THE

Pennsylvania
Magazine

OF HISTORY AND BIOGRAPHY

The "Industrious Poor" and the
Founding of the "Pennsylvania Hospital

THE PENNSYLVANIA HOSPITAL,* the first hospital in thethirteen colonies, was founded in Philadelphia in 1751.1Doctor Thomas Bond initiated the idea for the hospital, but
it took the support of Benjamin Franklin, a coterie of Quaker
merchants and a number of other public-spirited citizens to assure
the success of this venture to aid the sick-poor of colonial Penn-
sylvania.2

* The writer is indebted to the financial support provided by the American Philosophical
Society and the Barra Foundation of Philadelphia, and to the suggestions made by John
Munroe of the University of Delaware, Whitfield J. Bell Jr., of the American Philosophical
Society, Robert Brunhouse of the University of South Alabama, John Woodward of the
University of Sheffield and Norman Capener, Vice-President of the Royal College of Sur-
geons, London.

1 The primacy claim of the Pennsylvania Hospital is not undisputed. The Philadelphia
General Hospital correctly maintains that the Philadelphia Almshouse, from which the
Philadelphia General evolved, antedates the Pennsylvania Hospital by some twenty years.
The Almshouse, however, was primarily a welfare institution during the eighteenth century,
even though many of its inmates did suffer from physical or mental afflictions of some sort.
The Pennsylvania Hospital, on the other hand, was specifically founded as a hospital.

2 For a brief discussion of the Pennsylvania Hospital's first twenty-five years, see William
H. Williams, "The Early Days of Anglo-America's First Hospital," The Journal of the Ameri-
can Medical Association, Apr. 3, 1972, vol. 220, 115-119. For a more detailed discussion of
the Pennsylvania Hospital's first fifty years, see William H. Williams, "The Pennsylvania
Hospital, 1751-1801" (doctoral dissertation, University of Delaware, 1971).

431



4 3 2 WILLIAM H. WILLIAMS October

Anglo-America's first hospital was a conscious copy of the British
voluntary hospital as it developed in provincial centers outside of
London. These voluntary hospitals were spawned by a reform move-
ment that swept Great Britain during the eighteenth century. The
institutions thus founded differed from the older Royal Hospitals
in that the former were maintained entirely by voluntary sub-
scribers and attended by consulting physicians, gratis,3 while the
latter received support from both municipal government and volun-
tary subscribers, and used salaried physicians on their staffs. Great
Britain's first voluntary hospital was established at Westminster in
1720, but more important to the Pennsylvania Hospital was St.
George's, established at Hyde Park in 1733. St. George's was the
prototype for the first English provincial voluntary hospital founded
at Winchester in 1736. The Winchester institution, in turn, became
the prototype for most of the subsequent provincial hospitals.4

There is no doubt that the founders of the Pennsylvania Hospital
had in mind the creation of a "small provincial hospital" of the
Winchester type.5 Franklin's 'Pennsylvania Cjazette, in an effort to
promote the local undertaking, cited the successful examples of the
voluntary hospitals at Hyde Park, Bath, Edinburgh, Liverpool,
Exeter and, of course, Winchester. The Qazette even carried some
information on Anglican clergyman Alured Clarke, the founder of
the hospitals at Winchester and Exeter.6

Acquiring specific information on the newly founded provincial
hospitals, whether at Winchester or elsewhere, was no great problem
to colonial Philadelphians. The Cjentlemans <iMagaziney published in
London but widely read in the colonies—Franklin thought it the
best of England's magazines—carried detailed accounts of indi-
vidual hospitals. In 1736, it announced the opening of the hospital
at Winchester and later provided a detailed account of that insti-
tution's first year. The Cjentlemans ^Magazine ended its report on

3 W. H . McMenemey, "The Hospital Movement of the Eighteenth Century and Its
Development," The Evolution of Hospitals in Britain, F . N . L. Poynter, ed. (London, 1964), 57.

4 Alured Clarke, A Collection of Papers Relating to the County Hospital for Sick and Lame
at Winchester (London, 1737), x; Gentleman's Magazine, X I (London, 1741), 474; X I I (London,
1742), 152; X I I I (London, 1743), 640; XIV (London, 1744), 52; An Account of the Public
Hospital for the Diseased Poor in the County of York (York, 1743), 3.

