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As the twenty-first century began, hospitals and academic medical centers played a central role in the economies of many major U.S. cities, including Philadelphia. As centers not only of patient care but also of scientific research and, often, sources of urban redevelopment, urban medical institutions created jobs in deindustrialized cities and spurred the spatial, social, and economic transformation of neighborhoods. As such, they emerged along with universities as part of a distinct economic sector–the “eds and meds”–often seen as one of the core growth industries of the urban United States.
Few cities exemplified this “eds and meds” model better than Philadelphia. By the first part of the twenty-first century, health care, in particular, constituted a core economic sector in this former manufacturing center. Data from the 2012 U.S. Economic Census showed that hospitals had become the largest employment sector in the city. As of 2013, nine of Philadelphia’s sixteen largest private employers were hospitals (another was a health insurance company); at least six more hospitals ranked among the top fifty employers. Over the previous decade, employment in the city’s health and education sector increased by 18 percent, but declined in all other sectors except one (leisure and hospitality). Although most of Philadelphia’s hospitals were nominal nonprofits, together they generated more than $9 billion in patient revenues. Key institutions included the Hospital of the University of Pennsylvania (HUP), Children’s Hospital of Philadelphia (CHOP), Thomas Jefferson University Hospital, Albert Einstein Medical Center, Temple University Hospital, Pennsylvania Hospital, and Hahnemann University Hospital. Many other smaller institutions contributed to the sector’s importance as well. It may thus be accurate to understand Philadelphia not only as a deindustrialized city, but also as a medicalized city. Although perhaps an extreme example of this phenomenon, Philadelphia was broadly typical of patterns found around the United States in formerly industrial cities.
In one respect, this development built on the city’s singular history as the location of the first hospital in British North America (Pennsylvania Hospital) and the first medical school (at the University of Pennsylvania). Yet in other ways, the centrality of Philadelphia’s hospital sector was the product of specific choices made in recent decades. The emergence of this urban health care sector, however, was not an unqualified benefit, in Philadelphia or elsewhere. This tension can be understood by tracing the sector’s development across three areas: land use and financing, labor, and taxation.
Land Use and Financing
Philadelphia leaders first came to view the hospital sector in economic terms during the 1970s. In 1974, the city established a municipal Hospital Authority (as authorized by Pennsylvania’s Municipal Authorities Act of 1946) with the power to issue tax-exempt revenue bonds that could be used to finance hospital expansion projects. Although the Hospital Authority issued $1.25 billion in bonds between 1974 and 1985, it also became known as a nest of political infighting and patronage. According to a 1987 study of the authority by the Philadelphia Industrial Development Corporation (PIDC), the city’s hospital administrators viewed the Hospital Authority as “autocratic, unreasonable and uncooperative.” During the 1980s, Mayors William Green (b. 1938) and Wilson Goode (b. 1938) further prioritized the health care sector as a potential source of jobs and economic development. Under Green, the authority also expanded its activities to include colleges and universities, and as a result became known as the Hospitals and Higher Education Authority of Philadelphia. Shortly after taking office in 1984, Goode proposed reorienting the functions of the authority to encompass not just project financing but also coordination of the local health care sector and, specifically, the pursuit of economic development through hospital expansion.[caption id="attachment_29441" align="alignright" width="300"] Philadelphia General Hospital, the complex of brick buildings near the center of this 1966 aerial photograph, presented an opportunity for redevelopment but also posed challenges. The cleared area in the lower right later became a site for buildings for the Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia. (PhillyHistory.org)[/caption]
Redeveloping the site of Philadelphia General Hospital (PGH), the city’s former municipal hospital in West Philadelphia, provided a test case for the city’s ability to implement this model of development. In 1975, faced with PGH’s outmoded physical plant and a pressing municipal budget crisis, Mayor Frank Rizzo (1920-91) made the controversial decision to close the hospital. Ignoring heated protests and widespread opposition, Rizzo replaced the public hospital with a system of free primary health care provided at decentralized clinics around the city, along with subsidized emergency and specialty care for city residents at private hospitals. In January 1978, the Philadelphia Daily News observed that “for all practical purposes, Philadelphia now has socialized medicine.” Although the new system initially received widespread praise, by the 1990s many of the clinics had long waiting lists, and the city increasingly strained to finance the program, particularly hospital care.
Reusing the PGH site posed other challenges. PGH had occupied twenty-one acres adjoining the Hospital of the University of Pennsylvania, Children’s Hospital of Philadelphia, Children’s Seashore House, and the Philadelphia Veterans Administration (VA) hospital, as well as Philadelphia’s Convention Hall and Civic Center. The University of Pennsylvania and Drexel University campuses lay just blocks away, with Center City Philadelphia only a short distance across the Schuylkill River. Highways and mass transit served the area as well. The land, as a result, had significant value. Clearance of the site took three years because of the hospital’s size and solid construction, as well as the need to relocate utilities. Contractors finally completed the job in early 1982, leaving only PGH’s distinctive exterior fence of wrought iron separated by pillars of red brick surrounding much of the site to remind visitors of the earlier structure.
