SPECIAL ARTICLE
683
THE
CHILDREN’S
HOSPITAL
OF
PHILADELPHIA-
100 YEARS
By Joseph Stokes, Jr., M.D., PhysicianinChief*
N
ONE to our knowledge in thishemi-sphere before 1855 had thought in-fants and children were sufficiently
differ-ent from adults to warrant special care and
facilities for them when they were sick.
This meant that no one had really faced
the proposition that the well child-and
this means a healthy mind and spirit in a
healthy body-must precede the healthy
adult.
Only a few perhaps in the last century
have faced, in the field of health, the
po-tentialities of the bending of the
twig-whether before birth, soon after birth, in
infancy, in childhood, or in adolescence.
Until the middle of the Nineteenth
Cen-tury medicine was too much engaged in
the saving of life alone to center its interest
in the future potentialities of the child,
healthy in mind, spirit, and body. And
mid-way between the discoveries of the life
say-ing procedure of anesthesia and the
micro-biologic origin of infectious diseases it was
natural that a Philadelphia physician-an
emissary from our western
hemisphere-should be deeply affected and stimulated
by the saving of infants’ and children’s
lives he witimessed in London. The emissary
was Dr. Francis West Lewis and his
stim-ulus was the mother of all children’s
hospi-tals in the English-speaking world-The
Great Ormond Street Hospital of London.
When Dr. Lewis visited Great Ormond
Street just before 1855 he was not thinking
so much of the healthy mind and spirit in a
healthy body as he was of the infants and
children who suffered and died literally by
the tens of thousands because of the lack
of knowledge of the origins of diesases and
Opening remarks at the Centennial Medical
Convocation of the Children’s Hospital of
Phila-delphia, June 2-4, 1955.
#{176}ADDRESS: 1740 Bainbridge Street, Philadelphia 46, Pennsylvania.
of methods for their treatment and control.
Prevention of diseases would have had at least no place in his thoughts and one can
assert, with considerable assurance, that the promotion of health in children was quite out of his ken.
The immediate problem he faced and for
which he saw a beginning answer in what had been done at Great Ormond Street, was
the serious neglect of infants and children
in hospitals for adults. They either died of
neglect in the hospital for adults or in most
cases couldn’t even reach the hospital.
In-fants were handled at home chiefly because
families knew they would die in the hospi-tal-as indeed most of the admitted infants
did because of cross infection, diarrhea, and
neglect.
The shaft of light thrown by Great Or-mond Street into the darkness of the slums
of London opened a vista to Francis Lewis
which he quickly interpreted to his
profes-sional and lay friends in Philadelphia.
It is of particular interest that Lewis
chose the day after Thanksgiving,
Novem-ben 23rd, for the opening of the new hospi-tal. With Lewis were 2 other young men (Lewis himself was then but 30 years, R. A.
F. Penrose, 28 years, and T. Hewson Bache,
29 years) who signed an advertisement on
the first page of the “Public Ledger” Phila-delphia’s morning paper which read as
fol-lows:
“The Children’s Hospital-located on Blight
Street, running from Pine to Lombard, below
Broad, is now open for the reception of
pa-tients. Children suffering from acute diseases
and accidents will be received free of charge. A dispensary, for sick children, is also attached
to the hospital and will be open at the same
place every day (Sundays excepted) from 1 1 to
12 o’clock, when advice and medicines will be
given free of charge.”
How different the cost now of more than
684 STOKES - CHILDREN’S HOSPITAL OF PHILADELPHIA
FIG. 1. Aerial view of the Children’s Hospital of Philadelphia (new Research Building and Serum
Exchange Building not simown). Buildings (from top, center to lower, left) include Nurses’ Home, main building, housing administration, wards, private floor and doctors’ offices, connecting with building,
extending from Bainbnidge Street along 18th Street, housing X-ray, Heart Station, 1)iagnostic Clinic, 4
new operating rooms and service facilities, Nurses’ Infirmary, Out-Patient Department, new 12-bed
semi-private surgical ward, orthopedic ward, offices, and clinical laboratories. Buildings (at far right),
extending along Fitzwater Street, include Blood Donor Center, additional research laboratories, City
Health Clinics, Growth and Development Center, and Dental Clinics.
How interesting also that, although it was
only a small beginning of 12 beds, for a
total population then in Philadelphia of
about 460,000, it was a project of young
men with young ideas-may it always re-main so and may the cost always be less important than the work, if it holds to the ideals of its founders and their aims for in-fants and children.
