first of many incarcerations, said his son, Alan.

"The Society of Friends in Honolulu brought him a lot of decent food. . . . He always spoke highly" of the Hawaii jail experience, his son said with a slight laugh.

Two years later, Mr. Willoughby organized a dual-continent march to protest nuclear testing. Protesters in groups of about a dozen each covered six countries in 10 months between the United States and the Soviet Union.

Mr. Willoughby joined the group in Poland. Soviet officials stopped them 100 yards short of the Lenin-Stalin tomb in Moscow's main square, according to reports at the time. Instead of delivering speeches, the group was forced to stand in the square in a silent vigil.

In 1963, Mr. Willoughby embarked with about a dozen others on what he intended to be his longest hike - 4,000 miles from New Delhi to Beijing to promote peace between India and China.

Before his journey, a Philadelphia Evening Bulletin reporter asked whether there was a better way than marching to bring about peace.

Mr. Willoughby responded: "Most people of these countries walk; we can reach them. Even if it does no good at all, it is worth it. It's an idea I believe in, and if it produces fruit, so much the better."

After eight months of walking, Mr. Willoughby and company were stopped at the India-China border and barred from crossing into China.

In the next three decades, Mr. Willoughby's projects included the formation of A Quaker Action Group, which opposed the Vietnam War, in 1966; the Life Center Community in West Philadelphia, a training and campaign center for nonviolence, in 1971; and Peace Brigades International, a human-rights group, in 1981.

One of his most memorable contributions to South Jersey, family and friends said, was the creation of the Old Pine Farm Natural Lands Trust, 45 acres of natural conservancy in Deptford.

In his later years, Mr. Willoughby received honors around the world for his peace work, such as the Jamnalal Bajaj Foundation award in 2002 in Mumbai, India, which recognizes those who promote Gandhi's ideas and values.

Born in Cheyenne, Wyo., Mr. Willoughby spent much of his childhood in the Panama Canal Zone, where his father worked in construction.

Mr. Willoughby was part of his high school's JROTC program, but, according to friend and biographer Gregory Barnes, he quickly realized the military was not for him.

A family rift led Mr. Willoughby to live in Des Moines, Iowa, with a family friend, Elinor Robson. In the 1930s, he received three degrees in political science, including a doctorate from the University of Iowa.

In 1940, Mr. Willoughby married Lillian Pemberton, a "birthright Quaker" he met in college. By 1944, he became a Quaker, fully immersed in the Religious Society of Friends' beliefs and ideologies.

In the late 1940s and early 1950s, Mr. Willoughby worked for the Des Moines office of the American Friends Service Committee before moving to Philadelphia with his wife and their four children.

After bypass surgery in 2000, Mr. Willoughby had to slow down. He wasn't able to participate in as many marches and rallies as he would have liked, his son said, but he remained active online.

One of Mr. Willoughby's last protests was in March 2003, an organized obstruction of the entrance of a federal building in Philadelphia to protest the war in Iraq. He took photos of his 89-year-old wife getting her head shaved as part of the demonstration.

"I've never seen her like that, but I like it," he told a reporter. Lillian Willoughby died last year.

One of Mr. Willoughby's last speeches was at Scattergood Friends School in Iowa a few months after his wife's death. He took a road trip with Hackel and one of his daughters to the Scattergood refuge camp's 70th-anniversary reunion, which was held at the school.

Once there, Mr. Willoughby did what he did best: talk. "He just fascinated the young people there," Hackel said.

Some of Mr. Willoughby's last words of advice were: "It is the duty of the opposition to oppose," his son said. "He thought it is your duty to speak up . . . for what you believe is right."

In addition to his son, Mr. Willoughby is survived by daughters Sally, Anita, and Sharon and three grandchildren.

A memorial service will be held at 2 p.m. Saturday at the Friends Center at 15th and Cherry Street

Inazo Nitobe, Quaker Samurai

{Inazo Nitobe}
Inazo Nitobe

The story of Inazo Nitobe (1862-1933) comes in two forms, one from the Philadelphia Quaker community, and the other from his home, in Japan. One day in Philadelphia, a well-known ninety-year-old Quaker gentleman, rumpled black suit, very soft voice -- and all -- happened to remark that his Aunt had married a Samurai. A real one? Topknot, kimono, long curved sword, and all? Yup. Uh-huh.