Consortium Makes Progress
As demolition moved toward completion, the Rizzo administration charged the Philadelphia Industrial Development Corporation (PIDC) with overseeing the redevelopment of the PGH site. After financing for an early private development plan collapsed in the high inflation environment of the early 1980s, PIDC partnered with the PGH Development Corporation (PGHDC), a newly organized consortium formed by HUP, CHOP, and Children’s Seashore House. PIDC and PGHDC developed a plan for multi-institution reuse of the site as the Philadelphia Center for Health Care Sciences. The new consortium received more than $9 million in federal Urban Development Action grants to support new infrastructure construction on the site. This built on a long-standing pattern of federal support for hospital expansion going back to the post-World War II urban renewal and Hill-Burton Act hospital construction programs (both of which had supported earlier stages in the growth of Philadelphia hospitals such as HUP and Thomas Jefferson; the Hill-Burton program had been established by Hospital Survey and Construction Act of 1946). As a nonprofit corporation, PGHDC also secured tax-exempt financing for the project. By the 1980s, such efforts to expand Philadelphia’s large medical centers gained broad political support because they offered the prospect of creating employment at a time when Philadelphia had lost a considerable number of manufacturing jobs.
Initial projects on the site included a HUP clinical research building and CHOP’s administrative and ambulatory care facility. A new Seashore House facility followed shortly. By the time those buildings approached completion in 1989, CHOP and Seashore House had begun planning a $75 million clinical research building and HUP had undertaken a $100 million life sciences research building, both to be built on the PGH site as part of the Center. With the additional HUP and CHOP facilities, which would be completed in 1995 and 1998, respectively, the total cost of the project reached $457 million. During the early twenty-first century, the Center expanded beyond the old boundaries of PGH, as Penn and CHOP purchased and demolished the old Philadelphia Civic Center to the south. CHOP constructed the Colket Translational Research Center on the property, while Penn built the Perelman Center for Advanced Medicine, a 500,000-square-foot outpatient facility. The two institutions subsequently purchased former industrial properties on the opposite (east) bank of the Schuylkill River. Both planned to build on these sites later in the decade. These purchases, with their attendant transition to the institutions’ tax exempt, nonprofit status, removed $112,307 from the city’s annual tax rolls.
By 2016 CHOP employed more than ten thousand people, HUP, nearly six thousand. HUP also formed the Penn Health System, which included such venerable institutions as Pennsylvania Hospital and Presbyterian Hospital. The wider Penn system employed thousands more and had regional alliances extending as far west as Lancaster, Pennsylvania, and east to Princeton, New Jersey. Such alliances connected the system with patients and hence revenue sources across the Philadelphia region. The system’s development was reflective of a wider pattern of mergers and consolidation in the health care industry nationally.
Other large Philadelphia hospitals and medical centers followed HUP and CHOP’s example. Temple University Hospitals and Thomas Jefferson University, both of which initially expanded their medical centers through urban renewal projects in the 1950s and 1960s, forged small regional networks and undertook new construction projects. The Temple University Health System, for example, included the Fox Chase Cancer Center, Episcopal and Jeanes Hospital, and suburban locations in Fort Washington, Elkins Park, and the Oaks Corporate Center. Its medical school established branch campuses in Pittsburgh and Bethlehem. In North Philadelphia, Temple also demolished its original medical school building as well as the Masonic Home of Philadelphia, both located at Broad and Ontario Streets adjoining its main hospital facilities. Further medical center expansions were likely to follow.
Tactics of Smaller Medical Centers[caption id="attachment_29442" align="alignright" width="300"] Cooper University Health Care System plays a key role in economic redevelopment in Camden, New Jersey. (Wikimedia Commons)[/caption]
Smaller medical centers in the region also developed integrated health care systems. In New Jersey, the Cooper University Health Care System was based at the Camden Health Sciences Campus on Martin Luther King Boulevard and Broadway in central Camden. Formed in 1986, the system completed a $220 million expansion in 2008, and construction of a new $139 million medical school followed in 2012. Together, the growth of the Cooper campus represented a key part of Camden’s broader redevelopment effort. By 2016, the Cooper system included Cooper University Hospital, Children’s Regional Hospital, Cooper Medical School of Rowan University, and a Cooper-affiliate of the Houston-based MD Anderson Cancer Center. It employed over 6,500 people. In addition, following a failed attempt to incorporate the Rutgers-Camden campus into Rowan University, the state formed a new joint Rowan-Rutgers Board of Governors to oversee health care partnerships between Cooper, Rowan, and Rutgers-Camden.
