Back when I was doing my internship at Pennsylvania Hospital, I was so surrounded by history I felt like I was working in a museum. Even the china we dined on in the hospital cafeteria sported the original historic pattern. And when we finished our training, a brass plaque with our names went up on the same wall as the plaques of our predecessors going back to the 18th century.

At the time, none of this was widely known. But fortunately, Pennsylvania Hospital now has an actual museum, open to the public just in time for the nation’s 250th anniversary. The Pennsylvania Hospital Museum is compact yet chock-full of art, architecture, artifacts, and documents, and has at once become a must-see destination in Philadelphia.

Although Bellevue Hospital has roots that go back to 1736, it started out as an almshouse. Pennsylvania Hospital was the first institution in the colonies founded specifically as a hospital, established in 1751 by Benjamin Franklin and Thomas Bond. The 1756 building housing the museum is a National Historic Landmark. Not only is it considered an important example of Georgian architecture, but its cornerstone even bears an inscription by Franklin referring to King George II.

The landscaped grounds are a serene oasis in the middle of Philadelphia’s Society Hill neighborhood and include a Physic Garden containing herbs and plants used for medicines in the 18th century.

As one enters the building, the first room encountered is the pharmacy, which remained in use until 1927 and now contains interactive displays. A fire engine purchased in 1803 sits in the foyer at the base of a grand staircase. After ascending to the second floor, visitors enter America’s first medical library, a handsome wood-paneled room containing more than 13,000 volumes from floor to ceiling, including one of the nation’s most complete collections of medical books published between 1750 and 1850.

The third floor houses the nation’s oldest surgical amphitheater. In the era before electricity, it was illuminated by skylight, so surgeries could only be performed on sunny days. (I must confess that we interns used to sneak into this room when on call. It was spooky in the middle of the night!)

For me, as a psychiatrist, the highlights of the museum were the exhibits on mental health. I have previously written in MedHum about Benjamin Rush, often called the father of American psychiatry, whose portrait is on view here. Rush served on the staff at Pennsylvania Hospital from 1783 until 1813 and was known for his groundbreaking and humane treatment of the mentally ill. Metal shackles once used as restraints are also on display, although hopefully they predated Rush’s tenure.

Another psychiatric pioneer whose portrait hangs in the museum is Thomas Story Kirkbride, who came to Pennsylvania Hospital for residency training in 1834. When the psychiatric wards exceeded capacity and a satellite facility was built on 101 acres in West Philadelphia, Kirkbride was named superintendent. His ideas about the layout and design of mental institutions became highly influential, leaving an imprint on hospitals throughout the country.

Initially called the Pennsylvania Asylum for the Insane, the new campus eventually became known as the Institute of Pennsylvania Hospital. I completed my residency training there, but over time it was no longer financially viable, and it closed in 1997.

How fascinating to learn that Francis Scott Key, of “The Star-Spangled Banner” fame, wrote a poem titled On Visiting the Pennsylvania Hospital. And to see 18th-century anatomical casts used for teaching at a time when formal dissection was illegal.

There is so much history in this museum that I could not absorb it all in one visit. With its addition, Philadelphia further demonstrates its role as the cradle of American medicine. Indeed, one would have to travel to London to find a larger assemblage of medical historical sites.

In one very busy day—or a more leisurely two-day trip—a visitor can now experience this museum, plus the College of Physicians of Philadelphia and its famous Mütter Museum, while also stopping to see The Gross Clinic by Thomas Eakins. (The painting alternates between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, but will spend 2026 at the latter.)

Bravo, Philadelphia!

Benjamin Rush:  Reflections from a Psychiatrist 

Guy Glass 09.02.24 0

A founding figure in American psychiatry, known for pioneering reforms, but also controversial for his treatments and complex contradictions in beliefs and practices.

For more information about the museum, visit Pennsylvania Hospital Museum.
Web image from Wiki Commons

Dégas’ brilliant rendering of perspective pulls the viewer into the mystery of what has taken place in what appears to be a woman’s bedroom. At the foot of the single-width bed, a coat is thrown over the metal bedpost frame. In the right foreground a bearded man leans against a closed door. His shadow looms behind him, large against the door. His shadow is generated by the single small lamp set upon a small round table near the center of the room. On the floor next to the table lies a piece of cloth or clothing (said to be a corset, p.674 of reference below). 

Turned, bent away from the man, partially kneeling on the floor at the other side of the room, is a young woman whose left shoulder and upper back are bare. The short sleeve of her white dress (nightgown?) hangs off her shoulder. She clutches to her body a blanket or drape. In contrast to the man, who stands in semidarkness, the woman’s back is bathed in the light of the nearby lamp. 

