Medicine in Boston and Philadelphia: Comparisons and Contrasts, 1750–1820*

    AFTER the middle of the nineteenth century New York was the standard with which other American cities were compared; but in the latter part of the eighteenth and the first third of the nineteenth, it was Philadelphia. (Not until 1858 did Dr. Holmes at the breakfast table distinguish the Boston statehouse as “the hub of the solar system.”) Philadelphia was in those years the largest, wealthiest, and most cosmopolitan of American cities. For a quarter of a century it was the seat of the Continental and Federal governments; for an even longer period it was the capital of the nation in the sense in which no other American city was or has been—not Washington, not New York; as London is the capital of Britain and Paris of France —that is, the center of government and source of administration, the citadel of finance, the home of society, and the school of letters, arts, and sciences. Many American and most foreign travelers visited Philadelphia, some settled there, and all had opinions of the place. The Reverend Mr. Andrew Burnaby, traveling through the colonies in 1759, reflected that Philadelphia, “a wild and uncultivated desert, inhabited by nothing but ravenous beasts, and a savage people” only eighty years before, must certainly now in his day “be the object of everyone’s wonder and admiration.” Young Robert Treat Paine, later a famous lawyer and signer of the Declaration of Independence, made the long journey from Massachusetts in 1751 to be inoculated against smallpox by a Philadelphia physician. And John Adams, venturing out of New England for the first time in 1774, measured the American capital by what he knew, judged Boston superior in almost every respect—laws, morals, religion, language, even the comeliness of its citizens; but made an exception for “charitable public foundations.” Among these was the Pennsylvania Hospital, where he attended an anatomical lecture by Dr. William Shippen, Jr.1

    It was inevitable that some visitors and informed observers should compare the physicians and medical institutions and practices of Philadelphia with those of Boston, New York, even London. On the whole the comparison was not unfavorable. Daniel Coxe sent his son from London to study with Benjamin Rush at Philadelphia, where he thought the “lights & practical aids” of physic could be better got than in England. Benjamin Lincoln of Boston, after two years of study at Edinburgh, went to Philadelphia to take a medical degree. Thomas Jefferson sent his grandson to school in Philadelphia, which, he asserted, afforded advantages in the sciences and medicine “not to be had elsewhere in America.”2 How New Haven ranked the medical schools of the day was indicated by the action of President Dwight in appointing Benjamin Silliman professor of chemistry and natural history at Yale in 1802 and sending him to the University of Pennsylvania to study the subjects, obtain an M.D. degree, and so qualify himself for the post. This program having succeeded, when the Medical Institution of Yale College was established in 1810, Silliman chose Jonathan Knight, who had just begun practice, to be professor of anatomy, and sent him to Philadelphia to qualify by two years’ study at the University and the Pennsylvania Hospital.3 A more sweeping judgment was expressed a few years later by Dr. Thomas Cooper, President of the University of South Carolina, when urging the legislature to establish a medical school in that state: “The Medical Schools of the United States, are principally those of Philadelphia and New York; lately that of Baltimore promises to become a most useful institution, and a formidable and honorable rival. I say nothing respecting those of New England, because they have furnished no manifest occasion for peculiar notice, nor have they risen beyond the level of mediocrity.”4

    * * *

    This comparative study of the medical profession, institutions, and traditions of Philadelphia and Boston concerns the years from 1750 to 1820, when strong leaders emerged and broad-based institutions were established in both cities. To compare the two cities and their institutions in any selected year, however, is likely to be misleading. Though Boston was half a century older than Philadelphia, the latter grew more rapidly. On the eve of the Revolution it was larger than Boston, by 1790 it was twice as populous, and thereafter it continued to expand at a faster rate. It was also wealthier, as was evidenced by the “charitable public foundations” which so impressed John Adams, and by the “mighty sinful feasts” that he and other delegates to the Continental Congresses consumed at the homes of local grandees.5 If Philadelphia and Boston are to be compared in the years from 1750 to 1820, an allowance of fifteen to twenty-five years should probably be made for Boston. Although size and wealth are essential supports of social and cultural institutions, and, other things being equal, there may be a close correlation between density of population and the emergence of social phenomena and institutions, other forces were also at work to make Philadelphia the preeminent American city.

    Franklin made a difference. So did a patron like Chief Justice William Allen, who paid for John Redman’s medical studies abroad, probably underwrote John Morgan’s as well, and sent Benjamin West to Rome to study painting, making him an allowance lest, as he put it, “such a Genius should be cramped for want of a little Cash.”6 The Quakers, sensitive to human suffering and attracted to the study of the natural world, were accordingly well represented in medicine and among the naturalists who were industriously describing all that lay just beyond their gardens. To these influences was added the presence of foreign visitors and foreign-born residents, who created a cosmopolitan air unknown in Boston. In the American Philosophical Society, for example, the pastor of Gloria Dei Church, a graduate of Uppsala, the Reverend Dr. Nicholas Collin, kept his colleagues in touch with Swedish scholars; the civil lawyer Peter S. DuPonceau, with French, German, and Russian linguists; and G. H. E. Muhlenberg of Franklin College, with German botanists. Refugees from the French Revolution and Napoleon sought Philadelphia; they included the Count Ambroise M. F.J. Palisot de Beauvois, working happily in Peale’s Museum; the liberal-minded Portuguese scholar Abbé J. F. Correa da Serra; Moreau de St. Méry, whose bookstore was a rendezvous of the emigrés; and—improbable resident of the Quaker City—Talleyrand, who passed one of his lives in Philadelphia in 1794–1795. An English Whig, Samuel Vaughan, who spent several years in Philadelphia in the 1780’s, was largely responsible for both the postwar reorganization of the American Philosophical Society and the first formal planting of the State House Yard.7