5 Benjamin Franklin, Some Account of the Pennsylvania Hospital, I. Bernard Cohen, ed.
(Baltimore, 1954), 4.

6 Pennsylvania Gazette, Aug. 8 and 15, 1751.



I973 THE PENNSYLVANIA HOSPITAL 433

Winchester (often referred to as Hants) by noting that "so truly
charitable an undertaking is worthy the immitation of all counties
in Britain." Further praise for the Winchester hospital appeared in
1739 a n d then, in 1741, the Qentlemans (Magazine published a de-
tailed account of the new county hospital at Exeter. Subsequent
issues carried details of other newly established hospitals, including
those at Bristol, York, Bath, Reading and Northampton.7

Information was also available on British hospitals through
numerous hospital reports published by the individual institutions.
The first report from Winchester appeared in 1737, and by 1744
Dr. Philip Doddridge, a nonconformist divine, was able to look over
published reports of at least five provincial hospitals while in the
process of planning the new voluntary hospital at Northampton.8

Although there is no proof that these published reports were in the
hands of the founders of the Pennsylvania Hospital at that insti-
tution's inception, there is reason to believe that the supporters and
managers of the Philadelphia institution made a conscious effort to
collect published reports put out by the various British hospitals.9

Newspapers also carried many reports on the voluntary hospitals
in Great Britain. In 1749, for example, an unidentified letter writer
noted that the hospital at Edinburgh had been much in the news-
papers lately.10 Certainly many of these newspaper articles made
their way to Philadelphia. Philadelphians touring Great Britain
supplied yet another avenue of information. A case in point was
Dr. Phineas Bond, brother of the founder of the Pennsylvania
Hospital and later one of that hospital's first physicians, who re-
turned from Europe in 1743 after spending some time in London
and Edinburgh. Although there is no extant supporting evidence, it

7 Gentle?nanis Magazine, VI (London, 1736), 618; VII (London, 1737), 636', IX (London,
J739) 4°8; XI (London, 1741), 474, 497, 652; XII (London, 1742), 152; XIII (London,
1743), 640; XIV (London, 1744), 52; XVIII (London, 1748), 198; Verner W. Crane, Benjamin
Franklin and a Rising People (Boston, 1954), 25.

8 Alured Clarke, A Collection of Papers; W. H. Me Me ne my, "The Hospital Movement of
the Eighteenth Century and Its Development," $3.

9 Occasional references indicate that a systematic effort by the Pennsylvania Hospital to
collect material on contemporary British hospitals was underway at an early date. Board of
Managers Minutes, Pennsylvania Hospital Archives, I, 147; James Pemberton to William
Logan, Feb. 5, 1761, Pemberton Copy Book, 1740-1780, Historical Society of Pennsyl-
vania, 199.

10 A Letter From a Gentleman in Town to His Friend in the Country Relating to the Royal
infirmary of Edinburgh (Edinburgh, 1749), 1.



4 3 4 WILLIAM H. WILLIAMS October

seems safe to presume that the Philadelphia physician toured the
important hospitals of those cities and reported to his brother what
he saw.11

Philadelphians were receptive to the idea of a voluntary hospital
because the Quaker city suffered some of the same problems and
exhibited some of the same attitudes found in British provincial
centers. The growing number of sick paupers was a trans-Atlantic
phenomenon as was the Christian impulse to give to those who were
less fortunate. Indeed, the example of the Good Samaritan was
often called upon to rally support for the voluntary hospitals on
both sides of the Atlantic,12 and more often than not the deeply
devout occupied the front ranks of the movement. Quakers John
Bellers and Henry Hoare, Anglican divine Alured Clarke, and non-
conformist clergyman Philip Doddridge, who were front and center
in the British voluntary hospital movement, had their Philadelphia
counterparts in Quakers John Reynell and Israel Pemberton, and
Anglican clergyman Richard Peters.