Clothing strewn on the floor and the looming man posted against a door suggest an assault. Although early 20th century critics did indeed perceive the painting as depicting the aftermath of a rape, that interpretation is not a foregone conclusion. The Philadelphia Museum of Art notes that Dégas referred to this work as “my genre picture” (a picture showing everyday life). The museum states further that “an annotation in a notebook used by Degas in this period provides a clue as to his intentions: ‘Work a great deal on nocturnal effects, lamps, candles, etc. The fascinating thing is not always to show the source of light but rather its effect.’ ” For another discussion of this painting, see Body, Place, and Self in 19th-Century Painting, by Susan Sidlauskas (Cambridge University Press, 2000). 

Web image from wikicommons

“Prof. William Osler, of the University of Pennsylvania, was summoned by telegraph this afternoon to go to Walt Whitman’s bedside. The aged poet had a relapse, and it was feared that he was dying. When the doctor came away from the little frame house at 328 Mickle Street, Camden, at 8 o’clock tonight, he said the poet was resting easily and about holding his own.” 

Osler first visited Whitman in 1884, shortly after moving to Philadelphia to take up his position as Professor of Medicine at the University of Pennsylvania. Dr. Maurice Bucke, a Canadian psychiatrist and mutual friend, had asked Osler to look in on Whitman, who was complaining of dizzy spells and fatigue. The professor obligingly ferried across the Delaware River to Camden and made a house call. Osler reported that the poet had no residual neurological deficits from his earlier stroke. He was unimpressed with Whitman’s current symptoms and, in fact, later described him as “a fine figure of a man who had aged beautifully, or more properly speaking, majestically with a large frame and a well-shaped, well-poised head…“ ^{1, p. 21} 

However, four years later the situation was more serious. On June 14, 1888, Whitman developed slurred speech, prostration, and confusion “such as we know are not uncommon with sclerosis of the arteries of the brain.”^{1, p. 178} When Osler was called in, he recommended general supportive care and issued a cautiously optimistic prognosis (as the Times reported), but evidently did not present his patient with a specific diagnosis or discuss pathophysiology. Whitman recovered over the following weeks, but his health gradually deteriorated over the next several years until his death in 1892. 

During the years Osler served as the poet’s primary care physician, their relationship was respectful, but not ideal. Whitman frequently complained about the great clinician’s rosy bedside manner. “Osler made light of my condition,” the poet wrote. “I don’t like his pooh-poohs. The professional air of the doctor grates on me.” ^{1, p. 50} On another occasion he told his friend Horace Traubel, “I confess I do not wholly like or credit what he (Osler) says. I do not fancy the jaunty way in which he seems inclined to dismiss my troubles.” ^{2, July 3, 1888} Evidently, Osler continued to speak in generalities, rather than addressing specific concerns that Whitman raised as he became progressively feebler.  

This situation contrasts with some of the poet’s earlier medical experience. For example, shortly after his stroke in 1873, Whitman consulted Dr. Mathew Grier who must have explained the etiology of the problem. Whitman later wrote to his friend Peter Doyle, “Did I tell you that Dr. Grier here says that my real disease is the brain not being properly furnished and nourished with blood…” ³ The poet’s other physicians included Drs. Silas Weir Mitchell and his son John Kearsley Mitchell. The famous neurologist and champion of neurasthenia made house calls on Whitman twice in 1878 when the poet reported symptoms of rheumatism and prostration, which he had self-diagnosed as a recurrence of his previous stroke. Mitchell assured him that the stroke, which had resulted from a ruptured blood vessel in the brain, was not responsible for the current symptoms. These, Mitchell claimed, were caused by chronic stress, perhaps exacerbated by anxiety over a public lecture that the poet was just then preparing to give.³ In other words Mitchell considered the illness a manifestation of neurasthenia. He prescribed travel, mountain air, and vigorous outdoor activity, which was Mitchell’s generic regimen for neurasthenia in males, quite the opposite of his more famous regimen of complete bed rest for female neurasthenics. ³ The poet took Mitchell’s advice seriously and embarked on a trip to Colorado, after which he professed himself cured.  

While Osler’s optimistic persona must have pleased many patients, it irritated Whitman. He judged his doctor’s cheerfulness to be insincere, or at least questionable. The elderly poet was an eccentric who fiercely valued his independence. While at times he showed a sweet and gentle side, he could also be touchy, irascible, and assertive. As the poet grew progressively frailer during 1888 and 1889, Traubel recorded a series of house calls during which Osler assured him that he would soon recover. “Do not take a gloomy view of Whitman’s case,” Osler told Traubel, “he will come around.” ^{2, July 3, 1888} In this short poem, I try to resurrect the poet’s attitude toward his famous doctor: 

Walt Whitman Reflects on His Doctor’s Bedside Manner 

As an old rat that must be allowed to die 
in his own way, I start with a prejudice 
against doctors. Never mind worrying 

about your sickness, he scolds me,  
I’m seeing to all that. The man tinkers  
with platitudes and conceals his thoughts.  