The first year of the hospital saw 67 “in-door” and 306 “out-door” patients with 821
visits. Such diseases as tuberculous bone
and joint infections, diphtheria, and typhoid fever were then common, and any suppur-ative process was controlled with the great-est difficulty.
In the second year an adjoining house was purchased, thus increasing the bed ca-pacity to 20, and
in
the sixth year of itsexist-ence 133 “in-door” patients were cared for
and 3516 “out-door” visits were made. In 1866, 11 years after its founding, the
hospital moved to a new building on the east side of 22nd Street between Locust and Walnut Streets and many blocks west of its original location in the oldest part of the city.
During the 50 years of location on this
second site and after it moved in 1916 to the present location, enlargement of the bed space, increase of the staff, and new skills were slowly added to the hospital in
facili-ties of space and personnel.
However the program during this earlier
period up to 1930, comprising exactly
three-quarters of the hospital’s life, can hardly
SPECIAL ARTICLE 685
From Ulysses by Alfred Lord Tennyson.
Fic. 2. Model of Children’s Hospital of Philadelpliia. Model shows present hospital buildings and
projected buildings. Completed are the new Research Building (6 stories), second from left on 17th
Street; Plmiladelphia Child Guidance Clinic, an affiliate of the hospital (on corner of 17th and Bainbridge); and new Serum Exchange Laboratories (at top right of picture). Proposed 10-story patient care building (top, center) on Fitzwater Street.
The accelerating pace of achievement in
the past 25 years to a great extent is merely
a reflection of medicine as a whole and the
basic fields of science upon which medical
progress rests. But also such achievement
clearly reflects the striking stimulus which
all teaching hospitals have received from
the development of full-time and part-time
clinical investigators and men and women in the basic fields of the medical sciences
who cluster about groups of out-patients
and in-patients and most of all about young
men with ideas.
Where patients-including the family
re-lation-ane the keystone of the arch, and
where one pillar of the arch is research and the other pillar teaching, this arch of cx-perience frames the ever changing medical
vista of the future. “Yet all experience is
an arch, where thru gleams that untravelled
world whose margin fades forever and
for-ever as I move.”0
Each teaching hospital, insofar as it ful-fills to a greater or lesser extent these 3
functions, forms a clearer or a less distiimct
frame for the future. For a true perspective
requires the near and the far, the frame and
the vista.
This is the distinctive achievement of
American Medicine. Though it was late in
the development of science and clinical
medicine, to a great extent it has lead the
way in the joining of the basic medical
sciences and the patient. The survey of
American Medicine by Abraham Flexner
for the Carnegie Foundation and the
de-velopment of full-time clinical chairs at
Johns Hopkins Medical School played a
major part in this achivement.
The acceleration at the Children’s Hospi-tal in the past 25 years has not been the
re-suit of a few individuals’ efforts but rather
the inevitable stimulus of young men
associ-ated in a collaborative venture of a
hospi-tal, a school of medicine, and a farsighted
Board of Managers and administrative
leaders.
In the years preceding this event the
pro-686 STOKES - CHILDREN’S HOSPITAL OF PHILADELPHIA
vided a sound basis for the accelerated
de-velopment:
1) In 1870 children’s surgery was added.
2) Various departments such as
orthope-dies, otolaryngology, radiology and
ophthal-mology and many others were gradually
added.
3) In 1899 a Country Branch of 8 acres
near Ovenbrook for convalescent care of
about 20 cases was added. Ten years later
this work was turned over chiefly to the
Children’s Seashore House in Atlantic City and the Country Branch was gradually closed.
4) In 1892 the hospital was increased to 94 beds.
5) In 1895 a training school for nurses
was started.
6) Just preceding and during 1900 two wards were opened which, for the first time, admitted infants to the Hospital. The
Cath-erwood Milk Laboratory for training nurses
in milk mixtures was initiated.
7) Probably the most important
develop-ment during this period of 75 years was the establishment of a Department for the
Pre-vention of Disease-the first for this purpose in the United States. This was the concept
of Dr. Howard Childs Carpenter, who
de-voted most of his life and efforts to the de-velopment of this Department. We still have a Child Health Conference of the
Depart-ment of Public Health within our hospital
as a result of his efforts.
8) After 50 years on 22nd Street, the
Hospital was moved to its present quarters in 1916.
9) In 1918 the School of Nursing was
de-veloped as a training center for student
nurses from other hospitals. In 1921 Miss
Susan C. Francis became Superintendent
of the hospital and Director of Nursing.
She also later became President of the American Nurses Association. It was in her
administrative regime that the hospital
achieved its most active advancement.