That would have been Inazo Nitobe, who met and married Moriko, nee Elizabeth Elkinton, while in college in Philadelphia. He became a Quaker, and when the couple returned to Japan, the Emperor then found himself confronted with a warrior nobleman who was a pacifist. You can next perceive the hand of his Quaker wife in the deferential diplomatic suggestion that there were vacancies for Japan at the League of Nations and the Peace Palace in the Hague. Perhaps, well perhaps, there could be service to his Emperor as well as his new religion in such an appointment for her new husband. Good thinking, let it be done. As far as Philadelphia is concerned, Ambassador Nitobe next appeared when Japan was invading Manchuria. The Emperor had sent Nitobe on a tour of America to explain things. At the meetinghouse then on Twelfth Street, Nitobe adopted the line that Japan was only bringing peace and order to a chaotic barbarian situation, actually saving many lives and restoring quiet. After a minute of silence, Rufus Jones rose from his seat on the "facing bench": He was having none of it. And that was that for Nitobe in Philadelphia.

The other side of this story quickly appears if you go to Japan and ask some acquaintances if they happen to have heard the name Inazo Nitobe. That turns out to be equivalent to asking some random American if he has ever heard of Abraham Lincoln. To begin with, Nitobe's picture appears on the 5000 Yen ($50) bills in everybody's pocket. He was the founder of the University of Tokyo, admission to which now is an automatic ticket to Japanese success. He wrote a number of books that are now required reading for any educated Japanese. A number of museums, hospitals, and gardens are named after him; one of them outside Vancouver, at the University of British Columbia.

Nitobe's father, Jujiro Nitobe, had been the best friend of the last Shogun, deposed by the return of the Emperor to effective control after Perry opened up Japan to Western ideas. The Shogun was beheaded, of course, and the tradition was that the victim could ask his best friend to do the job because he would do it swiftly. Jujiro was unable to bring himself to the task, refused, and his family was accordingly reduced to poverty. Subsequently, the Samurai were disbanded by the newly empowered Emperor, given a pension, and told to look for peaceful work. Inazo Nitobe was in law school when the Emperor's emissary came and said that Japan did not need culture, it had plenty of culture. The law students would please go to engineering school, where they could help Japan westernize.

Nitobe later wrote a perfectly charming memoir, called Reminiscences of Childhood in the Early days of Modern Japan , which dramatizes in just a few pages just how wide the cultural gap was. For example, Nitobe's father brought home a spoon one day, and this curious memento of how Westerners eat was placed in a position of high honor. One day, a neighbor ordered a suit of western clothes, and hobbled around it, saying he did not understand how Westerners are able to walk in such clothes. He had the pants on backward.

One of Nitobe's greatest achievements was to struggle with his appointment as Governor of Formosa (Taiwan). Japan acquired this primitive island in 1895, and Nitobe got the uncomfortable role of colonist in Japan's first experience with colonization. He sincerely believed it was possible for Japan to bring the benefits of Westernization to another Asian backwater, but just as the British found in their colonies, there was precious little gratitude for it. Although he was undoubtedly acting dutifully on the Emperor's orders when he later came to Twelfth Street Meeting, he surely knew -- perhaps even better than Rufus Jones -- that there was something to be said on both sides, no matter how conflicted you had to be if you were in a position of responsibility. This most revered man in his whole nation almost surely saw he had been a complete failure in Philadelphia.

The King's Road

Harry Kaufman is now long gone, but for decades he represented the volunteer spirit of Haddonfield and the earnest, innocent happy way it contributed the essence of conflicted memories of its Revolutionary origins. The last time anyone counted, there were forty-two direct descendants of Elizabeth Haddon living in the borough, for example, and in a quiet determined manner, they keep alive the Quaker heritage of a non-Quaker town. For example, Harry made his living as a public relations officer for the milk industry. During World War II the Nicholson family who arrived here before William Penn still had a vast dairy farm with its own port on the Cooper River. It was located where Stoy's Landing Road crosses Grove Street, where there used to be something called the Race Track Circle, in honor of the Garden State Race Track which followed the dairy farm, and preceded the big-box shopping center which is still there, without the circle. New Jersey still has over two hundred traffic circles, and those who grew up here remember them as part of the New Jersey heritage, each one characteristically having a diner restaurant, also a Jersey invention and tradition.