    Comparisons and contrasts in the progress of institutions are the easiest to recognize and document. In both Philadelphia and Boston almshouses were established early—in Boston in 1662, when the city was thirty-two years old; in Philadelphia in 1732, when it was fifty; and since many inmates were aged and ill the houses required physicians. The overseers of the poor, however, who were civilians motivated principally by a desire to protect the helpless, discouraged or even forbade attempts by almshouse physicians to take their pupils through the house or offer regular medical instruction. Military hospitals, though scarcely noticed by the generality of local physicians and inaccessible to students, offered some important opportunities for civilian practice. At least one local lad, Paul Jackson of Chester County, for example, received instruction at the British army hospital in the barracks constructed in the Northern Liberties of Philadelphia during the French and Indian War; so, too, probably did John Morgan. In similar fashion the Continental Army hospital in Boston after 1776 became a school of instruction; there in 1780 a military surgeon, John Warren, commenced the formal course of lectures on anatomy and surgery which led directly to the founding of the Harvard Medical School two years later. These hospitals had advantages not enjoyed by civilian institutions: they offered not only a variety of medical and surgical cases, but also a supply of cadavers, which could be studied without exciting popular protests. And both Philadelphia and Boston established dispensaries for out-patient care. Philadelphia’s was founded in 1786; its physicians were usually abler young men, who looked forward to appointment to the Pennsylvania Hospital staff, and there seems not to have been any serious conflict between the two institutions. The Boston dispensary, opened in 1796, was the first public institution for medical care in that place; physicians brought their students to observe their practice, but the managers were uneasy with this development and soon restricted it.8 What most distinguished the Philadelphia and Boston medical scenes before 1820, however, was the Pennsylvania Hospital. Founded in 1751, when Philadelphia had an estimated population of 20,000, receiving its first patients in 1752, opening its own building in 1755, the Hospital was a testimony to both the charity of the citizens and the professional aspirations of the physicians. The admission of apprentices was countenanced from the start; inevitably, clinical lectures were soon begun by one of the attending physicians; and these lectures, when the Medical School was established in 1765, were made a required part of the curriculum.9 The opportunity to attend hospital practice was a principal benefit that Philadelphia offered medical students after mid-century; many availed themselves of it who were not candidates for a degree. In Boston, however, smaller and poorer than Philadelphia in the later colonial period, a general hospital was not proposed until 1810, when the city’s population was 33,250; and the Massachusetts General Hospital was not opened for the reception of patients until 1821.

    Probably all the principal surviving documents relating to the early history of the first American medical schools have been found; they have been assembled, published, and carefully studied. In 1765 the trustees of the College of Philadelphia elected John Morgan and William Shippen, Jr., as professors, inaugurated a course of formal instruction, and thus created a medical department in frank imitation of that in Edinburgh. Adam Kuhn and Benjamin Rush were soon added to the faculty, and Dr. Thomas Bond’s lectures at the Hospital were required of candidates for degrees. In 1768 ten students received the M.B. degree. As the reputation of the new school spread, students came to Philadelphia from other colonies—one, Jonathan Easton, from Newport, Rhode Island. Despite temperamental incompatibility and the rival and antagonistic ambitions of most of the faculty, the school was well established on the eve of the Revolution. William Cullen, professor of medicine at Edinburgh, expressed satisfaction that the founders were all his pupils, and he gave his opinion that the institution would “be the most certain means of transmitting my name to a distant posterity, for I believe that this School will one day or other be the greatest in the world.”10

    With the outbreak of war, in which Morgan, Shippen, and Rush all had active roles, regular lectures at the College were suspended, and no degrees were awarded for several years. But the reputation of Philadelphia’s medical faculty and hospital remained high; and surgeon’s mates sometimes took leave from the army during the winter months to attend the Pennsylvania Hospital and to hear such lectures as were delivered.11 Upon the reorganization of the College as the University of the State of Pennsylvania in 1779, medical lectures were resumed, albeit irregularly. When the University of Pennsylvania was created in 1791 to succeed both the old College of Philadelphia and the Revolution-born University of the State of Pennsylvania, a full medical course was reestablished.12