The drive for increased medical knowledge also led to support for
new hospitals on both sides of the Atlantic during the eighteenth
century. As early as 1714, John Bellers called attention to the
potential of hospitals in the field of medical education, an argument
taken up by Bishop Seeker (the future Archbishop of Canterbury)
and echoed in Philadelphia by Franklin's (gazette when it pointed
out that hospitals

"not only render the physicians and surgeons who attend them still more
expert and skillful . . . but afford such speedy and effectual instruction to
the young students of both professions, who come from different and

11 James Thacher, American Medical Biography (Boston, 1828), 179. Carl and Jessica
Bridenbaugh in Rebels and Gentlemen (New York, 1962), 244, maintain that Thomas Bond
visited England in 1748, returning to Philadelphia in the same year full of such enthusiasm
for the English hospital movement that he immediately proposed the establishment of a
hospital in Philadelphia. Actually, Thomas Bond left Philadelphia in 1748 but his destination
was Barbadoes, his purpose to improve his health. John Ross to Cadwalader Evans, Nov.
13, 1748, Pennsylvania Magazine of History and Biography, XIII (1889), 381-382. The fact
that Thomas Bond did not travel to England in 1748 was called to my attention by Elizabeth
Thomson of the Yale University School of Medicine. Miss Thomson, a biographer of Bond,
is convinced that the founder of the Pennsylvania Hospital did not travel to Europe from
1739 to the founding of the Pennsylvania Hospital in 1751.

12 Pennsylvania Gazette•, Aug. 8, 1751; A. Logan Turner, The Story of a Great Hospital,
The Royal Infirmary of Edinburgh (London, 1937), 84.



1973 THE PENNSYLVANIA HOSPITAL 435

remote parts of the country for improvement, that they return with a
more ample stock of knowledge in their art, and become blessings to the
neighborhoods in which they fix their residence/'13

Physicians and surgeons were particularly cognizant of this aspect
of the hospital movement and were leaders, in many cases, in the
founding of new hospitals. John Harrison in the founding of the
London Hospital, a group of physicians and surgeons in the founding
of St. George's, the Royal College of Physicians of Edinburgh in the
rise of that city's Royal Infirmary and, of course, Thomas Bond in
the founding of the Pennsylvania Hospital are just a few cases in
point.

But neither Christian charity nor the growing desire for medical
knowledge can wholly explain why the voluntary hospital movement
suddenly blossomed during the eighteenth century. Rather, there
was some other aspect of the movement that elicited the same
strong support in both Winchester and Philadelphia.

The poor and how they should be treated were much on the minds
of eighteenth-century Anglo-Saxons. With the increase in beggars
and other dependents, poor rates were bound to increase, much to
the consternation of the middling sort and their betters. But, noted
Alured Clarke in 1737, the antidote was at hand. The hospital,
Clarke argued, "will considerably lessen the poor rates in every
parish." The same theme was sounded by other hospital supporters,
but in greater detail. Poor rates, it was argued, would decline be-
cause the hospital was more efficient and therefore less costly than
such previously used methods as hiring physicians to treat the
sick-poor at home at public expense. By contrast with the older
practices, pointed out the Rev. Richard Grey, the care of the sick-
poor in a hospital would be only a tenth as expensive. The refrain
was picked up in Philadelphia by the Qazette which agreed with
Grey that the difference in cost was "at least ten to one."14

!3 John Bellers, An Essay Towards the Improvement of Physick in Twelve Proposals (London,
1714), passim; David Owen, English Philanthropy, 1660-1960 (Cambridge, Mass., 1964), 40;
Pennsylvania Gazette, Aug. 8, 1751.

14 Alured Clarke, A Proposal For Erecting a Public Hospital (Winchester, 1736), 5; Gentle-
marts Magazine, XI (London, 1741), 475; XIII (London, 1743), 640; Richard Grey, A Sermon

for the Sick and Lame at Northampton County Infirmary (Northampton, 1744), 16; Pennsyl-
vania Gazette, Aug. 15, 1751.



4 3 ^ WILLIAM H. WILLIAMS October

In 1743, the Qentlemans ^Magazine pointed out that if a poor
laborer died from medical neglect, his wife and children became a
burden to the parish. It was obvious, therefore, that saving the
sick-poor was essential on purely fiscal grounds. Eleven years later,
Franklin seemed to be alluding to this very same point when he
noted that a hospital allowed the sick-poor to "become useful to
themselves, their families and the public for many years after."15