In the Pennsylvania suburbs, the Crozer-Keystone Health System resulted from the 1990 merger of Upland’s Crozer-Chester Medical Center with Drexel Hill’s Delaware County Memorial Hospital. The system later added Ridley Park’s Taylor Hospital, Chester’s Sacred Heart Hospital (which it renamed as Community Hospital of Chester), and Springfield Hospital. Crozer-Keystone also developed a comprehensive physician network and branched out into health related activities such as the Healthplex Sports Club in Springfield. All these components served to drive patients into the system’s hospitals. In July 2016, a Los Angeles-based for-profit hospital chain (Prospect Medical Holdings) acquired the Keystone-Crozer system.
These mergers and health system expansions reflected the competitiveness of Philadelphia’s health care environment. Featuring five academic medical centers and dozens of community hospitals, the region also had a concentrated insurance marketplace, with only two major private insurance carriers. This limited the leverage available to even the largest hospitals in negotiating insurance payments. Beginning in the 1980s, these factors led to the closure of a number of the area’s weaker hospitals, including Metropolitan Hospital (later known as both Franklin Square Hospital and Cooper Hospital-Center City), St. Joseph’s Hospital, Graduate Hospital, and the Medical College of Pennsylvania Hospital. Others survived bankruptcy procedures or merged into the larger health care systems. A number of these closures resulted from the area’s most disastrous experience with health care system failure. During the 1990s, the Pittsburgh-based Allegheny Health and Research Foundation (AHERF) acquired eight Philadelphia hospitals and medical centers, including most prominently Hahnemann University Hospital and the Medical College of Pennsylvania. Vastly over-leveraged, with inadequate cash flow, and hit hard by changes in Pennsylvania’s Medicaid program, Allegheny collapsed into bankruptcy in 1998. Tenet Healthcare, a national for-profit chain, acquired the network’s Philadelphia hospitals. It subsequently managed Hahnemann University Hospital in conjunction with Drexel University, which used Hahnemann as the teaching hospital for its College of Medicine. Tenet also continued to control St. Christopher’s Hospital for Children, the city’s eleventh-largest hospital by patient revenue.
In the first decades of the twenty-first century, expansion projects at many Philadelphia hospitals and medical centers proceeded with financing provided by the revamped Philadelphia Hospitals and Higher Education Authority, which underwrote nearly thirty expansion projects in the decade preceding 2016. The hospital city thus emerged from a combination of public and private action.
For all of the hospital sector’s importance, relying on health care as a source of economic growth came at a significant cost for the City of Philadelphia. Hospitals, as nominally nonprofit institutions, are exempt from paying property taxes to the city. Critics have argued that nonprofit status meant relatively little when the institutions involved generated billions in revenue and were deeply intertwined with government as well as with financial markets (through their bond issues) and the private health insurance industry. In a few cities, such as Boston, major hospitals have provided a “payment-in-lieu-of-taxes” (or PILOT) to reimburse the city for core municipal services.
Philadelphia’s hospitals, however, have continually used their nonprofit exemption to avoid paying taxes on the property they own. For a five-year period during the 1990s, the University of Pennsylvania and other large nonprofit institutions made a voluntary but substantial payment to the city in lieu of taxes. After a 1997 change in state law broadened the tax exemption in a way that called the PILOT program into question, Penn and other institutions ceased these payments–despite the deepening fiscal crisis of the city, especially, its school system. The institutions continued to claim that they contributed to the city through economic development, employment (and its associated taxes), and the provision of health care (including some charity care).
Labor[caption id="attachment_29473" align="alignright" width="300"] Members of District 1199C of the National Union of Hospital and Health Care Employees and community partners meet with Governor Tom Wolf (seated, left) in April 2016 for a discussion of health-care apprenticeships. (Governor Tom Wolf on Flickr)[/caption]
Health care jobs in the late twentieth and early twenty-first centuries varied greatly in pay and benefits. Many jobs paid well but required relatively high levels of education. Lower-skilled service workers often found employment in the sector, but at very low wages. A study of health care employment in 2013 found that more than 25 percent of hospital workers in Philadelphia had a high school education or less (38.7 percent had a bachelor’s degree or higher). The workforce was heavily female (70 percent of hospital workers). Nearly 26 percent of hospital workers in the city were African American, and 4.9 percent were Latino.
