Hannah Joyner, PhD
Independent Historian, Takoma Park, Maryland, United States (Winter 2016)
|Pennsylvania Hospital, 1811|
The Pennsylvania Hospital in Philadelphia opened its doors more than two decades before the American colonies separated from Britain. Originally designed to care for all patients regardless of their circumstances, the hospital admitted those who could pay and those who could not. From the first days of the institution, white patients were joined by free as well as enslaved blacks patients. Patients with both physical and psychological illnesses were welcomed and treated. Founded in 1751 by Dr. Thomas Bond and Benjamin Franklin, the hospital was inspired by Quaker religious beliefs of charity and egalitarianism.
Pennsylvania Hospital was the first hospital in America. Over the centuries, it has profoundly influenced the development of medical care throughout the United States. Starting roughly a decade after “Pennsy” was founded, the hospital instituted a long tradition of providing medical education to new or aspiring doctors. Staff physicians gave medical lectures to their private students and apprentices. Soon afterward, the hospital’s training program became more formal, allowing students to combine medical studies at the new College of Philadelphia with clinical experience at the Pennsylvania Hospital. By 1824 medical residents were required to have a medical degree before starting their clinical training at the hospital, a tradition that continues to this day. In addition to clinical experience, residents had access to a burgeoning collection of medical literature. In the nineteenth century, this collection was, according to the American Medical Association, the first medical library in the United States as well as the largest and most important one.
Pennsy also constructed the first surgical amphitheater in the hemisphere. During the early days, students learned about the human body by watching postmortem dissections. After the surgical amphitheatre was built in 1804, students and spectators filled the galleries of the large circular room and watched surgeons set broken bones, excise tumors, and even amputate diseased or injured limbs. In this era before electric lights, surgery had to be conducted in the middle of the day and only when skies were clear and sunny. There were complications: before the germ theory was widely accepted, patients were at high risk of infection, as no efforts were made to keep the amphitheatre sterile. Before anesthesia came to the hospital in the 1840s, many patients were given liquor or opium to help them withstand the pain of surgery. Others were tied down and made unconscious with a hit on the head with a mallet.
Pennsylvania Hospital led the young nation in mental health treatments. During the 1700s half of its patients were admitted for psychiatric care. Benjamin Rush, often called the “father of American psychiatry,” revolutionized the hospital’s treatment of the mentally ill patients. Believing that mental illness was a disease rather than indicating spiritual or demonic possession, he attempted to find cures for his patients’ psychiatric disorders. Some of his treatments seem inhumane today, such as his belief in not only moderate physical restraint but regular bloodletting. Yet these treatments were improvements over the disciplinary methods then in common use such as chaining patients to beds in basement cells.
New approaches to psychiatric care were developed during the 1830s by Thomas Kirkbride. Moving even further away from punishment, Kirkbride introduced “moral treatment” for his patients, believing that kindness was more effective than restraints, and offering exercise, entertainment, and intellectual activities as therapy. The hospital population during Kirkbride’s administration boomed and the institution grew both in reputation and in its finances.
Although Pennsylvania Hospital was committed to many inclusive policies about race, class, and type of illness, there were limits to its egalitarianism. During the decades before the Civil War, for example, the hospital conformed to the country’s prevailing racial attitudes and began to segregate its wards by race. Another limit to egalitarianism was seen in the hospital’s conceptions of gender. Women, always accepted as patients, had only limited access to medical education. As early as 1869, the hospital Board invited female medical students to join male residents in the surgical amphitheatre for training, but they were given an inhospitable welcome by both male students and male faculty. Although the Board continued to support the practice of limited education for female doctors, opposition both internal and external continued. The first female intern at the Pennsylvania Hospital enrolled only in 1951, almost one hundred years after the early experiments in women’s medical education.
Pennsylvania Hospital continues to be a thriving hospital. Still committed to its mission to provide healthcare for Philadelphia residents of a variety of backgrounds, the institution is now affiliated with the Hospital of the University of Pennsylvania.
Graham, Kristen A. A History of the Pennsylvania Hospital. Charleston, SC: The History Press, 2008.
HANNAH JOYNER, PhD, is an independent historian who lives in the suburbs of Washington, DC. She is the author of From Pity to Pride: Growing Up Deaf in the Old South and the co-author of Unspeakable: The Story of Junius Wilson.