Plays and Players of Haddonfield

Harry Kaufman may not have started the Plays and Players of Haddonfield, but he certainly sparked it to a near-professional level in a town of 7000 people. The orchestra and the ballet company are particularly outstanding at the moment, the soloists on the stage quite good, although they never made the grand European tour which is thought to be the prerequisite for getting into the big time. Harry was the life of any party, and particularly good at composing little ditties, never quite getting around to stringing them together into a musical comedy until the 250th anniversary of the town. Even then, it is recalled he was shy and reluctant and had to be pushed a little. Since The King's Road appeared shortly after Oklahoma! transformed, even revolutionized, American musical comedy, it was not only the model but the stimulus for a similar comedy celebrating the beginnings of our little state. The plot was a simple one of a conflicted love affair. The striking innovation of Oklahoma! was to crowd most of the show's songs into the first act, repeating snatches of their themes as sort of Wagnerian background commentary throughout the remainder of the play. The other innovation of what was originally called Green Grow the Lilacs was the addition of Agnes DeMille's ballet company to emphasize the real historical theme with light-hearted music. Since I was one of the original reviewers for Oklahoma! in its New Haven tryouts, I can remember the revolutionary impact of that play, very well.

{William Bingham class=}
Anthony Wayne

Harry had to go to the Historical Society for authentic details of the conflict between the attraction for Revolutionary aspirations for Liberty, and loyalty to the earlier sufferings of Quakers for their pacifist leanings. Some Quakers deserted their faith to join the Revolution, and other Quakers tried to convert the Hessian soldiers. And still, others were loyal to the King of England. The Revolution was almost won at this moment, as the British occupants of Philadelphia had abandoned their supplies to attack, and had to get to the British fleet, bottled up in the lower Delaware River by fortifications at Fort Mifflin and Fort Mercer on the Jersey side of the river. The Hessians had been sent to attack Fort Mercer from the rear, passing through Haddonfield and stopping one night before going on to what we now call National Park. While the Hessian officers were being entertained by John Gill with discussions of the futility of war, Jonas Cattell slipped out of town and ran to alert Fort Mercer of its danger. The guns of the Fort were turned around, and the defenders pretended not to notice the approach of the Hessians until they were ambushed and largely destroyed. If Fort Mifflin on the Pennsylvania side of the Delaware River could have held out, the starving British might have had to surrender, but that didn't happen. In any event, the New Jersey Militia did its part, and little Quaker Haddonfield helped them in a sort of characteristic Quaker way. With a ratta-tat-tat and a fiddly dee, the rag-tag swallow-tail Jersey Militia got all the credit.

The play does not emphasize that the State of New Jersey was founded at the Indian King Tavern during these commotions, or that General Washington starving at Valley Forge sent Mad Anthony Wayne to circle up and around Trenton to drive a herd of cattle back from Salem County, two hundred miles back to Valley Forge. The British sent Captain Simcoe down to Salem County to massacre the Quaker farmers who provided the cattle. These later developments are only mentioned in its anthem to "Generals Wayne, LaFayette, and Pulaski", and every good resident of Southern New Jersey is supposed to know what that is all about.

The Quaker historian Rufus Jones established the enduring tradition that this split is what ultimately reduced the Quakers from the dominant religious group to a small religious sect in the three states once owned by William Penn, Delaware, Pennsylvania, and New Jersey. Related to such turmoil was the claim that more battles of the Revolution were fought in New Jersey than in any other state; if you include the large privateer navy going to see from the Jersey Pine Barrens, that is probably true. And every twenty-five years or so, we have to put on a revival of "The King's Road", and just show 'em.

1688 Germantown Quaker Petition Against Slavery

{1688 Anti-Slavery Petition}
1688 Anti-Slavery Petition

COPY of Contemporary Germantown 10/15/18 10:44 pm

The Strittmatter Award is the most prestigious honor given by the Philadelphia County Medical Society and is named after a famous and revered physician who was President of the society in the 1920s. There is usually a dinner given before the award ceremony, where all of the prior recipients of the award show up to welcome to this year's new honoree.

{Bockus}
Bockus

This is the reason that Henry Bockus and Jonathan Rhoads were sitting at the same table, some time around 1975. Bockus had written a famous multi-volume textbook of gastroenterology which had an unusually long run because it was published before World War II and had no competition during the War or for several years afterward; to a generation of physicians, his name was almost synonymous with gastroenterology. In addition, he was a gifted speaker, quite capable of keeping an audience on the edge of their chairs, even though after the speech it might be difficult to recall just what he had said. On this particular evening, the silver-haired oracle might have been just a wee bit tipsy.

Jonathan Rhoads had likewise written a textbook, about Surgery, and had similarly been president of dozens of national and international surgical societies. He devised a technique of feeding patients intravenously which has been the standard for many decades, and in his spare time had been a member of the Philadelphia School Board, a dominant trustee of Bryn Mawr and Haverford Colleges, and the provost of the University of Pennsylvania. Not the medical school, the whole university, and is said to have been one of the best provosts of the University of Pennsylvania ever had. When he was President of-of the American Philosophical Society, he engineered its endowment from three million to ten times that amount. For all these accomplishments, he was a man of few words, unusual courtesy -- and a huge appetite in keeping with his rather huge farmboy physical stature. On the evening in question, he was busy shoveling food.