Hospital unions attempted to address the wages and working conditions in the city’s health care economy as far back as the late 1960s, but hospital unionization persisted as a contentious issue in Philadelphia. Not all of the city’s major hospitals were unionized, including most notably the Hospital of the University of Pennsylvania. Under the leadership of Local 1199c of the National Union of Hospital and Health Care Workers, CHOP unionized in the early 1970s as did Temple University Hospital, Thomas Jefferson University Hospital, and Hahnemann University Hospital. During a 1972 organizing campaign at Philadelphia Metropolitan Hospital (now defunct), a hospital guard shot and killed Local 1199c organizer Norman Rayford (1938-72). After a protest march to Metropolitan, hospital administrators agreed to bargain collectively for the first time. Norman Rayford day, celebrated on August 28 (the date of the first hospital union contracts in Philadelphia), remains a paid holiday for members of Local 1199c. The union experienced a further surge in organizing after Congress in 1974 amended the National Labor Relations Act to cover health care institutions. HUP, in contrast, did not unionize despite a number of attempts by Local 1199c. The union has been led since its 1969 founding by Henry Nicholas (b. 1936), one of the area’s most prominent labor figures.
In 1989, the National Union of Hospital and Health Care Employees split in a racially-charged dispute over control of union locals. Most East Coast locals joined the Service Employees International Union (SEIU), but Henry Nicholas successfully pushed for Local 1199c to align with the American Federation of State County and Municipal Employees Union (AFSCME), as did most West Coast locals. In 2016, workers at St. Christopher’s Hospital for Children and Delaware County Memorial Hospital (in Drexel Hill) voted to join Local 1199c; earlier in the year, nurses at the two hospitals organized under the Association of Staff Nurses and Allied Professionals.
The centrality of hospitals and academic medical centers to Philadelphia’s twenty-first century economy simultaneously provided critical jobs and economic activity in a city reeling from the wrenching loss of a manufacturing base that had previously formed the core of the city’s economy. The new hospital city, however, brought real costs as well. These included the sector’s limited contribution to the city’s property tax-base, the low wages that it paid to many workers, and its frequent physical incursion into residential neighborhoods and commercial spaces. In all of these ways, Philadelphia, and its substantial urban health care economy, proved quite typical of the cities around the United States.
Guian McKee is Associate Professor at the University of Virginia’s Miller Center. He is the author of The Problem of Jobs: Liberalism, Race, and Deindustrialization in Philadelphia (Chicago, 2008) and is working on a new book entitled Hospital Cities, Health Care Nation: The Rise of the Medical Economy and the Transformation of Urban America (under contract with the University of Pennsylvania Press). He is the editor of three volumes of the Miller Center’s series The Presidential Recordings of Lyndon B. Johnson (published by W.W. Norton and The University of Virginia Press).
Located a mile north of the Routes 611-202 convergence, thirty-five miles north of Center City Philadelphia, Doylestown has served as the government center of Bucks County for over two centuries. Once a small village surrounded by farms, Doylestown developed into a bustling borough with a thriving downtown, a university, two museums, and commuter rail that carried passengers to Philadelphia in an hour.
Prior to European colonization, the Lenni Lenape Indians lived on the land that later became Doylestown. Ceded by William Penn to the Free Society of Traders in 1682, it was subsequently owned by Jeremiah Langhorne (1672-1742) and Joseph Kirkbride (1662-1736). The borough’s origins traced back to William Doyle (1712-1800), a tavern keeper of Irish ancestry. Doyle’s home sat adjacent to Dyers Mill Road, a north-south route established in 1722, which ran from Philadelphia to Easton (and later became Route 611). In 1730, a new east-west route (later Route 202) was established that ran from Coryell’s Ferry (later New Hope) to Norristown along the Schuylkill River. In response to the increase in traffic at the intersection of these two roads, Doyle opened a tavern that operated from 1746 to 1776, and a commercial and legal hub quickly developed around it.
Newtown had been the county seat since 1726, but as northern Bucks County’s population grew over the eighteenth century, county residents seeking a more central location petitioned the Pennsylvania legislature following the Revolutionary War. In 1810, the legislature appointed three commissioners from outside Bucks County to choose a new location for the county seat, stipulating that it could be no more than three miles from Bradshaw’s Corner, the county’s geographic center. In May 1810 the commissioners voted unanimously to make Doylestown the new seat.
Following the American Revolution, a stagecoach was formally established between Philadelphia and Easton, with a stop in Doylestown. The weekly coach charged $2 and was soon joined by a biweekly route from Bethlehem to Philadelphia. Beginning in 1810, when Doylestown became the county seat, local coaches left for Philadelphia every Monday and Thursday (with return trips on Wednesdays and Saturdays). Mail coach lines through Doylestown were established in 1823, and a daily coach to New York began in 1829, with stops in New Hope and New Brunswick, New Jersey.
