The Pennsylvania Hospital
Franklin's Foundation, Rush's Practice — 1751 to 1813
THE Pennsylvania Hospital was the product of a legislative maneuver so elegant that Franklin described it in his Autobiography as "the best of my political manoeuvres." In 1751, convinced that the Assembly would not fund a hospital directly, he proposed a conditional grant: the legislature would provide two thousand pounds if private citizens first raised an equal sum. The Assembly agreed, confident the private goal was unachievable. Franklin organized the subscriptions himself, met the target, collected the matching funds, and the hospital was built. "The subscribers," he observed, "are thereby encouraged to subscribe more readily, and to become more active in collecting from others."
Thomas Bond had conceived the institution; Franklin had made it happen. The Pennsylvania Hospital, which opened on Pine Street in Philadelphia in 1756, was the first hospital in America. It was simultaneously a charity (treating the poor without charge), a medical facility (treating paying patients), and a teaching resource (providing medical students access to clinical cases they could not otherwise observe). All three functions reflected the Philadelphia Enlightenment's characteristic conviction that private philanthropy, public support, and practical education should work together.
Rush joined the Hospital staff in 1783, fourteen years after his return from Edinburgh. He served as physician to the Hospital until his death in 1813 — thirty years of practice in the institution Franklin had founded. During those three decades he treated thousands of patients, trained scores of students in clinical settings, and argued repeatedly with the Board of Managers over matters ranging from the treatment of the insane (Rush wanted more active intervention; the Board was cautious) to the Hospital's response to the yellow fever epidemics of the 1790s (Rush wanted his methods applied; the Board was divided).
Franklin did not live to see Rush's full tenure at the Hospital. He died in April 1790, three years after Rush joined the staff. But the institution he founded was the setting in which Rush's medical career reached its fullest expression, and the founding documents of that institution — Some Account of the Pennsylvania Hospital (1754), the promissory notes, the ledgers, the rules of government — are among the most important items in the collection.
"I do not remember any of my political manoeuvres, the success of which gave me at the time more pleasure." — Benjamin Franklin, Autobiography, on founding the Pennsylvania Hospital
Some Account of the Pennsylvania Hospital
Franklin printed this Account at his own shop on Market Street, making it simultaneously a philanthropic argument and a physical product of his printing enterprise. The pamphlet documents the Hospital's founding rationale — a city of Philadelphia's size requires a dedicated medical institution for its poor; private philanthropy combined with legislative support is the appropriate funding mechanism — with the precision and clarity that characterize all of Franklin's public writing. Thomas G. Morton, in his History of the Pennsylvania Hospital (1895), notes that this Account was the essential document of the Hospital's public legitimacy in its first decades. Rush inherited all of Franklin's arguments when he joined the staff thirty years later.
Promissory Notes for the Pennsylvania Hospital
The physical instruments of Franklin's fundraising campaign: the documents through which Philadelphia citizens committed their subscriptions and through which the matching-grant strategy was implemented. These notes are the ledger-level reality behind the legislative maneuver — the civic infrastructure of early American philanthropy in its most material form. Franklin understood that institutions were built through the accumulation of individual commitments recorded in ink on paper. Each note is a citizen's investment in the proposition that a city owed its poor the means of healing.
Pennsylvania Hospital Ledger
The administrative backbone of the institution Rush practiced at for thirty years: admissions, discharges, deaths, expenses, and attending physicians. Rush's name appears in the Hospital's records during the yellow fever years of the 1790s, when his insistence on his own treatment protocol made him a controversial figure on the staff. Rush clashed repeatedly with the Board of Managers over the management of the insane patients in the lower ward — a conflict that informed his eventual Diseases of the Mind (1812) — and over the institution's response to the epidemics. The ledgers are silent on these controversies but document the institutional life within which they occurred.
Rules for the Government of the Pennsylvania Hospital
The institutional constitution of the facility that Rush and Franklin helped define. The Rules establish the hierarchy of authority (Board of Managers, attending physicians, resident apothecary, nurse), the terms of patient admission and discharge, the obligations of the medical staff, and the moral expectations placed on patients. Rush's influence on the Hospital's culture is visible in the Rules' combination of humanitarian concern and disciplinary expectation — medicine as reform, healing as civic virtue — that characterized all of his professional commitments.
Franklin's role at the Pennsylvania Hospital was that of the inspired founder who creates an institution, endows it with a rationale, and then leaves it to be inhabited by others. Rush's role was that of the dedicated practitioner who inhabits the institution for a lifetime and is shaped by it as much as he shapes it. Between them, they turned a charitable facility into the most important medical teaching resource in the early republic.
The Hospital's connection to Rush's later career in psychiatry is particularly significant. The institution's care for the mentally ill — the "maniacs" and "melancholics" housed in the lower ward, often in brutal conditions by modern standards — gave Rush three decades of clinical observation that would eventually produce the first systematic American treatise on mental illness. The book that resulted, Diseases of the Mind (1812), is documented in Chapter III of this catalog.