    The medical school in Boston, like that at Philadelphia, began as the undertaking of one man. John Warren, surgeon in the army hospital in Boston, began to give lectures there in 1780; the next year students at Harvard College were allowed to attend and in the same year Warren was appointed professor of anatomy in the College. In 1782 the Harvard corporation appointed three medical professors, made their students members of the College, and adopted a plan of medical instruction. The requirements of the new school, however, were far less rigorous than at Philadelphia: students were not required to have had a previous grounding in some of the liberal arts; no clinical instruction was even offered, except as the professors might take students among their own patients; and candidates for degrees were not expected to present a thesis. With no personal experience with an established medical school, Warren turned to Rush in Philadelphia for advice, including the delicate question of precedence.13

    The Medical Institution of Harvard College, as it was named, was seriously hampered from the beginning. Whereas the medical school of the University of Pennsylvania was in a large city, with ample opportunities for clinical teaching and observation close at hand, Cambridge was a village, with no hospital, no dispensary, hardly more than scant chance to attend the sick; and, until the West Boston bridge was thrown across the Charles River in 1793, the opportunities Boston offered in these respects were not easily accessible.14 Furthermore, Philadelphia students were likely at least occasionally to be provided with bodies for dissection. Although, to be sure, Shippen had one experience with a mob angered because he had robbed a grave,15 on the whole few if any other incidents of the sort are recorded. In Cambridge, however, grave-robbing and demonstrations on the human body were virtually impossible to conceal; and even in Boston, where no medical school or hospital could justify or conceal the act, grave-robbing was a hazardous undertaking, as the half ludicrous case of Levi Ames demonstrated. Sentenced to be hanged for a felony, Ames obtained a promise of decent burial from the Baptist minister, the Reverend Mr. Samuel Stillman; to keep the promise Stillman and his friends, like a gang smuggling contraband, spirited the body away to burial before it could be seized either by members of the Spunkers Club, a group of medical students in town, or by Doctors Jeffries, Lloyd, and Clark, the latter armed with the governor’s permission, all of whom wanted it for their own purposes. “It seems as if fate had placed medical knowledge profunda in puteo, saxis et vix mobilibus submersa” (“deep in a well, beneath barely movable rocks”), one of the students, William Eustis, complained only half-humorously to his fellow student John Warren. “Could any one be a spectator of our honest, laudable intentions, and, at the same time, observe the momentous difficulties with which we are constantly perplexed, methinks it would lead a flinty soul to pity us....”16

    In the matter of professional organization, too, there were notable differences between the two cities. In Philadelphia the effort by John Morgan to obtain for his Philadelphia Medical Society in 1766 proprietary authority to issue licenses to practice came to nothing; the American Medical Society, founded in 1770, was a student-faculty group like the Medical (later Royal Medical) Society of Edinburgh;17 and the College of Physicians, founded in 1787, was a Philadelphia, not a statewide, institution, with no pretensions to govern or control the profession by examination and license. As a result, no challenge to the diploma of the Medical School as a qualification to practice was ever offered by any organized portion of the profession in Philadelphia. In Boston, on the other hand, the medical society founded in 1781 preceded both the hospital and the medical school, was the earliest focus of the profession there, and claimed, as in the circumstances was understandable and proper, the right to examine and license physicians. It asserted this claim against the Medical School and only in 1803 agreed to accept a Harvard diploma as equivalent of its own examination. Not all Boston physicians willingly surrendered the right of exclusivity, and a claim to license was revived in 1811 when some members of the profession, led by Benjamin Waterhouse, proposed another society, the Massachusetts College of Physicians.18

    * * *

    Here one can see important differences in the professional structures of Philadelphia and Boston. In Philadelphia the hospital came first, then the medical school, finally a medical society. In Boston it was the other way around—first a medical society, then a medical school, finally a hospital. In Philadelphia a basis for clinical instruction was laid before the medical school was established. From the start the Pennsylvania Hospital was an integral part of the medical curriculum of the College of Philadelphia; and, with no challenge from a medical society, the College’s diploma was everywhere accepted as sufficient testimony of professional competence. In Boston, however, physicians with professional standards but limited formal training founded a medical society at a time when there was no objective basis for distinguishing qualified from unqualified practitioners; they undertook to raise standards of practice by making the distinction.19 The founding of the Harvard Medical School threatened this activity and the doctors’ status, and the reaction of the society’s members was sharp and, in human terms, understandable: what doctor newly made at Harvard, they asked, was the equal of an experienced old practitioner? and so there was friction between the society and the School.20 (Similar frictions, from similar causes, prevailed for some years between the Connecticut Medical Society and the Medical Institution of Yale College.21) Finally, the Harvard Medical School, during its first forty years, was without access to a general hospital—a fact that, paradoxically, might be thought to have made education in that institution less practical and more academic than at Pennsylvania. The School’s removal from Cambridge to Boston in 1810 was significant because it took the students to where the patients were.22 A clinical professor was appointed at the same time, and the overseers of the poor agreed to allow the professors to teach in the almshouse. But more than this was required. A circular letter addressed by Dr. James Jackson and Dr. John C. Warren to a number of citizens in 1810 argued that the future of the Medical School was closely linked with the establishment of a general hospital:

    The means of medical education in New England are at present very limited, and totally inadequate to so important a purpose. Students of medicine cannot qualify themselves properly for their profession, without incurring heavy expenses, such as very few of them are able to defray. The only medical school of eminence in this country is that at Philadelphia, nearly four hundred miles distant from Boston; and the expense of attending that is so great, that students at this quarter rarely remain at it longer than one year. Even this advantage is enjoyed by very few compared with the whole number. Those who are educated in New England have so few opportunities of attending to the practice of physic, that they find it impossible to learn some of the most important elements of the science of medicine, until after they have undertaken for themselves the care of the health and lives of their fellow-citizens. This care they undertake with very little knowledge, except that acquired from books; —a source whence it is highly useful and indispensable that they should obtain knowledge, but one from which alone they never can obtain all that is necessary to qualify them for their professional duties....

    A hospital is an institution absolutely essential to a medical school...,23

    With the opening of the Hospital in 1821 the Harvard Medical School was set on a clear course of growth and improvement. New England’s need of Philadelphia for medical training and direction lessened.

    * * *

    Here I should like to interject a query. Were Boston physicians with high ideals for their practice frustrated by their inadequate training and opportunities? Were they so keenly aware of their limitations that they took little satisfaction from their work? The query arises from this observation: Boston physicians, rather more readily than Philadelphians, seem to have given up medicine for politics. Rush, to be sure, was a member of Congress and a signer of the Declaration of Independence; but he was a delegate for only a few months and, though deeply interested in public affairs, held no other elective office during his long life. Shippen, Morgan, Kuhn, and Bond never held public office; nor did their successors Wistar, Griffitts, Physick, and Barton. In Boston, on the contrary, many physicians seem to have embraced public careers eagerly. Twenty-two physicians were members of the Provincial Congresses of 1774 and 1775. Benjamin Church and Joseph Warren were Boston Massacre anniversary orators, and Warren, though a successful doctor, was deep into revolutionary politics long before Bunker Hill, where death in battle sealed his reputation with most Americans not so much as a skilful surgeon but as a patriot hero. William Eustis became a congressman, secretary of war, ambassador, governor of the Commonwealth, and president of the Cincinnati. John Brooks dropped his scalpel for a musket, was captain of the minutemen at Concord, an officer in the Revolution, a federal marshal, member of the state legislature, and governor of Massachusetts. The Philadelphia medical faculty could offer no such record as this. Eulogizing John Warren in 1815, James Jackson seemed to regret that Warren was barred by the terms of his professorship from actively engaging in public affairs.24 In short, was the practice of medicine unrewarding to Massachusetts practitioners; or was it only that they and their fellow citizens ranked careers at the bar and in public service as preferable to all others?25

    * * *

    Most doctors in Philadelphia and Pennsylvania and the middle colonies, as in Boston, Massachusetts, and New England, acquired their knowledge of medicine as apprentices to older physicians. The medical care available in the country and smaller towns everywhere was provided almost exclusively by men trained in this traditional way. In the latter eighteenth century in both northern and middle colonies one could find clerical physicians of the kind described by Cotton Mather in Magnalia Christi Americana.26 In the second third of the century, for example, James Baker, a Harvard graduate in the class of 1760, both preached and practiced at Dorchester.27 Farther south, the Reverend Mr. Robert McKean, a missionary of the Society for the Propagation of the Gospel, was the first president of the New Jersey Medical Society in 1766; and the Reverend Dr. Heinrich Melchior Muhlenberg prepared himself for mission work as “the Lord’s sheepdog” among the Lutherans of Pennsylvania by studying medicine as well as theology at Halle. “Since doctors are few and far between,” he explained, “I necessarily had to take a hand myself.”28 But it was the physicians with European educations who gave the profession a palpable forward thrust in both Philadelphia and Boston in the latter part of the eighteenth century. Here, however, despite many similarities, there were significant differences.

    A greater number of Philadelphia than of Boston physicians had completed a formal course of study in a European medical school. Of Americans receiving degrees at Leyden in the colonial period, for example, eleven were from Pennsylvania, New Jersey, and New York; but only five were from New England, and three of these were students there in the seventeenth century.29 A similar disproportion appears among Americans at Edinburgh in the eighteenth century: in the twenty-five years from 1770 to 1795 fifteen Pennsylvanians, but only five New Englanders, are recorded as students.30 The contrast in the formal preparation of the first faculties is more striking: at Philadelphia Morgan, Shippen, Kuhn, and Rush were all graduates of Edinburgh and Bond, though his degree was from Rheims, had also studied at the Scottish university; but at Cambridge in 1783, though Benjamin Waterhouse had studied at Leyden, neither Warren nor Aaron Dexter had had formal medical training.31