In his gospel of encouragement 
I’m supposed to be agreeable and dumb 
while he puts the best construction  

on what’s happening. What does he know 
about Whitman, the old rat? A shoemaker  
tells his customer the shoe fits just right 
but the shoe pinches the fellow wearing it.  

Whitman was a master of self-promotion. He appeared to encourage members of his inner circle who viewed him as a prophet, as well as a poet. Dr. Maurice Bucke even wrote a book claiming that his friend was one of the few humans who had achieved “cosmic consciousness.” The others included Jesus, Mohamed, and the Buddha. Did Osler fail to understand that his one- size- fits- all approach to physician-patient communication might not be appropriate for a patient with Whitman’s complex and eccentric personality?  

Although dissatisfied with Osler’s bedside manner, the poet respected his doctor’s clinical abilities. Several months after the medical crisis in 1888, Whitman wrote, “As for Osler: he is a great man—one of the rare men. I should be much surprised if he didn’t soar way, way up—get very famous at his trade—someday. He has the air of something about him—of achievement.”^{2, December 26, 1888} Indeed, by that time, Osler had already accepted the position of Professor of Medicine at the new Johns Hopkins medical school in Baltimore.  

Osler was a sensitive, cultivated man, but also a rationalist, who initially looked askance both at Whitman’s exuberant poetry and the cult that had grown up around its author. Although he admired the man, he had no wish to become a disciple. He loved poetry and enjoyed quoting passages from Shakespeare and the Romantic and Victorian poets. Regarding his first impressions of Leaves of Grass, Osler later wrote, “Whether the meat was too strong, or whether it was the style of cooking—‘twas not for my pampered palate.” ^{1, p. 22} He found his new patient’s long, unruly poems and earthy subject matter self-indulgent and lacking in discipline. The boisterous persona reflected in Whitman’s poems jarred Osler’s methodical mind. In the following poem, I imagine the clinician’s response to his early encounters with the Good Grey Poet: 

Dr. William Osler Remembers His Call on Walt Whitman 

I took the ferry that day and found him 
in the front room of a small house 
on Mickle Street, buried to his chest 
in papers, magazines, and musty  
brown bundles. Push yourself a path, 
he said. I reckon you’re a friend of Bucke’s. 

His famous head had aged majestically— 
unkempt white beard; smooth, clear cheeks; 
a fissured, geographic forehead. 
His voice was pitched a shade too high,  
but strong like the rest of him. Of symptoms 
he said but little–remarkable 

for a man of 65. For a moment 
I felt that sweet aromatic presence 
his disciples spoke of–for me, though, 
the edge of chaos. I sometimes wish 
the man had made a difference in my life, 
opened me up, but how could I forego 

my restraint? Or professional kindness? 
For a man like me, a man of substance, 
what could be worse than falling in love 
with Whitman? I listened to the music 
of his tongue, but could never cross the line 
that reads, Who enters here, abandons discipline. 

Yet, in his later years, Osler grew to respect his one-time patient’s poetry, as well as his charismatic personality. In fact, at the time of his death from pneumonia in 1919, he was in the process of writing an appreciative reminiscence of his encounters with Whitman. 

The uneasy, but respectful, relationship between these giants in their respective fields provides interesting material for reflection. If the poet was so dissatisfied with Osler, why didn’t he go back to Weir Mitchell or his son, who were more easy-going and communicative? Mitchell’s reputation as a clinician easily equaled Osler’s, and he was a poet as well. Could it be that Whitman benefited in some way from Osler’s staunch optimism, or had developed deep trust in Osler’s judgment, despite the constant complaints he issued to Traubel and others? Alternatively, why didn’t Osler modify his paternalistic approach, since it seemed clear that Whitman preferred to play a more active role in the relationship? And those time-consuming house calls that required taking a ferry across the river! Why not recommend a more pliable colleague?  

References 

1. Philip Leon, Walt Whitman & Sir William Osler, ECW Press, Toronto, 1995. 

2. Horace Traubel, With Walt Whitman in Camden, vol. 2, at http://whitmanarchive.org/criticism/disciples/traubel (accessed December 30, 2024) 

3. Feinberg CE. Walt Whitman and his doctors. Arch Intern Med 1964; 114: 834-842. 

Photo of Sir William Osler and Walt Whitman from WikiCommons.