"Hey, Rhoads, wherrseriland?". Jonathan's eyes rose to the questioner, but he kept his head bowed over his plate.

"HeyRhoads, Westland?" The surgeon put down his fork and asked, "What are you talking about?"

"Well," said Bockus, "Every famous surgeon I know, has a house on an island, somewhere. Where's your island?

"Germantown," replied Rhoads, and returned attention to his dinner.

How They Do It in Delaware

Founding Fathers

Come to think of it, the nation's smallest state still does things the way the Founding Fathers did them, sort of confirming my feeling that population growth is the source of our trouble. Correction: the failure to adjust to population growth is our trouble.

They really do "bury the hatchet" in Lewes, Delaware, and they really do get the candidates, victor and vanquished, to ride around the town square in Georgetown, Delaware after the election is over. The implication is, of course, there was a hatchet in use, and yet the two candidates can be cheerful gentlemen afterward.

A Pennsylvania Farmer in Delaware

{over Air Force Base}
John Dickinson

It is difficult to have a coherent view of the mind of John Dickinson. Seriously offended by the Townshend Acts, he rightly perceived them to be the work of a few malignant personalities in British high places who would mostly soon be replaced. Later on, he refused to be troubled by the inconsequential Tea Act, which he appraised as a face-saving gesture of reconciliation, but more recent historical information demonstrates was more likely aimed at avoiding an unrelated vote of no-confidence in Parliament. Unfortunately, Dickinson was too remote from these events and additionally could not comprehend reckless hotheads among his own neighbors. Reckless hotheads in turn seldom comprehend the measured meekness of Quakers. In any event, although Dickinson played a major role in the Declaration of Independence, he refused to sign it when the time came, evidently sensing an opportunity to separate the three lower counties from Pennsylvania and its Proprietors. A few months later when the British actually invaded the new State of Delaware on the way to capturing Philadelphia by way of Chesapeake Bay, Dickinson enlisted as a common soldier and fought at the Battle of Brandywine. Obviously, he was seriously conflicted.

{John Dickinson's Farmhouse}
John Dickinson's Farmhouse

Dickinson had become internationally famous for twelve letters he had meant to publish anonymously. The Letters From a Pennsylvania Farmer were written about 1768 out of resistance to the Townshend Acts. Because the three counties which were to become the State of Delaware were then still part of Pennsylvania, many school children have become understandably confused about the actual location of the man who became governor of both states, simultaneously.

The causes of the separation of the two colonies are still a little vague. Delaware schoolchildren are taught the two states separated, but often report they didn't retain much information about why it happened. The Dutch and Swedes who originally settled southern Delaware were not sympathetic with Quaker rule, which could be seen as a reaction to their living here for generations as Dutchmen before William Penn arrived, but then saw the colony sold out from under them. As a further conjecture, there might have been friction with the Quakers over slavery, similar to the hostility of other Dutch settlers in northern New Jersey when William Penn purchased that area. This pro-slavery attitude resurfaced in both areas during the Civil War. One alternative theory which has considerable currency in Delaware is local dissension about Quaker pacifism during the Revolutionary War. On a recent visit to Dickinson's home outside Dover, a school teacher was overheard to instruct his flock that the Dutch Delawarians wanted to fight the British King, but the Quakers wouldn't give them guns. "We value peace above our own safety," was the unsatisfying response they received from the Pennsylvania Assembly. But that line of reasoning bumps up against Dickinson's role in local affairs, his ambiguity over the Declaration, and his vacillation in warfare. One would suppose the simultaneous Governor of both states would play a major role in the separation of the two.

{over Air Force Base}
over Air Force Base

Dickinson's plantation, quite elaborately restored and displayed, is tucked behind the Dover Air Force Base. Perhaps all that aircraft noise will discourage sub-development in the area of Dickinson's plantation and the rural atmosphere may persist for years. At the time of the Cuban missile crisis, your correspondent happened to be driving past, observing the sky filled with bombers, just circling and circling until the diplomats settled matters. Since eight-engine bombers are seldom seen around Dover, it has always been my presumption that they came from elsewhere to be refueled at Dover; but that's just a presumption. One of the pilots later told me he was carrying nuclear "eggs" and was completely prepared to take a long trip to deliver them.

