The Philadelphia Almshouses and Early American Medical Education
Beginning in the colonial period and extending into the nineteenth century, the concepts of hospitals, medical education, and patient treatment followed similar, connected paths of formalization and Philadelphia, established in 1682, lay at the center of these developments. During the first half of the eighteenth century, hospitals that were privately supported and controlled by a self-appointed group of socially prominent citizens (called voluntary hospitals) were opened in colonial almshouses and workhouses following the British model; these later became publi- cally supported institutions staffed by physicians where medical students paid to attend lectures and observe dissections. They also served as a steady source of the cadavers needed for use in the anatomy courses offered by medical schools which began to proliferate at this time.
Medicine in this period was loosely organized into four categories: treatment, surgery, pharmacy, and midwifery (Starr 1982; Stevens 1998). Even after the opening of the first medical school in the colonies in 1765 at the College of Philadelphia (now the University of Pennsylvania), American medical students served apprenticeships in a parochial, unregulated system that varied greatly by region. Students who desired university medical degrees studied in Europe, especially at the University of Edinburgh in Scotland which had established its faculty of medicine in 1726. Indeed, the first faculty members at the College of Philadelphia’s medical school were Edinburgh graduates (Stevens 1998). They consequently designed their curricula following the Edinburgh model of education which emphasized human anatomy based on lecture demonstrations, student dissections of corpses, the use of prepared anatomical specimens, and clinical observation of patients in hospitals (Chitnis 1973 ; Rosner 1992). It was not until 1852, however, that the American Medical Association standardized medical education nationally.
With respect to its role in early American medical education, Philadelphia is a city of firsts. In 1730, Dr. Thomas Cadwalader (1707-1779) presented the first documented medical lectures and dissections in the colonies. In 1751, Benjamin
Fig. 12.1 Woodcut of the Blockley Almshouse in 1853 from Gleason’s Pictorial Drawing-Room Companion. The cemetery site was located in the open field at the far left of the image
Franklin helped to establish the first hospital in America (Pennsylvania Hospital) where the colonies’ first medical museum, library, and surgical amphitheater all were located (Henry 1897; Williams 1973). In 1765, physicians William Shippen, Jr. (1736-1808) and John Morgan (1735-1789) opened the colonies’ first medical school, initiating the regular dissection of the bodies of criminals and people who had committed suicide supplied by the coroner.
Predating the Pennsylvania Hospital by 20 years, the Philadelphia Almshouse opened in 1731 and was the first such institution in the colonies. It included an infirmary that in 1835 was officially named the Philadelphia Hospital (Croskey 1929; Lawrence 1905; O’Donnell 2005). The first two almshouses were located in the center of Philadelphia near Independence Hall but later concerns with overcrowding, unsanitary conditions, and its negative effect on city property values led in 1830 to construction of a new expansive almshouse complex on a 187-acre property located two miles away in Blockley Township on the west side of the Schuylkill River (Fig. 12.1). Effectively isolating the sick poor and other marginalized Philadelphians, the new institution comprised included quarters for 1750 paupers, an asylum for 400 children, and a hospital capable of treating 600 patients (Croskey 1929; Hunter 1933; Lawrence 1905). Recognizing the growing role of the hospital in contributing to the “just reputation which Philadelphia enjoys for furnishing the best and most copious means of medical instruction in the United States,” the new building was designed to “have a lecture room sufficient to hold 500 students” and “a dead room and another for post-mortem examinations, etc.” (Lawrence 1905:85, 90). The first group of 1081 residents were moved into the new almshouse in July 1834. Thousands would follow them over the next seven decades.
When it opened, the city’s Board of Guardians adopted the name “Philadelphia Hospital” for the almshouse’s medical department; this name was changed to the “Philadelphia General Hospital” in 1902 as the almshouse system was replaced by facilities that were both physically and bureaucratically separated (Hunter 1933; Rosenberg 1982). Within 10 years of its opening, the almshouse hospital had become central to medical education in the city. For example, the University of Pennsylvania Medical School required all of its students to attend “one course of Clinical Instruction in the Philadelphia Hospital, (Blockley,) or the Pennsylvania Hospital” to earn their medical degrees (Medical Faculty of the University of Pennsylvania 1841:32). By 1845, the Philadelphia Hospital was staffed by four resident physicians and four surgeons, each appointed for 1-year terms. A report by the Board of Guardians that year noted that the physicians were “connected with the medical schools of the city as Professors or Lecturers, and for about 4 months of the year attend regularly at the Hospital, for the purpose of lecturing to their classes.” (Lawrence 1905:156). Thousands of medical students subsequently passed through the halls of “Old Blockley” during the second half of the nineteenth century; indeed, in 1893 Curtin (1893 :4) estimated that between 15,000 and 20,000 students had attended lectures in the almshouse clinic room over the previous 30 years.