Rail Services Arrive[caption id="attachment_29330" align="alignright" width="250"] Doylestown's development by 1850 is shown in this detail from a map of Bucks County. The county seat's original courthouse and jail are depicted in the lower right. (Library of Congress)[/caption]
Train service arrived in 1856, when the North Pennsylvania Railroad built an offshoot from its primary line stretching from Philadelphia north to Bethlehem. In addition to passenger trains, that branch line also serviced commercial interests, taking milk and other agricultural goods to Philadelphia and bringing industrial goods as well as coal to Doylestown. The Reading Company later took over the North Pennsylvania Railroad, and the Doylestown route was among Reading’s first to be electrified, in 1929. Trolleys also served Doylestown. Initially run by the Bucks County Electric Railway Company and later by the Philadelphia Rapid Transit Company, the first trolley line ran twelve miles between Doylestown and Willow Grove, with later lines established in Newtown and Easton.
In 1928, an airport opened as Doylestown Flying Field, later renamed Doylestown Airport. In addition to private planes, in 1946 the Veterans Administration accredited the airport to provide subsidized flight training to former GIs.
In 1897, Joseph Krauskopf (1858-1923) founded the National Farm School. A leading reform rabbi in Philadelphia, Krauskopf had been encouraged by Leo Tolstoy (1828-1910) to build a farming school for Jewish immigrants similar to farm schools in Russia. Krauskopf chose Doylestown as the location for the school because of its proximity to the city, as well as the abundant farmland that surrounded the downtown area. Over the twentieth century, as the school expanded its programs of study, it became Delaware Valley College of Science and Agriculture in 1960 and Delaware Valley University in 2015.
In the 1930s, Doylestown acquired the formerly unincorporated land to the north known as the Doylestown Annex, resulting in a nearly threefold population increase between 1930 and 1940. Lacking a tributary to the Delaware River, Doylestown eluded the growth of commercial factories experienced in New Hope and other towns along the river and remained largely agrarian outside the commercial district. The newly incorporated land consisted primarily of late nineteenth and early twentieth-century dwellings in a residential setting, in contrast to the business district of the borough and outlying farms of the incorporated district.
Postwar Population Boom[caption id="attachment_29337" align="alignright" width="300"] In this aerial photograph taken in 1971, the crossroads that gave rise to Doylestown is still evident, but construction is underway for the Doylestown Bypass. (Pennsylvania Department of Conservation and Natural Resources)[/caption]
In the postwar era, deindustrialization and “white flight” from Philadelphia neighborhoods led to a dramatic increase in population in Bucks County, with the overall county population more than doubling between 1950 and 1960. While lower Bucks County experienced the largest growth in population, Doylestown saw a steady increase as well. Between 1950 and 1980, the population of Doylestown grew from just over five thousand residents to nearly nine thousand, and over two thousand new homes were constructed, primarily in developments outside the downtown area. The growth in the county’s population meant a growth in the central bureaucracy, and in the 1960s, the nineteenth-century courthouse was demolished to make room for an expanded county courthouse and administration building.
Following a national trend, car-centric office, retail, and recreational complexes rapidly replaced main street business districts as the preferred locations for commerce and leisure throughout Bucks County. As a result, the downtown Doylestown business district suffered, and by the early 1960s, many storefronts stood empty. In response, the Bucks County Redevelopment Authority, backed by a federal grant, proposed tearing down twenty-seven historic structures, to be replaced by strip-mall-style complexes as well as parking lots. Among the structures slated for demolition was the Fountain House, a former tavern built by William Doyle.
The plan met resistance from longtime residents, who overwhelmingly rejected tearing down the historic buildings. At a public meeting in June 1964, Doylestown civic leaders organized and presented “Operation ’64,” a plan for restoring dilapidated historic structures and repurposing empty residential structures for retail. With the assistance of low-interest bank loans and assurances that building improvements would not lead to tax increases, the plan called on business and homeowners to improve their facades and landscaping. The project also provided parking incentives such as merchant discount tokens to customers who used parking meters.[caption id="attachment_29336" align="alignright" width="207"] The former Doylestown Agricultural Works, which produced farming implements from 1867 to 1967, was restored and developed into offices, shops, and restaurant space. (Wikimedia Commons)[/caption]
Doylestown’s approach to revitalization through restoration drew national praise and produced a moderate increase in sales and foot traffic to the downtown business district over the next decade. Moreover, Operation ’64 ensured that the historic buildings and layout of the business district survived the era of urban renewal. The Doylestown Historic District was added to the National Register of Historic Places in 1985.
Doylestown maintained its historic character and pedestrian-friendly business district in the early twenty-first century, and it benefited from the renewed popularity of the downtown business district model. In 2015, a larger justice center complex replaced the court and administration building from 1960. At a cost of over $85 million, the Bucks County Justice Center became the most expensive public project in Bucks County history.
In the two centuries it has served as the county seat, Doylestown saw a steady growth in population, with a spike in the 1930 when it annexed the unincorporated land outside the downtown center. Because of its distance from the Delaware River, Doylestown did not experience the upheaval of industrialization or a crisis of deindustrialization and remained a largely residential community, as it had been since the eighteenth century.
Bart Everts is a reference librarian at the Paul Robeson Library at Rutgers University-Camden and teaches history at Peirce College.