To get back to Dickinson's wavering about the Declaration, maybe there was a good reason to waver. Joseph J. Ellis (in His Excellency, George Washington) relates that after the devastating British defeat at the Battle of Saratoga, Lord North made an offer to settle the war on American terms. In a proposal patterned after the concepts of the separatists in Ireland, America could have its own parliament as long as it maintained trade relationships with England. As an opening offer, that comes pretty close to what the colonists had been demanding. Governor Morris was active in disdaining this offer, although it is unclear whether he was acting alone or as the agent of others. The offer came too late to be accepted, but it might have shortened the war by six years, and we might now have a picture of the Queen on our postage stamps.


REFERENCES


His Excellency: George Washington: Joseph J. Ellis: ISBN-13: 978-1400032532 Amazon
Letters From A Farmer In Pennsylvania To The Inhabitants Of The British Colonies (1903): John Dickinson: ISBN-13: 978-1163969533 Amazon

IF ALL MEN WERE ANGELS, NO CONSTITUTION WOULD BE NECESSARY

{Privateers}
James Madison

JAMES Madison, Washington's floor manager at the Constitutional Convention of 1787 in Philadelphia, stated the main necessity for holding the Convention at all arose from selfish and untrustworthy human nature. The assembly probably understood exactly who he had in mind, although that is a little unfair to residents of Virginia. He really meant everybody. In the theology of the time, mankind was stained with original sin. Particularly in France, many 18th century romanticists responded to the Enlightenment by defiantly declaring human nature is born pure in heart. In their view, current evils grow from the pollution of civilization, without which it might be possible to have no government at all. At its root, such romanticism was an outcry against progress and civilization, blaming the world's troubles on the Industrial Revolution, so to speak. From Madison's skeptical viewpoint, the most awkward feature of the Romantic Period was its adoption by his Francophile friend and neighbor, Thomas Jefferson, the current American ambassador to France. Madison recognized that Jefferson and Patrick Henry were prepared to assail any attempt to add the slightest power to a central government, particularly if it weakened the power of Virginia. As indeed they promptly came forward to do and nearly succeeded.

{Privateers}
Treaty of Paris

After fighting an eight-year war for freedom, American belief was wide-spread that it was time to draw back from such anarchy. But there was widespread suspicion in every other direction, too. England seemed to concede, not defeat but only current military overstretch, possibly displaying reluctance to see its former colonies with full sovereignty. George III might wait for America to weaken itself and then try to take them back. Britain almost couldn't do anything right; it was also possibly up to no good when the Treaty of Paris astonishingly conceded land to the Mississippi instead of stopping at the Appalachians. Even our ally France nursed regrets for its somewhat older concessions after the French and Indian War. If even the two mightiest nations of Europe could not maintain order in the vast North American wilderness, perhaps they felt the inexperienced colonies would soon collapse from the effort. Further intra-European wars seemed likely, and could soon spread from Europe to the Western hemisphere. The guillotine was bad enough, Bonaparte would be worse. Our governance as a league of states was in fact, only a league of armies. The Articles of Confederation would not quell inter-state rivalries in peacetime, as only four years (1783-87) experience after the Treaty of Paris were clearly foreshadowing. It was time we listened to Benjamin Franklin, who had been arguing since the Albany Conference of 1745 for unification of the colonies, and to Robert Morris who had been arguing for a written constitution since 1776, a bicameral legislature since 1781, government by professional departments instead of congressional committees, and the ability to levy national taxes -- since at least 1778. Professor Witherspoon of Princeton had provided some ideas about how to make these proposals self-enforcing, Washington was firmly behind a Republican system and opposed to a monarchy. On the other hand, everyone knew that under the Articles of Confederation the thirteen States had often refused to pay their share, abused their ability to deal independently with foreigners, dealt unfairly with their neighbors, and capriciously mistreated their own citizens. It was time to act boldly. With a blue-ribbon convention of national heroes behind these simple ideas, surely it would be possible to convince the sovereign state legislatures to dethrone themselves.

{John Marshall}
John Marshall

Two men quietly applied even deeper thinking than that; Benjamin Franklin of Pennsylvania, and John Marshall of Virginia. Both of them had served in state legislatures, both were dismayed by the experience. Franklin also had a long period of close-up observation of the British Parliament, suffering personal abuse there, and had reason to reflect on the earlier abuses by that Parliament under Cromwell during the English Civil War. Certain bad tendencies seemed universal in legislative bodies. Although John Marshall was not a member of the Virginia Constitutional delegation in 1787, he was active in the politics of the group it represented back home. Both Marshall and Franklin had reason to be uneasy about misbehavior in representative bodies, whether called legislatures, congresses, or parliaments. When people said states misbehaved under the Confederation arrangement, they really meant legislatures misbehaved. Franklin did what he could within the Convention to curb this observed behavior by enumerating limited powers and endorsing power balanced against power. When he had nudged it as far as he could, he wearily agreed to give the product a try. Franklin did not trust Utopias, but he had lived among Quakers for years, observing one Utopian society which seemed to endure without resorting to tyranny.