Being useful meant, in part, keeping off the poor rolls and therefore
keeping down the poor rates. The latter goal was very much on the
minds of mid-eighteenth-century Philadelphians and contributed to
the incorporation of the Overseers of the Poor in 1749, a s w e ^ a s t o

the founding of the Pennsylvania Hospital two years later.16

As the poor increased in number their betters began to express a
feeling of uneasiness about the future of the social order. At Win-
chester, in 1736, Alured Clarke pointed out that the hospital was a
means of procuring the affections of the poor and softening their
passions. At Northampton, in 1744, the Rev. Richard Grey was
even more to the point when he noted that hospital care would
"tend to give the poor in general grateful and honorable sentiment
of and inspire them with proper love and reverence towards their
superiors . . . and by consequence promote that harmony and sub-
ordination in which the peace and happiness of society consists."17

To insure that British sick-poor were aware of their debt to the
respective hospitals and, more important, to those who supported
those institutions, discharged patients were required, upon release
from the hospital, to offer formal thanks to the managers or gover-
nors for treatment rendered. Across the Atlantic the same practice
was followed, as the founders of the Pennsylvania Hospital required
discharged patients to "sign certificates of their particular cases and
of the benefit they have received in this hospital to be either pub-
lished or otherwise disposed of as the managers may think fit."18

15 Gentleman's Magazine, XIII (London, 1743), 640; Benjamin Franklin, Some Account of
the Pennsylvania Hospital, 3.

16 The incorporation of the Overseers of the Poor was aimed at keeping down Philadelphia's
poor rates by allowing the Overseers to accept private contributions, thus enabling private
philanthropy to shoulder some of the burden of public charity. William Clinton Heffner,
History of Poor Relief Legislation in Pennsylvania, 1682-1913 (Cleona, Pa., 1911), 73, 74.

17 Alured Clarke, A Sermon Preached in the Cathedral Church of Winchester . . . 1736 (Lon-
don, 1737), 8; Richard Grey, A Sermon for the Sick and Lame at Northampton County In-
firmary, 10, 11.

18 Board of Managers Minutes, I, Pennsylvania Hospital Archives, 39.



I973 THE PENNSYLVANIA HOSPITAL 437

More central to the rise of voluntary hospitals than the drive to
keep down poor rates, or the desire to render the poor more content
with their lot, was another aspect of the attitude of the nonpoor
toward the victims of poverty. In her study of the English poor
during the eighteenth century, Dorothy Marshall noted a decreasing
sympathy for paupers. Disciplining the lazy and extravagant was
advocated with greater energy than previously, with workhouses
and contractors the expedients proposed and employed. Complaints
were often heard of the ill management of private charities "which
are too heavily felt to need any particular explanation . . .," and
public laws enacted for the benefit of the poor were merely dis-
missed as being ineffectual. In Winchester, it was charged, large
sums of money given to charity were so misused "that a great many
families are known to live in idleness, on the support they receive
from the public and private contributions, which are frequently
found here "19

Pennsylvania Hospital spokesman Benjamin Franklin was of the
same mind. Franklin criticized charitable institutions aimed at
aiding the poor because they made the poor "less provident/' The
giving of mankind "a dependence on anything for support . . . be-
sides industry and frugality during youth and health, tends to
flatter our natural indolence, to encourage idleness and prodigality,
and thereby promote and increase poverty, the very evil it was
intended to cure: thus multiplying beggars instead of diminishing
them."20 Nor did Pennsylvania's Quakers seem much more inter-
ested than Franklin in supporting large institutions that would
alleviate the sufferings of the poor. Although, in the latter half of
the eighteenth century, Pennsylvania's Friends would lead the way
in charitable ventures of an institutional nature, in 1751 recipients
of organized Quaker benevolence along the Delaware seemed to be
largely restricted to those of the Friendly persuasion.21

19 Dorothy Marshall, The English Poor in the Eighteenth Century (London, 1926), 13, 14,
22, 23; Alured Clarke, A Collection ojPapers, iv, xiv; Clarke, A Proposal for Erecting a Public
Hospital, 1.

20 Albert Henry Smyth, ed., The Writings of Benjamin Franklin, V (New York, 1907), 123.
2 1 Up until mid-century, Quakers in Pennsylvania were not much different in their chari-

table benevolence t h a n other colonial sectarian groups. Generally, Quaker philanthropy was
aimed at helping fellow Quakers. The one Philadelphia institution t h a t the Quakers did
establish prior to 1751 in the field of poor relief was an alms house exclusively for the use of
Quaker unfortunates. For a discussion of the change in Quaker attitudes towards institutional



4 3 8 WILLIAM H. WILLIAMS October

In short, an apparent paradox existed. A transoceanic society,
ostensibly unsympathetic to institutions aiding the poor, simultane-
ously spawned a number of voluntary hospitals which, quite obvi-
ously, were aimed at aiding the impoverished. A closer look at the
situation, however, indicates that rather than a paradox, the found-
ing of the Pennsylvania Hospital as well as the founding of the many
British provincial hospitals was a logical outgrowth from this lack
of faith in the established methods of dealing with poverty.