It seems as if there is a man named Benjamin Rush who follows me everywhere I go.  He was one of the founding professors at the medical school I attended.   He was on the staff of the hospital where I did my training.  He was one of the initial fellows of the College of Physicians of Philadelphia where I’m now a fellow, and where a medicinal plant garden now bears his name.   He appears on the seal of my professional organization, the American Psychiatric Association.   At one point, apparently, he even came within spitting distance of my future home when he made the famous crossing of the Delaware River along with Washington and the troops. 

But who was this person, really?  That is what I was wondering when I picked up Stephen Fried’s biography Rush. He seems to have known everyone who was anyone, yet Rush himself is one of the least well-known of our country’s Founding Fathers.  It turns out that the answers are complicated. 

Rush has been called the father of American Psychiatry.   When he began to work at Pennsylvania Hospital, he was appalled to discover the “lunatics” chained up and below ground in unheated cells, receiving no treatment.   The public could come in and gape at them for four pence.  Although Rush made wide-ranging contributions to medicine in his long career as a physician (such as guiding Philadelphia through a series of yellow fever epidemics), he returned repeatedly to the problem of the patients in the basement.    

In an era when madness was frequently seen as a moral failing, Rush put forth the theory that it was a disease.  (He believed that about alcoholism too.)  He spoke to the mentally ill like human beings, and when they had delusions, which he called “errors of thinking” (Fried, 2018, p.269), even tried to understand them.  He banished the public from the basement, had heaters installed in the cells, and petitioned the hospital to supply the patients with “exercize and amusements” (Fried, 2018, p.450).  Although Rush wrote prolifically throughout his career, he finally published his magnum opus on the subject just a few months before his death. In Medical Inquiries and Observations, upon the Diseases of the Mind, he sought to bring mental diseases “to the level of all the other diseases of the human body…. Time I hope will do my Opinions justice.  I believe them to be true and calculated to lessen some of the greatest evils of human life.” (Fried,2018, p.469)  

All of this is admirable.  However, the other side of the coin is that some of Rush’s treatment methods were questionable.  True, he was far from being the only physician at the time to use bloodletting for…just about anything and everything.  However, even among his contemporaries, he was known as being so aggressive a bloodletter he was parodied as Doctor Sangrado (a reference to an evil physician in a popular novel who bled patient dry).  He also comes off, at least in Fried’s book, as having as a character flaw an inability to ever admit he was wrong.  So, in defiance of his detractors he persisted in using bloodletting to the end of his career.  And although his recommendations about diet and exercise were indisputably helpful ones, his Tranquilizing Chair and Gyrator (they sound like rides in an amusement park, but probably weren’t very amusing) did not turn out to be.   

In addition to his stubbornness, Rush had a tendency to say things that perhaps he might have thought out more carefully.  He never lived down a foolish criticism he had made of George Washington. He made outrageous pronouncements as a physician based solely on observation.  In what Fried calls “the most spectacularly wrong-headed address of Rush’s career” (Fried, p. 389), he conjectured that the dark skin of black people comes from leprosy. A man of profound contradictions, Rush was an abolitionist who also turns out to have been a slaveowner. While this may not have been unheard of in the 18^th century, it is disturbing today considering some of his statements.  In 2021 The New York Times published an article entitled “Psychiatry Confronts its Racist Past, and Tries to Make Amends” which sees Rush’s leprosy theory as one source of the structural racism in psychiatry that has led to the pathologization of African Americans for hundreds of years.  

Back in 1894, when the American Psychiatric Association unveiled its official seal, it included a likeness of Benjamin Rush’s profile: “The choice of Rush…for the seal reflects his place in history…Rush’s practice of psychiatry was based on bleeding, purging, and the use of the tranquilizer chair and gyrator.  By 1844 these practices were considered erroneous and abandoned.  Rush, however, was the first American to study mental disorder in a systematic manner, and he is considered the father of American Psychiatry.” But today, Rush is evidently no longer considered to be a role model. in 2015, the APA adopted an entirely new logo that did away with Rush altogether, although the organization would “continue to use the seal…for ceremonial purposes and for some internal documents.”  (“American Psychiatric Association,” Wikipedia)  

In conclusion, although we can not necessarily hold historical figures to task for making comments that were considered acceptable at the time, we also need not put them on a pedestal.  Fried’s book Rush depicts its subject as a brilliant man with weaknesses.  The more I read about Rush, the more interesting and complex I find him to be.   

References  
Fried, Stephen. Rush. New York, Broadway Books, 2018 
Warner, Judith. “Psychiatry Confronts its Racist Past, and Tries to Make Amends.” The New York Times, April 30, 2021 (updated May 21, 2021) 
“American Psychiatric Association,” Wikipedia, updated July 3, 2024