The Constitutional provisions in Article I, Section X became the heart of what the 1787 Convention wanted to change about the relationship of the national and state governments.

States are forbidden to ...

"emit bills of credit, make anything but gold or silver a legal tender in payment of debts, pass any bill of attainder, ex post facto law, or law impairing the obligation of contracts."

{1787 Convention}
1787 Convention

This brief clause is almost a presentment of what state legislatures were doing, which serious patriots regarded as wholly unacceptable. Failure of states to abide by the terms of international treaties must be included in such a summary, although the new Constitution went beyond the powers of states by locating treaties beyond the power of even Congress to change, once ratified. Some observers in fact feel that within the First Article clause, protecting the sanctity of contracts was really the nut of the matter. In one way or another, most states seemed to resort to paying their debts with inflation, somehow failing to recognize that borrowing never pays debts, it only postpones them. The great bulk of this new nation's business was to be conducted as voluntary agreements between two contracting parties. The State -- and the states -- were to stay out of the private sector, except as referee, to see that both sides kept their agreements. As a footnote, the matter of government intervention in private affairs was to rise again in the behavior of the Executive branch in the 1937 Court Packing uproar, and in the 2009 health insurance legislation. Some critics, therefore, have discomfort that the heaviest Constitutional weight was placed by the Founding Fathers on protecting private property. Are not other issues more important, they ask, like life, liberty and the pursuit of happiness? The Founders, of course, we're here not ranking benevolences by value; they were stating principal urgencies for convening the meeting. In a strange unintended way, they here stumbled on the right to property as the foundation for all other rights. But John Marshall understood it was true and was to spend thirty years hammering it into place. People broke individual promises by defaulting on debts; they simply did the same as governments, using inflation.

Increased Potential for Retirement Villages

{Privateers}
Pennsylvania Hospital, Nation's First Hospital, 1751

Healthcare institutions may well have mission statements, but the main force visibly shaping hospital mission is third-party reimbursement. One must be sympathetic with institutions which really prefer their own mission to the pressures from third parties, particularly when the "second party" -- the patient -- also likes the original mission better. Teaching hospitals surely would prefer to concentrate on streamlining tertiary care, retirement villages on enriching the lives of elderly residents, etc. And they could probably make a better case for what they prefer than third-parties can. When one-size-fits-all health insurance is imposed on institutions which must survive by internal cost shifting therefore, insurance mandates invisibly prevail. It is not always strictly a matter of "Who pays the piper calls the tune", as it is "Who pays the most can run the place."

Considering these invisible forces of control at work, it seems highly desirable to search for situations in which the incentives of the third-party do not run parallel to the incentives of the provider community. In the case of government third-parties, the goals of the agency may not even be parallel to the will of Congress. The public clearly prefers to pay for private rooms and private duty nurses if it can afford to, but those are mainly relics of the past. Doctors used to work out of offices in their homes, but you seldom see that, now. There once were twenty hospitals in Philadelphia which were owned, paid for and operated by churches, but now at most, the church name is a relic on the front door surviving from a former era. If these changes were a response to public preference it would be another thing, but they are usually not even traceable to a written mandate which might be appealed. So it becomes all the harder to defy a mandate which grew out of the hospital's surmise as to what the third party would probably prefer. Perhaps some examples of social pressures at work would be useful.

It happens my own first office experience was in the home of an older doctor on vacation. The location of that family residence was a careful triangulation of convenience, expense, distance to the hospital, and the preferences of the patients. It was a grand experience to put aside the breakfast coffee, walk into the next room, and see the first patient of the day. Or to interrupt office hours for an emergency in the neighborhood for less than an hour and to have your excuses readily accepted by the waiting patients upon return. My colleagues had explained the financial advantages of sharing a roof and heating system with a tax-deductible business. But my accountant explained that the Internal Revenue Service didn't like offices in the house, and would surely audit any doctor silly if he persisted. So I spent fifty years in an office across the street from the hospital, commuting and seeing patients who had to commute to see me; the extra expenses of parking and the rest of that arrangement are easy to imagine. True, it was easier to visit the hospital patients, and nice to eat lunch with other doctors in the hospital cafeteria. But all of these decisions were not my own first choice. I never got a letter from the IRS or heard a murmur from them, but I always believed I was responding to their mandate. When an IRS agent finally wandered into my office as a patient, he admitted the IRS prejudice but said he believed it grew out of fear the business expenses reported would really be the expenses of a hobby, not a business.