Mount Holly, New Jersey, established by Quakers in 1677 and known variously in its early history as Northampton and Bridgetown, became the county seat for Burlington County through an act of legislation in 1793. Three years later the Burlington County Court House, similar in style to Philadelphia’s Congress Hall, opened to serve as the official county court facility, a position it held until a new building assumed those responsibilities in 1959. Officially renamed in 1931 as Mount Holly, the name that it had been commonly known as since the Revolutionary War, the town owed its position as county seat to its central location twenty-four miles east of Philadelphia and its agricultural and manufacturing prominence. Over time, Mount Holly played a significant, and sometimes controversial, role in the Philadelphia region, even serving as a temporary capital for New Jersey during the Revolutionary War.
Mount Holly was originally home to the Lenni Lenape people, who lived in the area for over ten thousand years—long before the arrival of the Europeans in the seventeenth century. When British settlers arrived, the Lenape not only traded with them but also taught the settlers the skills necessary for frontier survival. However, these interactions brought devastation to the Lenape through diseases like smallpox and cholera, to which the Native Americans had no immunity. The indigenous people died in shockingly large numbers, so much so that by the mid-1700s only a few enclaves of the Lenape remained.
The first white, English-speaking person credited with settling the area was Walter Reeves (?-1698), who arrived in 1677 to establish a plantation along the Rancocas Creek. As it flourished, it attracted other settlers who established grist and sawmills in support of the predominantly farm community, which was incorporated in 1688. The first gristmill in Mount Holly was built in 1723, and a sawmill situated on the Rancocas was built in the early 1700s. In the eighteenth century, the Rancocas Creek was dammed and water redirected for use by the farms and mills, an area later preserved as a recreational facility known as Mill Dam Park.
Battle of Trenton[caption id="attachment_29252" align="alignright" width="300"] Completed in 1796, the Burlington County Court House opened three years after Mount Holly became the county seat. (Library of Congress)[/caption]
Mount Holly played a pivotal role in the Battle of Trenton during the Revolutionary War. The Battle of Iron Works Hill, also known as the battle of Mount Holly, aided General George Washington (1732-99) in his 1776 assault on Trenton by diverting a large number of Hessian troops to rout forces at Mount Holly. Over two days, December 22 and 23, 1776, a small American force of six hundred militiamen under Colonel Samuel Griffin (1746-1810) engaged some two thousand British regulars and Hessians commanded by Colonel Carl von Donop (1732-77).
In addition to the indigenous people and the European settlers, people of color played important roles in developing the region. The African American presence in New Jersey, including the area that encompassed Mount Holly, extended back at least to the late seventeenth century, when slavery served as a source of labor for agriculture and industry. That practice continued until 1804, when the New Jersey legislature passed “An Act for the Gradual Abolition of Slavery.” Although this law freed children of enslaved parents when those children reached the age of majority, it did not emancipate those currently enslaved and it permitted the practice of “apprentice for life” until 1865. Members of Mount Holly’s African American and Quaker communities participated actively in the antebellum abolition movement, and Mount Holly became one of the original stops on the Underground Railroad. The town’s historic village of Timbuctoo, a community of free African Americans founded in 1820, was such a haven for escaping slaves using this network.[caption id="attachment_29293" align="alignright" width="300"] In this map detail, Mount Holly is shown in 1849 with nearby Timbuctoo, a free black settlement, and a railroad connection extending to Burlington. (The map's orientation is tilted, with north in the upper left corner.) (Library of Congress)[/caption]
Mount Holly’s proximity to the transportation hubs of Philadelphia and Camden, as well as its agricultural, canning, manufacturing, and textile industries, contributed to its economic success as a regional force by the onset of the nineteenth century. Among its manufacturing endeavors were Semple’s Cotton Mill (founded in 1856) and the Ridson Foundry (1847). Travel from Mount Holly to Philadelphia and Camden was made possible by ferries, stagecoach, and a rail service that started in 1867. Mount Holly’s town center hosted many small businesses and retail stores as well as newspaper offices.
In the twentieth century Mount Holly’s economy received a boost from the Camp Dix army base, established in 1917 as a staging and training center for World War I and located approximately ten miles from the township. Construction of the camp involved recruiting and hiring eleven thousand workers from the area. During the 1930s the camp served as a base for members of the Civilian Conservation Corps, and in 1939 the army made it a permanent military base, Fort Dix. In 2009 the Department of Defense merged Fort Dix with McGuire Air Force base and the Lakehurst Naval Air Engineering Station to create McGuire-Dix-Lakehurst, the only tri-service joint base in the country. In 1994, Fort Dix added a low-security federal correctional institution housing over four thousand inmates to its primary mission as an induction center.