Since the sixteenth century English society had distinguished
between various types of poor. Although the distinctions might
vary, generally two subgroups were recognized: those who could
work but wouldn't; and those who would work but couldn't. The
members of the former group were often referred to as 'Vagabonds"
or "sturdy beggars," while the latter group included the indigent
elderly and the dependent young. A third subgroup which would
later be labeled the "industrious" or "worthy poor" was also be-
ginning to be recognized by the sixteenth century. Like Gaul, the
British poor were divided into three parts.

Relief for the poor was aimed at providing particularly for the
elderly and the young via almshouses, orphanages, and apprentice-
ships. As already pointed out, however, sometimes the "vagabonds"
and "sturdy beggars" were unwittingly supported by charity.22

Exasperated because the poor rolls featured lazy but able paupers,
it was only logical that eighteenth-century Great Britain turn to work-
houses to force the reluctant poor to work. In Philadelphia, Franklin
applauded the concept of the workhouse as it was being applied in
Great Britain and suggested that Pennsylvania needed the same
sort of institution. Franklin's main concern was to encourage the
"work ethic" (i.e,> industry and thrift) among able-bodied colonists,
because "as matters now stand with us care and industry seem
absolutely necessary to our well being, they should therefore have
every encouragement we can invent. . . ,"23

charity, see Sydney James, A "People Among Peoples: Quaker Benevolence in Eighteenth Century
America (Cambridge, Mass., 1963).

22 A. G. R. Smith, The Government of Elizabethan England (New York, 1967), 80; Marcus
W. Jernigan, Laboring and Dependent Classes in Colonial America, 1607-1783 (Chicago, 1931),
191; Samuel Mencher, Poor Law to Poverty Program (Pittsburgh, 1967), 22, 23.

23 Franklin to Peter Collinson, May 9, 1753, The Papers of Benjamin Franklin^ IV, L. W.
Laboree, ed. (New Haven, 1961), 482. As might be expected, a workhouse was established



I973 THE PENNSYLVANIA HOSPITAL 439

Leaders in the British voluntary hospital movement, while gen-
erally castigating the lazy-poor as an unjustified burden to public
and private charity, singled out the "industrious poor" for praise.
Encomiums for the latter group reached a crescendo in 1748 when
the Rev. John Nixon called them "the strength and bulwark of the
nation/'24 The irony of it all was that eighteenth-century British
charity rarely aided the industrious poor, because that group was
self-sufficient and, therefore, "not entitled to a parochial relief."
Some of the "industrious poor" even tended to be "ashamed to
receive any constant assistance from the parish collections. . . ."25

Obviously the "industrious poor" were the most deserving, but how
to help them without further aiding the lazy-poor?

In 1741 the Cjentlemaris ^Magazine, in an article concerning the
"many peculiar advantages of public hospitals," pointed out that
unlike other charities, the hospital is not subject to imposters be-
cause they would "be discovered by the physicians and surgeons."
Moreover, while the profligate and lazy were being weeded out,
care would be given to the "multitudes" who had not come under
the "care of a parish or workhouse; and yet are most of all entitled
to the regards of the public, since they are in present want, and are
of the diligent and industrious, which is the most useful and valuable
part of all society."

Four years later at Northampton, the Rev. Thomas Holme
assured his listeners that the voluntary hospital benefited not only
society in general, but in particular "those most useful members of
it, the industrious poor." Holme went on to say that only deserving
objects would be provided for in the hospital and "lazy and clamor-
ous poverty will find no relief." Other voices joined in to inform
the public that the new voluntary hospitals were particularly aimed
at aiding the industrious and hard-working poor.26

in Philadelphia in 1767 to promote industry and frugality among the poor. Carl and Jessica
Bridenbaugh, Rebels and Gentlemen, 232.