A second relevant experience occurred when I was a resident physician. A staff physician at the hospital had a heart attack, and the Chief of Medicine asked me to take a few days off to tend to the problems in the stricken doctor's practice. His home and office were in the midst of a row-house district of town. When I arrived, the office was empty of patients, but the nurse was waiting with an umbrella. "Before we see the office patients, we must make rounds to see the bedridden patients at home." To my amazement, within a three-block radius of his office, there were nearly twenty patients in hospital beds at home. Some of them had oxygen tents, several of them had intravenous fluids dripping into their arms. The nurse told me that she drew blood for pickup by a laboratory and that with a little argument a portable x-ray machine could be brought to the home. At the foot of each bed was a hospital chart, all up-to-date with notes and reports. It might not be possible to run such a show in many other neighborhoods, but the city row house neighborhood was ideal. Or, not ideal perhaps, because there must have been many problems. But it was clear why Blue Cross had slow progress making sales to the people accustomed to this arrangement. And it even made clear why patients were content with open twenty-bed wards in a hospital, for at least ten years after Medicare would have gladly paid for a semi-private room. No private duty nurses, however, it might set an unwise example.

Two things are at work, here. Things happen to medical care which is undesirable, so someone needs to complain about them, and complainers must be provided with a place to appeal. The reverse is also true; good things which ought to happen, don't happen. So in addition to providing an appeals system, we somehow have to provide a wise and unbiased ombudsman to suggest what new initiatives ought to be undertaken. And the two functions, negative and positive, need to commune with each other. Parenthetically, since everybody gets involved in health care to some degree, adversary roles must be filled in this process, containing representatives of patients and also providers (both institutional and individual), as well as guardians of the purse. Since the process quickly becomes unwieldy, it needs to be associated with a special committee of Congress and needs to be able to summon both witnesses and experts. An annual convention in some pleasant spot might enhance the concept.

Institutions are another matter since quite often the personal opinions of the spokesman are constrained by the incentives of the institution. It must be made clear to them which opinion is desired.

Institutions choose their location for other considerations, chief among which is cheap land, but the location near public transportation is another factor. Whatever the thought process underlying it, nursing homes and retirement villages are almost always in the far suburbs. A related problem is a vexing difficulty for a center-city hospital to find a nearby nursing home for convalescents. These annoyances are protracted by the licensing rules in a round-about way. When a corporation is formed, typically a lawyer with a yellow pad asks two questions: "What are you going to name this organization?", and then, "What is its purpose?". Presumably, he then completes some forms and files the necessary applications. The stated purpose may well have other uses, but it defines the sort of license needed, and eventually either match or does not match the rules some third-party reimbursement agency has laid down for what sort of institution is eligible for reimbursement. After that, the system becomes much more rigid than it needs to be. As long as the institution remains defined as a hospital it will be paid by the third-party, and without that designation, it won't. Effectively, the state licensing board acquires the power to shut off the revenue of some institution which displeases it. But what displeases it (let's say, mice in the kitchen) usually bears a scant relationship to whether or not the institution is capable of performing additional tasks. It does not take long for these issues to get blurred and forgotten; the retirement village can't receive hospital reimbursement because it doesn't have a hospital license. A hospital license would permit it to do a lot of things it doesn't want to do. While the general idea is sound enough, the rigidity it imposes is excessive, particularly when you consider the penumbra of reluctance it provokes from employees. Obviously, the interpretations vary greatly between jurisdictions. It leads to hospitals which may perform heart transplantations but may not run a day-care center for the children of their employees.

There are many simple solutions to this simple problem, but because so much of it is buried in-laws, it would probably require a special court to be appointed to oversee it. How busy that court would be would depend on how vigorously competitors would resist it, which would probably vary with the region.

In any event, Society has a legitimate interest in preserving the quality of care, but it does not fulfill that duty by transferring it to reimbursement agencies. During wars, surgery is satisfactorily performed in tents, for an extreme example of how expendable much oversight can be. Another principle would be to ease impediments to overlaps of functions between institutions, particularly including the backward sharing of component services and records toward the lower-level institution. Since such sharing is often observed to occur without objection within vertically integrated institutions, there is every indication it is both desirable and feasible between competitors.