Twentieth-Century Economic Shifts
As in Philadelphia and Camden, to which Mount Holly’s economy was closely tied, the latter part of the twentieth century became a period of economic decline. National trends of mills, factories, and food-processing plants relocating to less unionized states or overseas meant a loss of blue-collar and middle-class jobs and residents. After reaching a high of 13,271 residents in 1960, the town’s population fell to 9,536 in 2010. Additionally, the construction of nearby shopping centers and malls, notably the Cherry Hill Mall (which opened in 1961) and the Moorestown Mall (1963) changed consumer-buying habits to the point that many small shops and family-owned businesses that had dominated the commercial landscape of downtown Mount Holly closed.
As part of a redevelopment effort, in the early twenty-first century the township designated the 320-acre Mount Holly Gardens development for demolition and reconstruction. Erected in the mid-1950s to accommodate military families at Fort Dix and McGuire at affordable prices, the community consisted of 379 garden-style apartments. The development had been a boon at a time when area housing was in demand, but problems ensued after the builder filed for bankruptcy and the project fell first into the control of a New York City real estate company and subsequently to a patchwork of absentee owners. Despite the town’s periodic efforts to enforce building codes, physical and social conditions deteriorated. By 2002, when Mount Holly authorized the project’s demolition, its affordability had attracted a mixture of lower-income owners and renters, the majority of whom were black and Latino. Contesting the town’s effort to relocate them, the Gardens' remaining residents sued, taking their case all the way to the U.S. Supreme Court. Facing ever-mounting legal costs, Mount Holly settled the case in 2013 before the court verdict, agreeing to include units to accommodate the plaintiff’s needs in the new construction, a neighborhood called Parker Green Homes.
Less contentious was Mount Holly’s promotion of investment opportunities created after the state designated it as an Urban Enterprise Zone in 1995. Using the tax incentives available through this program, Mount Holly sought to capitalize on accessibility to Philadelphia, its historic assets, and a revitalized Main Street shopping district to draw retail dollars as well as to reestablish itself as a thriving residential community.
Vibiana Bowman Cvetkovic is a Reference Librarian at the Paul Robeson Library. She is a Ph.D. candidate in the Childhood Studies program at Rutgers University, Camden, New Jersey. Cvetkovic’s area of research and writing include children and media, intellectual ethics, and American popular culture. She is the coeditor of Fleeting Image: Portrayals of Children in Popular Culture (Lexington, 2013).
The Encyclopedia of Greater Philadelphia has been growing rapidly this summer, and we are pleased to announce that the project has reached a new milestone: 550 topics published online. The 550th essay to be published is Dispensaries, by Steven J. Peitzman, a longtime contributor who participated in one of our early Greater Philadelphia Roundtable programs, "City of Firsts." He has written two previous essays for The Encyclopedia: City of Medicine and Typhoid Fever and Filtered Water.
Free clinics known as dispensaries served the “working poor” of European, British, and American cities from the eighteenth through the early twentieth centuries. Paid or volunteer physicians saw patients on site or at their homes in the dispensary’s district, caring for both minor ailments and more serious diseases. The Philadelphia Dispensary for the Medical Relief of the Poor, considered the nation’s first, opened in 1786. By the late nineteenth century, a disorganized assortment of dispensaries large and small served the Philadelphia region’s growing population of new immigrants.[caption id="attachment_29126" align="alignright" width="300"] In 1801, the Philadelphia Dispensary opened a new building on Fifth Street between Chestnut and Walnut Streets, the middle building shown in this photograph taken in 1887. (Library Company of Philadelphia)[/caption]
The Philadelphia Dispensary opened in rented space but was able to erect a handsome building on Fifth Street between Chestnut and Walnut in 1801. Both Quaker and non-Quaker citizens supported the enterprise, originally headed by the admired Episcopal Bishop William White (1748-1836) and administered by other prominent Philadelphians, particularly members of the Wistar/Wister family. Benjamin Franklin (1706-90) headed the first subscribers, who could each list two persons for free care. Many prominent physicians served as regular dispensary doctors or consultants. An employed apothecary prepared the pills, tinctures, salves, and the like, which almost all patients received: the name “dispensary” well fit the function. The Philadelphia Dispensary also offered inoculation against smallpox. In the early decades of the nineteenth century, the dispensary cared for large numbers of African Americans, and then Irish following their increasing immigration in midcentury.[caption id="attachment_29116" align="alignright" width="296"] The Southern Dispensary for the Medical Relief of the Poor opened in 1816 on Shippen (Bainbridge) Street west of Third. The Renaissance Revival building dates from 1858. (Photograph by Steven J. Peitzman)[/caption]
Overwhelmed with clientele, the Philadelphia Dispensary in 1816 made loans to support the founding of the Northern Dispensary, serving the Northern Liberties into Kensington, and the Southern Dispensary (chartered in 1817) for Southwark, Moyamensing, and Passyunk. These functioned very much like the parent institution. Eventually, dispensaries could be found in the various townships and neighborhoods. For example, the Germantown Dispensary (later Germantown Dispensary and Hospital) opened modestly in one room in 1864, an initiative of the prominent physician James. E. Rhoads (1828-94). The Camden City Dispensary was founded in 1866, with members of New Jersey’s prominent Cooper family enrolling as “life members” (subscribers). Norristown Hospital and Dispensary was among facilities in the region to offer both inpatient and outpatient services; founded in 1889, it soon changed its name to Charity Hospital, and later Montgomery Hospital.