    Moreover, the studies of the Bostonians who did travel abroad had a different emphasis from those of the Philadelphia students. Where the latter preferred Edinburgh—only James Hutchinson, who intended to practice surgery in Philadelphia, did not go to Edinburgh32—the Bostonians preferred to concentrate their studies in London, where clinical lectures, demonstrations, and similar facilities were available.33 This is not to say, of course, that the Philadelphians did not also walk the wards in London—William Shippen, Jr., and Philip Syng Physick, for example, were favorite pupils of John Hunter34— but some of them at least seem to have regarded the opportunity as less to be coveted than the honor of an Edinburgh degree. James Hall, for example, confessed to Benjamin Rush that he attended John Hunter’s lectures “more for the name of the thing than anything else.”35 Many Bostonians, on the other hand, were content with the London experience, and went no farther. Before the Revolution James Lloyd, Charles Jarvis, John Jeffries, Thomas Kast, and young Isaac Rand, for example, studied at St. Thomas’s, Guy’s, or other London hospitals, but did not take a degree at Edinburgh (although Jeffries received one from Aberdeen); and after the turn of the century George Hayward, James Jackson, and John C. Warren registered with Henry Cline, John Abernathy, or the celebrated Astley Cooper, of whom Walter Channing wrote that he was “above, far above common men.”36 Professor Philip Cash, in a study (made for this symposium) of the careers of forty-seven Boston physicians practicing between 1760 and 1798, has shown that only three received degrees from Edinburgh, that of thirteen who studied in London only one received a degree from the Scottish university.37 This seems to suggest that the Bostonians were less attracted to theory than to practical experience. Their practice on their return to New England seemed to show as much.

    The influence of Edinburgh and Cullen was powerful in Philadelphia; and in Benjamin Rush Cullenian principles had an eloquent and persuasive spokesman. But Boston physicians and teachers, who, like Warren, had received their training from private preceptors and been greatly influenced by London clinicians, were less inclined in practice and teaching to make sweeping generalizations and build comprehensive theories. Although the practical nature of their training doubtless gave the Bostonians real advantages, they seem also perhaps to have made a virtue of the limitation. Certainly they often expressed pride in their common sense, their pragmatic rejection of theory for experience. They even preserved, if they did not cultivate, a certain rusticity of manner and speech. John Ware laconically listed “hyperpractice” among causes of death.38 Ebenezer Alden, who received his M.D. degree from Pennsylvania in 1812, reported in near-derisive terms on his Philadelphia teachers. Of Benjamin Smith Barton he wrote:

    The Doctor wept as usual over the Miseries and Misfortunes of Dr. Brown when on the subject of opium, and erected a verbose monument over the ruins of his exalted genius. The same day we had a Phillippic [sic] from Dr. Rush. I was the more surprized at this as it seems to me that the basis of the two systems is the same. Dr. Rush has indeed corrected some of the errors of Brown, and has extended the system in some respects; but perhaps it will hereafter appear, that he has occasionally fallen into errors, which are no where to be found in the writings of Brown. Yesterday he finished his therapeutics, and toward the close became exceedingly animated. The stimulus of the subject was so powerful that I feared it might overpower his excitability, until I perceived it was translated by a wonderful sympathy to the hands and feet of his audience.39

    Nathan Smith was more objective and more devastating in his rejection of Rush’s theory. Commenting on a former student’s description of the Medical School at Philadelphia, he wrote,

    Dr. Rush must be a very interesting lecturer. As to his classification of diseases I do not think it very material. However we may class diseases we must study them in detail.... perhaps Dr. Rush’s method of classing diseases is not wholly exempt from arbitrary reasoning. I cannot see how Nosology is essentially benefitted by adding the word ‘state’ to the name of disease, as the Pleurisy state, rheumatic or hydrophobic state of fever. ... As to the unity of disease, you know it is my opinion that we have in medical science of late generalized too much and that the progress of medicine has been checked by it. This mode of proceeding tends to substitute idleness for industry and dogmatism for patient inquiry.40

    26. Recommendation for admitting a patient to the Boston Dispensary, 1802. The decoration shows the Good Samaritan. From [William Richards Lawrence,] History of the Boston Dispensary (Boston, 1859). Courtesy Boston Medical Library.

    27. Certificate that Ebenezer Alden of Massachusetts attended the Pennsylvania Hospital in Philadelphia. The decoration shows the hospital. Courtesy American Philosophical Society.

    28. The [Massachusetts] General Hospital, Boston. Colored aquatint published in London, 1831. Courtesy Boston Medical Library.

    29. Dr. George Cheyne Shattuck (1783–1854). Painted by Gilbert Stuart in 1827. From a photograph in the Boston Medical Library.

    30. George Cheyne Shattuck’s notes on Dr. Benjamin Smith Barton’s lecture on opium at Philadelphia in 1806–1807. Elsewhere in his notebook Shattuck lists the texts on materia medica by Cullen, Lewis, Murray, and Barton himself that Barton recommended to his students. From Shattuck’s unpublished MS “Extracts from Doctor Barton’s Lectures upon Materia Medica,” 1806–1807. Courtesy Boston Medical Library.