Going much farther back to the town meeting form of oversight, the most radical departure from present custom would be to encourage a shift of the center of care from inpatient hospitals toward retirement villages. The simplest definition of the center of care would be the location of primary physician offices, and the most important step would be to discourage mandatory links between referring physicians and particular acute care hospitals. Doctors left to themselves will locate where the patients are, and increasingly it is possible to see a shift of patients requiring chronic disease management and terminal care into the retirement village. The tendency of doctors and laboratories to cluster around hospitals impedes this natural shifting together. If doctors shift their offices and are allowed a choice, laboratories and x-rays will soon follow them. Before Medicare, the center of care was found near the high-rent districts of cities. In London it was Harley Street, in Philadelphia it was Spruce Street. As reimbursement changed, it shifted toward the hospital campus, where the parking problem is also solved. Nowadays, early discharge and reimbursement shifts have made it unattractive for a primary care physician to visit his patients in the hospital, so hospitalist and emergency room specialties are flourishing, with computerization feebly bridging interruptions to the continuity of care. The primary care physician would find the retirement village solves the parking problem; pharmacies and laboratory pick-up are often already in place, and non-surgical specialists would soon follow primary care physicians. Patient transportation, at present crippled by expensive municipal monopolies, would be greatly eased by such shifts of medical interaction. The ultimate shift of the center of care would be for the more mobile younger population of suburbs to shift allegiances toward the retirement village location, a change mostly affecting pediatricians. It would take some time, and it would always be a partial migration. However, the infirmaries of retirement villages offer convenience and comfort near home.

The most effective force maintaining standards for this level of care, have no doubt of it, is the ease with which friends within the community drop in for visits. They have time for it, especially to and from the dining room, and all of them keep a watchful eye on how they would likely be treated there themselves when their turn comes. In retirement communities, client consensus is a powerful force. What is lacking is a willing sharing of reimbursement with acute care hospitals. Therefore, the idea of brief hospitalization followed by longer recovery near home is now only realistically available to the affluent. But their choices show the way, as they always did before third-party insurance dominated the scene. For a while, little children may think it is funny to get their shots at the old folks home, but they will soon get over it.

 

15 Blogs

A Quaker Carillon

Quaker Carillon
In an unprogrammed Quaker meeting, respectful pauses between messages should be long enough to form a "gathered opinion". Not too long, of course, or lacking some external signal of what the subject is. Gathered meetings and fragmented ones may sound alike to strangers, but little signals that others are listening can be found in the intervals of silence.

The Origins of Haddonfield
Haddonfield was founded by a 19-year-old Quaker girl in 1701 when it was still a fairly dangerous place to walk around. She has over 140 direct descendants, and forty of them still live in the town. Some famous scenes from the Revolutionary War took place here.

Camden NJ: The Third, or Irish, Tenth
Early settlers of the Delaware Bay, generally picked the eastern, now New Jersey, side of the river because the terrain was easier to farm. In time, the vast wilderness on the western, or Pennsylvania, side led to more commerce.

The Empire Visits Haddonfield, Briefly
All religions were welcomed and tolerated, but the English government was deathly fearful of French Catholics in Canada, and Spanish Catholics in Florida. The Stuart kings were Catholic, sort of, but the important issue was protecting colonial real estate more than protecting doctrinal purity.

Geckos: Academy of Natural Sciences brings Mini Dinosaurs
Philadelphia's Academy of Natural Sciences introduced the world to dinosaurs, and now introduces us to a miniature version.

George Willoughby, 95, Peace Activist
In The Philadelphia Inquirer for February 4, 2010, By Claudia Vargas Inquirer Writer.

Inazo Nitobe, Quaker Samurai
One of the most revered leaders of modern Japan was a converted Samurai, married to a Philadelphia Quaker. His father was an advisor to the Emperor, a family of famous warriors.

The King's Road
It's only been performed fifteen or twenty times, but Hayyr Kaufman's musical comedy captures the real spirit of Olde Haddonfield.

1688 Germantown Quaker Petition Against Slavery
The first official anti-slavery document to be considered by the Philadelphia Yearly Meeting in 1688.

COPY of Contemporary Germantown 10/15/18 10:44 pm
"Well," said Bockus, "Every famous surgeon I know, has a house on an island, somewhere. Where's your island?".

How They Do It in Delaware
The nation's smallest state conducts a lot of things the way they did in the Eighteenth Century.

A Pennsylvania Farmer in Delaware
John Dickinson achieved national fame in 1773 by publishing twelve letters written earlier denouncing the Townshend Acts. They were published anonymously as Letters From a Pennsylvania Farmer. His farm, curiously, was in Delaware.

IF ALL MEN WERE ANGELS, NO CONSTITUTION WOULD BE NECESSARY
A lot of shrewd thinking went into the checks and balances of the Constitution, some of it in quaint language.

Increased Potential for Retirement Villages
Third-party insurance is blocking certain patient preferences, as demonstrated by what rich people prefer to do when they are sick.