The evolution of Philadelphia’s various dispensaries reflected changes in the region’s population and in medicine. The Southern Dispensary in Philadelphia, for example, saw increasing numbers of immigrants from Eastern Europe and Italy as well as African American migrants from the South during the late nineteenth and early twentieth centuries. With the growth of specialization in medicine, specialty dispensaries arose for skin diseases, eye and ear problems, pediatrics, and for the ubiquitous and deadly tuberculosis. The older dispensaries organized their clinics by categories of disease. Nonetheless, the major dispensaries of Philadelphia remained mainstays of outpatient medicine for ailments such as coughs and catarrhs (colds), “rheumatism,” dyspepsia, and diarrhea and earaches among children. Dispensaries in industrial areas also looked after cuts, burns, and various injuries not needing hospitalization or major operations.
Something like a dispensary mania surged in the second half of the nineteenth century. The strong presence of the alternative therapeutic practice homeopathy in the city led to homeopathic dispensaries. The House of Industry and the College Settlement also offered dispensaries. Jewish anarchist physicians opened their Mt. Sinai Dispensary at 236 Pine Street in 1900. The major hospitals spawned dispensaries, as did some of the medical schools.
Medical education had played a major role at dispensaries from the beginning, since young doctors used them to gain experience. Alumnae of the Woman’s Medical College of Pennsylvania founded an outpost, the Barton Dispensary (named for a founder), on Third Street in South Philadelphia in 1895; it later moved, when the college did, to East Falls. The “Medical Society for Self-Supporting Women” for some years in the late 1880s conducted an evening dispensary for working women, with women physicians as staff. In 1883 surgeon John B. Roberts (1852-1924) and others opened the Philadelphia Polyclinic and College for Graduates in Medicine at Thirteenth and Locust Streets. This “short course” school for those already holding the M.D. aimed at providing practical experience sometimes lacking in conventional medical schools. Instruction depended largely on the institution’s dispensary practice, although later, at Lombard Street between Eighteenth and Nineteenth, it added a hospital (later known as Graduate Hospital). While many Philadelphia physicians practiced at a dispensary sometime in their careers, and some even founded one, other physicians thought the proliferation was getting out of hand. They suspected that persons capable of paying a fee to a private practitioner nonetheless would seek care at a dispensary–what was referred to as “dispensary abuse” or more broadly, “charity abuse.” This tension arose in other cities as well.
Over the course of the twentieth century, other forms of free clinics gradually replaced dispensaries. A 1929 report on medical facilities in Philadelphia listed seventy-one dispensaries, almost all of them outpatient practices of hospitals, medical schools, or other organizations. Only the Northern Dispensary and the Southern survived as independent entities. The original Philadelphia Dispensary had merged with the outpatient services of Pennsylvania Hospital in 1922. By the 1940s, health clinics conducted by the Philadelphia Department of Health assumed some of the work once done by the city’s dispensaries. Outpatient departments of hospitals and medical schools expanded (and eventually could gain reimbursement with the advent of Medicare and Medicaid in 1966). Nonprofit agencies such as the Public Health Management Corporation also opened free-standing clinics, including the Mary Howard Health Center, managed by nurses and serving Philadelphia’s homeless population. Into the 1980s and 1990s, community-minded medical students and faculty physicians at Hahnemann Medical College and the Medical College of Pennsylvania (the former Woman’s Medical College of Pennsylvania, coeducational as of 1970) reinvented the free neighborhood night clinic. Surprisingly, the term “dispensary” resurfaced in 2017 with a novel connotation—the place to go for medical marijuana.
Philadelphia’s dispensaries of the nineteenth and early twentieth centuries, including the nation’s first such institution, served basic health needs of the poor, particularly first-generation immigrants, though their educational function may have been at times exploitive. Various free or low-cost clinics continued to operate in the early twenty-first century, demonstrating a persistent need despite the availability of health insurance and the federal Medicare, and Medicaid programs.
Steven J. Peitzman is Professor of Medicine at Drexel University College of Medicine. His historical work includes the book A New and Untried Course: Woman’s Medical College and Medical College of Pennsylvania, 1850–1998 (Rutgers University Press, 2000) and articles about medicine and medical education in Philadelphia and Germantown.
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