10) In 1919 undergraduate teaching of students of the School of Medicine was started; and an affiliation was arranged for
teaching of graduate students of the
Uni-versity of Pennsylvania, although not until
10 years later was such an affiliation
an-ranged for the School of Medicine (Under-graduate).
11) In 1925 the Philadelphia Child
Guid-ance Clinic was established on the Hospital property and a close affiliation has existed
since that time between the two
institu-tions.
12) In 1925 the appointment system for
the Out-Patient Department with a far larger number of patients was started. In the same year a splendid nurses’ house, a gift by legacy of a member of the Board of Managers, Wilson Catherwood, was built,
including rooms for 117 nurses.
During the latter part of this 75-year period Dr.
J.
Crozier Griffith, Dr. AlfredHand, Dr. Howard Childs Carpenter and Dr. Horace Jenks on the medical side, and Dr. Edward Hodge, Dr. Walter Lee, Dr.
J
ohn Jopson, and Dr. Henry P. Brown on the Surgical side had been developing the Hospital as an institution which served the families of the area surrounding the Hos-pital with great skill and devotion. Dr. Graeme Mitchell was an outstandingyounger pediatrician of that era who had
developed great skill, despite relatively little opportunity. He was soon called away
to Cincinnati where he helped to establish one of the strongest pediatric centers in this
country.
Dr.
J.
Claxton Gittings, Professor ofPedi-atrics, had realized the possible value of
an affiliation with the School of Medicine, University of Pennsylvania over a number of years and despite considerable
opposi-tion this affiliation was finally consum-mated. From this time, in 1930, the hos-pital expanded rapidly from a local
institu-tion to one of national and international importance. This was increased by a similar close affiliation of the surgical service with
the School of Medicine. Neurosurgery for children also developed rapidly under this
new stimulus.
During the past year children have been
admitted to the Hospital from 20 different
687
Staff have received awards from national
scientific societies. The quality and volume
of research has been attested to not only
by such awards but by the assistance
through grants of funds to the clinical and
laboratory workers at least equal to any
other pediatric center. Products of the
Serum Exchange have been used nationally and internationally. All incubators have been greatly improved as a result of work conducted here. Also methods of control of
influenza, mumps, measles, hepatitis, and
poliomyelitis all owe great impetus and aid from work initiated in the laboratories of the Children’s Hospital.
The Hospital houses one of the few com-plete Virus Diagnostic Laboratories in this
country, and studies on antibody formation,
rheumatic fever, detection and control of
Rh sensitization, nephrosis, host-cell and
parasite chemical interactions, skin viruses,
the common behavior deviations of infants
and children, airborne infections,
hydro-cephalus, anesthesiology, congenital
glau-coma, surgery of the new-born, fetal
posi-tion and anomalies, cerebral blood flow in
the brain-injured infant, protein metabolism,
leukemia and congenital blood diseases, milk curd and digestion of milk,
gastrointes-tinal motility; antibiotics, bone growth
par-ticulanly as related to orthodontia and
finally, in this year, various endocrine
prob-lems in our newly acquired Division of
En-docninology-all of these studies have placed the Hospital in these past 25 years at the
center of a worldwide audience of interested physicians and scientists, and one might
add of a lay audience as well.
All of these developments have occurred
without in any way lessening but actually
by increasing the value of services to the
local population.
Only by means of many full-time and
part-time clinical investigators and teachers
who limit their affiliation to the Children’s Hospital has it been possible to develop an
institution of present stature. Were it not
for the close teaching affiliations such de-velopments could not have occurred.
The hospital increasingly has been called upon for help by other institutions inter-ested in the health of children in the
Phila-delphia area and together with some of these a Children’s Medical Center has been
formed having a consultative, rather than administrative, relationship. These institu-tions are the Philadelphia Child Guidance
Clinic, the Oakboume Colony Hospital, the Society to Protect Children from Cruelty, and the Camden Municipal Hospital. There has also been a close relationship with the Chestnut Hill Cerebral Palsy
Center, the Children’s Seashore House, the Woods Schools, the Pennsylvania Hospital, and the Hospital of the University of
Penn-sylvania. With all of these the benefit has been mutual and stimulating.
This all too brief review of a few items of interest occurring here during the 100 years preceding this “turn of the century for children,” could not close without a word of deep appreciation for the valiant work
of the lay groups who, without obvious
re-turn, have aided in giving breadth and
depth to our institution.
To the Board of Managers, the Women’s Committee and the Auxiliary Committee, is