    31. Dr. Benjamin Smith Barton (1766–1815). Stippled engraving, c. 1810.

    Courtesy American Philosophical Society

    The students’ reaction to fine theorizing and excessive emotion in the Philadelphia professors was understandable. Nor did their judgment change later on. Of Joseph Gardner, who had a large practice in the 1780’s, Ephraim Eliot wrote, “He pretended that he looked upon learning as superfluous; that the bedside was the only school for a physician; but he did study, and was a more learned man than he chose to appear.” There is a suggestion of disapprobation in Eliot’s appraisal of Isaac Rand, Jr.:

    Being much of a mathematician, he was seeking for something like demonstration on which to lean in his profession. For want of it, he was always dissatisfied, and probably read more books than any physician among us. He was apt to pin his faith on the last book. He was, however, a successful practitioner, had a discriminating judgment, was a good surgeon, and remarkably neat in his operations.41

    The use of bleeding illustrated the Bostonians’ pragmatic approach. Though it may be doubted whether Rush bled as much as his reputation suggests, the procedure is indissolubly linked with his name. Undoubtedly he and his Philadelphia colleagues bled more often than their New England brethren, as reports of medical cases published in the two cities seem to bear out.42 Additional evidence is in the frequently recorded opposition of New England doctors. Dr. Samuel Danforth, for example, gave up bleeding entirely. Called to the scene of an accident, he found another doctor engaged in drawing blood from the injured man. “Doctor,” the former called out to him, “I am doing your work for you.” “Then pour the blood back into the man,” Danforth retorted.43 Theory and conviction kept the Philadelphians bleeding long after the practice was questioned and abandoned elsewhere; they were kept to it, an old practitioner told Dr. Oliver W. Holmes, because there was a company of professional bloodletters in the city. At least the Philadelphia City Directory for 1818 lists, in addition to physicians, midwives, and nurses, forty-four “Dentists and Bleeders” and ten “Bleeders with Leeches.” No such classification appears in the Boston city directory of the same period, and inspection of more than half the individual entries has discovered no one identified as a bleeder (though, of course, there are dentists).44

    * * *

    We need not accept Thomas Cooper’s uncharitable judgment on the medical schools of New England to recognize that their influence in the nation was notably less than Pennsylvania’s. In the six classes graduated at the College of Philadelphia before the American Revolution twenty-eight persons received degrees, including one from Rhode Island, who later sent his son to Philadelphia to study medicine. The total number of graduates through 1815 was 808. Harvard’s figure in the first ten years is comparable—twenty-three medical graduates; but the Harvard school did not grow, and from its inception in 1783 through 1815 it awarded only ninety-four degrees. The largest class before 1813 numbered only five, and not until after the school removed to Boston in 1810 did the number of graduates in any year reach ten.45

    The influence of the University of Pennsylvania in these years was not simply a matter of numbers; it pervaded the profession almost everywhere. Students came from Pennsylvania and the middle states, as was to be expected, but they came in even greater numbers from the South and old Southwest, to which many returned to practice. Nathaniel Chapman and William E. Horner, both from Virginia, the former later the first president of the American Medical Association, the latter subsequently dean of the University of Pennsylvania Medical School, were graduates of the University; so were Charles Caldwell from North Carolina and Daniel Drake of Kentucky, pioneer educators in the Ohio and Mississippi Valleys, the distinguished New York surgeon Valentine Seaman, and Francis Kinloch Huger of South Carolina, who, however, may be better known for his quixotic attempt to rescue Lafayette from Olmütz prison than for his medical achievements. Wherever south or west of New York there was a medical school or society in the first third of the nineteenth century, there were sure to be Pennsylvania graduates. Most of the founding faculty of the University of South Carolina Medical School, for example, had received their professional training at Philadelphia.46

    Though perhaps stronger than has been realized, the influence of Philadelphia was fainter in New England than in the South and West. In some respects the state of medical institutions east of the Hudson River at the opening of the nineteenth century was comparable to their condition in Philadelphia thirty years earlier. An aspiring young New England physician in 1800, after apprenticing himself to an experienced preceptor, might take a medical degree from Harvard or Dartmouth; but if he wanted really good professional training he would go either to Philadelphia or to Europe. Some went to both places. The movement to Philadelphia, hardly more than a trickle in comparison with the flood from the South, began in 1805, when George Cheyne Shattuck, with a medical degree from Dartmouth (and after several years’ experience in practice), came to Philadelphia. Others followed in the next ten or a dozen years—Reuben Diamond Mussey, George Hayward, Walter Channing, to name but three; all ambitious, industrious, and able. Their presence in the city alone was recognition of the medical preeminence of Philadelphia, a fact which a few acknowledged cheerfully. Channing exclaimed that the University of Pennsylvania exceeded his “widest expectations.” This sentiment persisted after he returned to Boston. “I had Sir,” he told Dr. Barton in an embittered view of the profession there,

    an opportunity of contrasting the state of medical science & practice abroad with that at home. With you it is a philosophical pursuit. It becomes more interesting, because it is daily improved. With us Sir it is the medium of subsistence only and secondhanded are all our acquisitions. Its professors seldom agree, & frequently openly disagree. And more unfortunate for our science the influence of family will make moderate talents the means of almost splendid wealth, while more deserving men not so fortunate by accident starve or become sycophants. I almost mourn that fortune had not smiled on me & given me the means of supporting myself in Philada until I had made myself deserving one by industry & propriety of conduct.47

