A Medically Historic Walk in Philadelphia

Come along with me now, on the eve of another historic presidential debate.

I just completed a whole year as a writing fellow (called an “Op-Med Fellow”) for the healthcare professional networking site Doximity. They publish some pretty amazing original writing from clinicians of all ages and specialties, so it was a real honor for me. For my last piece, the editor I worked with asked me to compose a piece about my hometown of Philadelphia, with a medical tourism bend perhaps. Maybe the Mutter Museum could get a mention. I thought this would be a really fun thing to write, so I blew the dust off some historical accounts and melded these with my favorite haunts within walking distance. While not a complete list, or a completely medical themed walk through town, I hope you’ll join me nonetheless. The original post is here on Doximity.

It’s good timing. Philly is hosting the big presidential debate from The Constitution Center here on Tuesday night. Maybe you’ve heard of Kamala Harris and Donald Trump? I expect it will be quite a show. I just hope the best person wins, and wins the necessary votes to keep us voting and loyal to our core democratic ideals. You know, the Constitution and the Amendments? But I digress.

After I share this piece, I’ll invite you to a rare podcast I record from time to time. This one expands upon some of the archaic medical and psychiatric treatments that doctors like Benjamin Rush performed on patients at Pennsylvania Hospital. I’ll also give a quick briefing on the medical horrors that contributed to George Washington’s death. It was grisly stuff. This one’s for Examined supporters, so you might as well join ‘em. Time is flying by. Can you believe I’ve been writing this for 3 years now?

Ok here we go. Take good care,
Ryan

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A Medically Inspired Walk Through My Part of Philly

They say that going for a walk is good for your mental and physical health. Heck I’ve written about this before as I took a short walk with you. As a physician and citizen of Philadelphia, I find that walking these historic streets also connects me to our profession’s rich history. Unlike driving the depressing gauntlet of medical malpractice billboards festooned along major highways, the small alleys and grand landmarks here in Philly inspire me.  The following is not a comprehensive travel guide, but I’m going to present some favorite medical sites that are within easy walking distance of my home.  So please finish that cheesesteak with fried onions and whiz and then come with me. We’ll be back in time to watch the Phillies game.

The Mütter Museum and College of Physicians of Philadelphia, 19 S. 22nd Street

Our first stop is a bit of a bizarre one.  The Mütter Museum, established in 1863, houses a collection of more than 25,000 medical curiosities, like the 2,374 inhaled or swallowed foreign bodies that Dr. Chevalier Jackson extracted from patients’ throats, esophaguses, and lungs during his almost 75-year-long career. The museum was originally intended as an educational resource for medical students, but has since become a popular tourist attraction.  People come to see preserved body parts, skeletal specimens, and medical instruments that can make one wince.

While celebrated for its scientific and historical value, the Mütter Museum has faced ethical controversies in recent years. Critics argue that some exhibits, particularly those featuring human remains, raise questions about consent and the dignified treatment of the deceased. Additionally, there have been debates about the museum's approach to displaying specimens from marginalized communities, with some calling for greater contextual information and sensitivity.  Despite these controversies, the museum continues to provide medical education and public understanding of human anatomy and disease, even as it borders on the taboo.

When she was in 6th grade my daughter’s class took a field trip to the Mütter Museum.  She “learned quite a few things” and was at times “horrified.”

But that’s medicine, isn’t it?

Pennsylvania Hospital, 800 Spruce Street

When I walk by the old hospital grounds surrounded by colonial brick walls that enclose a lovely courtyard with centuries-old trees, I feel humbled by the art and science of medicine.  Our house was built painfully - brick by brick, trial by error, sorrow by success.  The old buildings exist alongside the new.

Pennsylvania Hospital, the nation's first, was founded by Benjamin Franklin and Dr. Thomas Bond in 1751, for “relief of the sick poor” of Philadelphia. The modern hospital offers rare guided tours that allow you to see the country's oldest existing operating theater where patients were “sedated” with alcohol, laudanum, or a hit to the head. This surgical amphitheater holds a significant place in American medical history. It was designed in a circular shape with six tiers of wooden benches, allowing medical students and other observers to watch surgical procedures from above. This design was inspired by European models and reflected the growing emphasis on surgical education in the early 19th century. The amphitheater remained in use until 1868. It is illuminated by natural light from a domed skylight above.

If you squint your eyes you can see the ghosts of the student doctors and surgeons gathered around to witness an appendectomy, tumor removal, or amputation.  In my mind it looks like the famous painting “The Gross Clinic” which we will be visiting later.