24 Richard Grey, A Sermon for the Sick and Lame at Northampton County Infirmary, 15;
Thomas Holme, A Sermon.... (Northampton, 1745), 27; John, Lord Bishop of Peterborough,
A Sermon.... (Northampton, 1748), 18; John Nixon, A Sermon.... (Northampton, 1749), 14.

25 Alured Clarke, A "Proposalfor Erecting a Public Hospitaly 7, 4; Richard Grey, A Sermon
for the Sick and Lame at Northampton County Infirmary, 13.

26 Gentleman's Magazine, XI (London, 1741), 476; Thomas Holme, A Sermon . . ., 27;
Subscription Book, Bristol Royal Infirmary Archives, Bristol, England, 1; An Account of the
Public Hospital for the Diseased Poor in the County of York, 2; Henry Layng, A Sermon. . . .
(Northampton, 1749), 14.



4 4 ° WILLIAM H. WILLIAMS October

It was obvious from the beginning that many more sick-poor
would apply to the new voluntary hospitals than those institutions,
given the limited number of beds available, could admit. Knowing
that they would have to be selective with hospital applications, the
founders of most British institutions gave a great deal of control
over admissions to a governing body chosen by the contributors.
(An exception to this generalization was the Royal Infirmary of
Edinburgh.)27 Given the prejudices of the day against "beggars"
and "vagabonds," the prospective hospital patient had best produce
a good character reference as well as a curable, noncontagious illness
compounded by poverty.28

A vital first step in the process of establishing voluntary hospitals
in Britain was the recognition that there were "industrious" and,
therefore, "worthy" poor. There is some evidence that eighteenth-
century America was moving in the same direction. In New York,
in 1769, it was argued that to assist the industrious poor was not
charity but justice, and a recent study of Philadelphia during the
1790's found a distinction being made in the press between the in-
dustrious or worthy poor on the one hand and the "vicious" and
lazy poor on the other. This distinction, however, was not universally
made in eighteenth-century America and the founders of the Penn-
sylvania Hospital, with the exception of Franklin, did not speak to
this subject. Franklin did deal at some length with poverty but, in
most of his correspondence and publications, did not distinguish
between the industrious and lazy poor. Indeed, through Franklin's
eyes "industrious" and "poor" would have seemed mutually ex-
clusive terms since poverty was largely the product of idleness and
extravagance.29

2 7 An Account of the Rise and Establishment of the Infirmary, Or Hospital for the Sick-poor,
erected at Edinburgh (Edinburgh, 1730), 11.

28 Sick-poor applicants to most eighteenth-century British hospitals had to be suffering
from a "curable," noncontagious malady before they could be admitted. The precedent for
refusing incurables to British hospitals had been established in the seventeenth century.
Contagious diseases were barred from the Pennsylvania Hospital, but some incurable insane
patients were admitted. Board of Managers Minutes, I, Archives of Pennsylvania Hospital, 38.

2 9 Jackson Turner Main, The Social Structure of Revolutionary America (Princeton, 1965),
157; John K. Alexander, "The City of Brotherly Fear," Cities in American History, K. Jackson
and S. Schultz, eds. (New York, 1972), 81. For the view t h a t most colonists did not make
this distinction, see Main, 198. For papers of some of the most important founders of the
Pennsylvania Hospital, see Coates-Reynell Papers, Pemberton Papers, and John Smith's



1973 T H E P E N N S Y L V A N I A H O S P I T A L 44I

And yet, on one occasion, Franklin seemed to recognize that some
of those suffering poverty did possess praiseworthy traits. In 1751
the Pennsylvania Assembly passed an act to establish the Pennsyl-
vania Hospital. The first few words of the act justified the hospital
on the grounds that it would save and restore "useful and laborious"
people to the community. Since these "useful and laborious" people
also had to be poor in order to qualify for hospital admission, the
words of the act indicate that its author and supporters were sensi-
tive to the fact that some of Pennsylvania's poor were not lacking
in industry. The author of the act was Benjamin Franklin.30

The act establishing the Pennsylvania Hospital made plain that
the purpose behind the founding of that institution was to provide,
specifically, for the "laborious" sick-poor. This is understandable in
view of the fact that industry and thrift were, in all probability,
even more highly esteemed among Philadelphians than among the
supporters of voluntary hospitals abroad. Franklin, of course, stands
out as the great exponent of the "work ethic," but the other leading
supporters of the Pennsylvania Hospital, such as Quaker merchants
John and Israel Pemberton and John Reynell, were of the same
mind.31

In order to assure that the Pennsylvania Hospital's avowed pur-
pose to provide for the "useful and laborious" poor was carried out,
a screening process was set up whereby each prospective patient
was required to procure a letter signed by an influential person

Diaries, all in the Historical Society of Pennsylvania. Franklin became even less sympathetic
toward the poor in his later years. Howell V. Williams, "Benjamin Franklin and the Poor
L a w s , " Social Science Review, X V I I I (1944), 7 7 - 9 1 .