    Like Channing, Shattuck, who settled in practice at Salem after returning to Massachusetts, at least briefly considered seriously returning to Philadelphia. “I consider this place to have advantages vastly beyond any others in the U. States,” a friend advised. “Barton & the other Doctrs. who give Lectures here are growing rich very fast….”48

    Others, however, seem to have resented having to leave New England at all; and this feeling grew on them as their own medical school flourished in mid-century. Yet even George Hayward, who felt that being in Philadelphia made him appreciate Boston more, after additional years of study had high praise for the Pennsylvania Medical School (though the sentiment obviously owed something to flattery of a professor):

    Though I have been in London, Edinburgh and Paris, I have found no place where the advantages were greater so far as it regards the lectures, than at Philadelphia. From the greater population of European cities there is more disease and also more cases of surgery, but it is only however in practical advantages that any of them can surpass your school. I feel proud that my preceptor is elevated to the head of the first medical institution of our country and one which is not surpassed in any other.49

    Benjamin Rush’s influence among the New England students appears to have been slight.50 One reason is probably that by the time the Yankees came to Philadelphia Rush’s doctrine was questioned, his therapeutics modified or rejected. Another is that most of them had already had medical training or experience before they matriculated at Philadelphia, and so had a basis for critical judgment of their professors and courses. In this respect they resembled American students at Edinburgh in the 1770’s. Rush could still sway a hall full of students, but the Yankees were skeptical. On the other hand, Benjamin Smith Barton, professor of botany and materia medica and Rush’s successor in the chair of medicine, was especially well liked by the New Englanders. This may have been due to the general popularity of botanical studies in New England; but it owed probably as much to chance personal ties and the fact that one student introduced another to Barton. Jacob Bigelow has testified that he “got from him [Barton] the rudiments of a botanical taste,” and Shattuck and Channing, making a natural history excursion into the White Mountains, sent Barton specimens and observations from the trip. Daniel Oliver of Salem assured his old teacher that “Natural knowledge appears to be cultivated with increasing ardor in this country; & for this happy spirit there is no doubt I believe, that we are in a great measure indebted to you.”51

    In general, however, the Yankees, whatever their intellectual competence, were not comfortable in Philadelphia. Raised, some of them, in straitened circumstances and in a provincial environment, they were awkward, easily unsettled by the wealth and worldliness of the capital city. Parents, teachers, and ministers had warned against the sin and corruption that would surround and seek to ensnare them; even that their professors harbored and might express “Priestleyan” and other such “infidel” opinions, which they must guard against. “I have never before had such feeling views of the pride & vanity of worldly grandeur as since my arrival at Philadelphia,” Shattuck agreed with his old college teacher, but then reassured him: “I have not, nor do I now feel the least inclination to enter into the amusements & dissipations of the city. Such a blaze of medical truth is presented to my view as obscures the sight of balls, routs, card-parties, theatres &c. &c. My chum is a very steddy man—he is a Georgian.”52

    If the Yankee students withdrew, uncomfortable and disapproving, from the social life of the city (unlike the Americans in Edinburgh forty years before), it was partly because they were not received cordially by the natives. The Yankee reputation for sharpness was reinforced by known cases. The year Shattuck entered the Medical School the professors determined not to extend credit to even poor students for tickets to the lectures. “If an angel of light were to descend from heaven, and proclaim in accents strong as the seven thunders that a man could be honest in the climate of New-England,” Shattuck complained with some indignation, “his story would be discredited in Philadelphia.”53 Though some New England graduates and their professors in Philadelphia established and maintained cordial professional relations over the years, there seem to have been fewer spontaneous friendships and less uninhibited correspondence between them than existed, for example, between Rush and his students from western Pennsylvania, Virginia, Kentucky, and South Carolina.

    Philadelphia exerted influences of another sort. After they returned home the Bostonians remained indebted to Philadelphia for various auxiliary aids to medicine. Boston doctors bought many of their medical texts in Philadelphia; they employed Philadelphia artists and engravers to illustrate their books;54 and for a time, until they founded the New England Journal of Medicine, the Bostonians could publish their observations and findings only in Philadelphia or New York. Rush continued to be consulted, if not always on medical problems, at least on medical education. Benjamin Lynde Oliver asked the Philadelphian for reading lists for candidates for degrees. “I should advance the interests of the institution, as well as that of society, by requesting your opinion on that subject.”55 And when the Massachusetts General Hospital was being planned, Charles Bulfinch, the managers’ architect, traveled to Philadelphia to study the Pennsylvania Hospital.56

    * * *

    After 1820 Philadelphia was less attractive to the New Englanders. With the opening of the Hospital the standard of medical education in Boston rose. Local students could go to Harvard confident of getting a sound education; if they wanted more, there was now Paris. Besides, Philadelphia’s reputation had lost some of its lustre. Nathan Ryno Smith, spending a few weeks in Philadelphia in the winter of 1822–23 “for improvement in my profession,” expressed his view of the University:

    I have been very much disappointed as respects the opportunities for improvement in the University of this place. They have indeed a very splendid museum, fine buildings, libraries, etc., but they do not appear to be animated with that scientific enthusiasm which makes men great, and awakens the same laudable spirit in others. They appear to me to be very ordinary men, and their minds to be more occupied with professional intrigue and in some instances disgraceful quarrels than with scientific pursuits. They seem jealous of genius, and strive to crush it unless completely subversive to them.57

    Not only did Boston students no longer have to go to Philadelphia; they were satisfied there were reasons why they should not.