Pennsylvania Hospital also has a rich history of renowned physicians who have practiced here. Dr. Benjamin Rush was one of the founding fathers of the United States and a signer of the Declaration of Independence. He practiced tirelessly and heroically during the Yellow Fever epidemic of 1793, and was also a pioneer in American psychiatry.  Dr. Philip Syng Physick, often referred to as the "Father of American Surgery," made significant contributions to surgical techniques and medical instruments here.  Dr. Thomas Bond, co-founder of Pennsylvania Hospital along with Benjamin Franklin, is considered one of America's first clinical teachers.  Dr. Jacob Mendez Da Costa was a prominent physician during the American Civil War who described "Da Costa's syndrome," also known as soldier's heart.  Dr. Joseph Pancoast, a renowned surgeon and anatomist who developed several innovative surgical procedures, lives on in eponyms like “Pancoast’s tumor.”  Dr. William Osler, who is more famously associated with Johns Hopkins, nevertheless practiced at Pennsylvania Hospital early in his career.  Dr. I.S. Ravdin was a pioneering surgeon who made significant contributions to cancer treatment and military medicine during World War II.  Dr. Jonathan Letterman, famous for his work as Medical Director of the Army of the Potomac during the Civil War, trained here.

And one last bit about Pennsylvania Hospital.  It pioneered the idea of the psychiatric ward.  Dr. Benjamin Rush successfully advocated for the establishment of a separate building for patients with mental illnesses in 1783.  It was a groundbreaking approach to mental health treatment for its time. Rush introduced more humane methods of care, moving away from the harsh restraints and punitive measures commonly used elsewhere. He believed in the potential for recovery and implemented treatments such as a kind of occupational therapy with social activities. While some of his other methods would be considered controversial by modern standards, Rush's work at Pennsylvania Hospital laid the foundation for the field of psychiatry in America, and helped shift perceptions about mental illness across the world

I’m guessing that you are wondering about those “controversial” methods.  I looked them up and they include bloodletting, purging with strong laxatives and emetics to "cleanse" the body, a "tranquilizer chair" that restrained patients and had a wooden box enclosing their head to supposedly calm by reducing sensory stimuli, cold water therapy, spinning techniques at high speeds with the supposition this would redistribute blood in the body and alleviate symptoms, mercury treatments, and “moral management” which involved imposing strict schedules and behavioral expectations on patients. The podcast arriving in your inbox in 15 minutes expands on this stuff if you’re interested.

While these methods seem harsh and misguided now, it is important to note that Rush was informed by the medical knowledge of his time and was actually considered progressive in his approach to mental health. His work, despite its flaws, helped pave the way for more humane treatment of mental illness.

Sorry.  We’ll pick up the pace now.  But did I mention my daughter was born at Pennsylvania Hospital?

Physick House, 321 S. Fourth Street

The Physick House in Philadelphia was built in 1786 by wealthy wine importer Henry Hill. It was later purchased by Dr. Philip Syng Physick, known as the "Father of American Surgery," who lived in and had an office in this building in the late 1700s and early 1800s. Among Physick's patients were President Andrew Jackson, Chief Justice John Marshall and Dolley Todd Madison. The house is notable for its Federal-style architecture and for being one of the few freestanding homes remaining from that era in Society Hill. Today, it serves as a museum showcasing early 19th-century medical practices, including blood letting instruments, stomach pumps, and tubes to remove kidney stones.

The house is said to be haunted, but as people of science we don’t believe that… but perhaps that sells more entrance tickets?

Wills Eye Hospital, 840 Walnut Street

The first U.S. medical facility dedicated to the treatment of eyes, Wills Eye Hospital was created through an endowment by Quaker merchant James Wills, and was established in 1832. The world-renowned institute was instrumental in establishing ophthalmology as its own branch of medicine in the United States, created the first residency program in the country, and pioneered many techniques for the prevention and treatment of eye disease.

We sense we are here as audible beeps and tones chirp at the crosswalks to help guide some by their ears.

Portrait of Dr. Samuel D. Gross at the Pennsylvania Academy of the Fine Arts

I used to marvel at this epic painting when it hung nonchalantly in a medical building at Thomas Jefferson University Hospital where I trained as a family medicine resident.  It was kind of a hidden treasure.  “The Gross Clinic," painted by lifelong Philly resident Thomas Eakins in 1875, is a monumental work depicting Dr. Samuel Gross performing surgery before a group of medical students. I often felt like one of those students in the painting, awed by the intellectual and experiential knowledge of my teachers, even as I slaved away working 120 hours per week sometimes.