30 Benjamin Franklin, " T h e Act to Encourage the Establishing of an Hospital for the
Relief of the Sick Poor of this Province, and for the Reception and Cure of L u n a t i c s , " Some
Account of the Pennsylvania Hospital, 5; Benjamin Franklin, The Autobiography and Other
Writings, L. Jesse Lemisch, ed. (New York, 1961), 134. Although, as noted in n. 29, Franklin
became increasingly critical of the poor, he, nevertheless, continued to hold the Pennsylvania
Hospital in high esteem. Ibid., 134, 135.

31 Verner W. Crane, Benjamin Franklin and a Rising People, 30; Judy M. DiStefano,
"A Concept of the Family in Colonial America: The Pembertons of Philadelphia" (doctoral
dissertation, Ohio State University, 1970), 275, 278, passim; Carl L. Romanek, "John Reynell,
Quaker Merchant of Philadelphia" (doctoral dissertation, Pennsylvania State University,
1969), 5, 6.



4 4 2 WILLIAM H. WILLIAMS October

describing his case. Patients recommended by contributors to the
hospital were to be given first preference to the limited beds avail-
able.32 As in Great Britain, charity of this type demanded deference
as well as good character on the part of the applicant since his ad-
mission depended on recommendations from his betters. Those sick-
poor who were turned away from the hospital probably turned to
municipal almshouses for succor. A random comparison of patients
at the Philadelphia Almshouse (House of Employment and Better-
ing House) and the Pennsylvania Hospital during the late eighteenth
century supports this assumption. On a typical admission day in
1794, for example, the Philadelphia Almshouse discharged one
patient it described as "one of the worst kind," a second who was
labeled "a skulking fellow," and a third who was laconically char-
acterized as "worse." Typical of Almshouse admissions that year
was Nathaniel Cope, "another of those worthless scoundrels who
there is no possibility of keeping in or out and who continually
makes a meer slipper of this institution to their own conveniency."
Although a few of the Pennsylvania Hospital's patients were of the
caliber of a Nathaniel Cope, on the whole they seemed a better sort
than most of the rabble who ended up in the Philadelphia Aims-
house.33

As initially pointed out, the founding of the Pennsylvania Hos-
pital can be best seen as an extension of the British voluntary
hospital movement to the "New World." During the eighteenth
century, the reluctance of the British middle and upper classes to
support the older, more established forms of charity was reconciled
with self-interest and a genuine desire to help the "industrious
poor." The voluntary hospital movement met with strong support
because it avoided some of the pitfalls experienced by the older
forms of charity and, at the same time, served to benefit the "indus-
trious" or "worthy" poor, a group that British philanthropy had

32 Board of Managers Minutes, I, Archives of the Pennsylvania Hospital, 38, 39.
33 Entries for Apr. 3, June 16, 1795, Book of Daily Occurency, House of Employment and

Almshouse of Philadelphia, Mar. 25, 1794-Sept. 28, 1795, on microfilm courtesy of Dale
Fields, Historical Society of Delaware; Board of Managers Minutes, I - V I I , Rough Minutes,,
1753-1801, Pennsylvania Hospital Archives. This is not to say that only those with un-
impeachable character were allowed into Anglo-America's first hospital. Certainly, if there
were empty beds and enough money available to support those beds, less desirable types,
were also admitted.



I973 THE PENNSYLVANIA HOSPITAL 443

hitherto ignored. There were, of course, many other reasons given
for the support of the hospital movement—the gentleman's zMaga-
zine listed more than ten—34 but the main impulse grew out of a
desire to help, in particular, those poor who showed a decent respect
for the "work ethic." It was in the same spirit that Anglo-America's
first hospital was created.

University of Delaware, Georgetown WILLIAM H. WILLIAMS

34 Gentleman's Magazine, XI (London, 1741), 476, 477.