    New England Students at the Pennsylvania Hospital from the Revolution to 1820

    The following New England students are recorded as “Medical pupils” in the Accounts of the Attending Managers of the Pennsylvania Hospital from the close of the Revolution to 1820 (the terminal date of this study). Names in italics are those of graduates of the University of Pennsylvania; those marked with an asterisk (*) were pupils of Benjamin Smith Barton, who died in 1815. The year is that of first registration.

    • 1792: John Stearns, Conn.
    • 1794: Elisha North, Conn.; Daniel Chickering, District of Maine.
    • 1796: Enoch Hazard, R.I.; John S. Peters, Conn.
    • 1798: Joshua Brackett, N.H.
    • 1799: Benjamin G. Harris, R.I.
    • 1800: Ezekiel Skinner, Conn.
    • 1801: Benjamin W. Dwight, Conn.; James Gilbert, Conn.; Eli Ives, Conn.; Abram Stoddard, Conn.; John Sayre, Conn.
    • 1802: John Carrington, Conn.; Armand Auboyneau, R.I.
    • 1804: Josiah L. Dennis, Plymouth, Mass.; Asahel Smith, N.H.
    • 1805: Abner Howe, N.H.; Horatio Jones, Berkshire Co., Mass.; Daniel Newcomb, N.H.; Horace Otter, Conn.; Samuel Wright, Conn.
    • 1807: William Aspinwall, Norfolk, Mass.
    • 1808: Charles Babcock, Conn.; * Walter Channing, Boston; Jonathan Easton, Jr., R.I.; Andrew Harris, R.I.; *Thomas G. Keegan, Maine; *Reuben D. Mussey, Ipswich, Mass.; Josephus Sanford, Conn.
    • 1809: Edmund Allen, Conn.; Benjamin Bassett, Conn.; Nathaniel Bemis, Boston; *Jacob Bigelow, Boston; Benjamin Clapp, Haverhill, Mass.; Charles Eldredge, Conn.; *Daniel Oliver, Salem, Mass.; Alfred Perry, Berkshire Co., Mass.; Lyman Spalding, N.H.
    • 1810: *Ezekiel D. Cushing, Plymouth, Mass.; Oliver Hubbard, Maine; Cyrus Perkins, N.H.; James Phelps, Conn.
    • 1811: Ebenezer Alden, Norfolk, Mass.; Timothy Beers, Conn.; Luke Dewey, Berkshire Co., Mass.; Eleazer B. Downing, Conn.; Thomas Forbes, Boston; * Andrew Foster, Cambridge, Mass.; Gordon Hall, Hampshire Co., Mass.; *George Hayward, Boston; Jabez Holmes, R.I.; Adonijah Howe, N.H.; Jonathan Knight, Conn.; *Benjamin Lincoln, Boston; Francis Moore, Salem, Mass.; Samuel Newell, Norfolk Co., Mass.; Seth S. Peck, Conn.; Benjamin Rogers, Berkshire Co., Mass.; * Thomas Russell, Salem, Mass.; *Thomas Sewell, Ipswich, Mass.
    • 1812: Elisha A. Belcher, Conn.; Ralph Carter, Conn.; James Richards, Hampshire Co., Mass.; Lewis Riggs, Conn.; Luther Spalding, Conn.; William H. Taylor, Conn.; Edward Warren, Middlesex Co., Mass.; *John Fothergill Waterhouse, Boston; William A. Whelpley, Berkshire Co., Mass.
    • 1813: Edward Barton, Conn.; George B. Dexter, Middlesex Co., Mass.; John W. Webster, Boston.
    • 1814: Nathaniel S. Perkins, Conn.; *Edward H. Robbins, Boston.
    • 1815: John Baxter, Jr., Boston; Joseph Comstock, R.I.; James G. Perceval, Conn.; Richard S. Spofford, Cambridge, Mass.; George Sumner, Conn.; Winslow Warren, Plymouth, Mass.
    • 1816: Elisha L. Allen, Berkshire Co., Mass.; J. P. Batcheller, N.H.; Francis D. Wait, Boston.
    • 1817: John C. Dalton, Boston.
    • 1818: Dudley Atkins, Boston; George Marvin, Conn.; Alfred S. Monson, Conn.
    • 1820: Jonas Green, Mass.; Horatio A. Hamilton, Conn.; Samuel W. Robbins, Conn.; Alfred Watkins, N.H.