The painting caused controversy upon its debut due to its graphic realism, which was considered shocking for its time. Despite initial rejection, it has since been recognized as a masterpiece of 19th-century American art, praised for its technical skill and unflinching portrayal of modern medicine. The artwork has had a significant impact on both medical and art history, influencing generations of artists and serving as a testament to advances in surgical practice.

After a contentious battle to keep it in Philadelphia, where it was created, "The Gross Clinic" is now jointly owned by the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, ensuring its place in the city's cultural heritage.  It lives not far from the scene at Jefferson Medical College's surgical amphitheater which it portrays.

Final resting place of Deborah and Benjamin Franklin and their son Francis, Christ Church Burial Ground, 340 N 5th St

I often jog to this point as it is about a two mile round trip from home, and I can pass Independence Hall and the Liberty Bell on my way to paying my respects to the legendary founding father.   One can easily miss the tombstones marking this hallowed ground on a corner with little fanfare across from the Philadelphia Mint, just as one can easily take for granted the American notions of tolerance, freedom, and democracy these troubling days.

Francis Franklin, Benjamin Franklin's son, died of smallpox in 1736 at the age of 4 and was buried here in the Christ Church Burial Ground.  His grave lies next to those of his famous father and mother.  Benjamin Franklin deeply regretted not having Francis inoculated against smallpox, a procedure that was available but controversial at the time. In his autobiography, Franklin expressed his remorse, writing, "I long regretted bitterly, and still regret that I had not given it to him by inoculation." This tragic loss became a turning point for Franklin, who thereafter became a strong advocate for smallpox inoculation, using his influence and writings to promote the practice while saving many other lives in so doing.

His son’s death shaped Franklin's views on public health and scientific progress, underscoring the personal cost of his initial hesitation to embrace this medical innovation.  I thought about this as my daughter received her routine vaccinations, and then again as we celebrated her opportunity to receive an mRNA wonder of the world in the spring of 2021 - a kind of capstone on a terrible previous year.

Washington Square

Now we’re walking through lush Washington Square, with its old oak and sycamore trees buttressing a kind of arboreal cathedral.  The tomb of the unknown soldier receives visitors, but few tourists walking through know of this park’s somber history of death and disease as buried below. Originally established in 1682 as part of William Penn's city plan, it served as a potter's field and burial ground for the poor and unclaimed dead from 1706 to 1795. The square gained particular significance during the yellow fever epidemic of 1793, which devastated Philadelphia. As the city's existing cemeteries filled, Washington Square became a primary location for mass graves of yellow fever victims. Thousands of bodies were interred there during this crisis, including many African Americans who worked as nurses and caregivers during the outbreak. It was erroneously believed that they were less at risk.

The square also served as a burial site for Revolutionary War soldiers and prisoners. In 1825, it was converted into a public park, but the remains of those buried there were left undisturbed beneath the surface. Today, you can find a small memorial in honoring the thousands of unknown individuals laid to rest here.

Walking through the park serves as a cool break from the sun, but also as a reminder of Philadelphia's difficult past and the universal human toll of epidemic disease.

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How are your legs feeling?  Should we head home now?  There are many more little sights, cobblestone alleys, buildings where people lived and laughed and suffered and tried to help one another.  Philly is a walkable city, and we’ve been told that’s good for our hearts, minds, and the planet.  Along the way we pass nurses, doctors, and patients as they enter and exit today’s Pennsylvania and Jefferson Hospitals downtown.  There is a core element of humanity that has never stopped caring for its sick, even as other elements wage war and sow division.  The throughline of healers stretches back through historical Philadelphia and every other place, converging perhaps in a single point of our common ancestry hundreds of thousands of years ago.

Thanks for walking with me through the local medical landmarks I personally consider significant and inspiring.  The next time you’re in Philly, try skipping the cheesesteak.  Go for the John’s Roast Pork sandwich with sharp provolone and wilted broccoli rabbi instead. Or better yet, hit Mabu for brunch, Stargazy on a wintry day, Paesano’s for an inspired sandwich, or Goldie for the best falafel sandwich and hummus you can imagine. And while we don’t believe in haunted houses, the ghosts of legendary physicians and patients, commoners and luminaries, and American patriots abound.

May they circulate among us, even as we contemplate the complicated past, the vulnerable future, and the evergreen promise of this nation.