Transforming “Old Blockley”: The Philadelphia General Hospital

Part of

The Philadelphia General Hospital: From Almshouse to Public Hospital and Beyond

In 1902, the Blockley Almshouse was officially renamed the Philadelphia General Hospital. Before the First World War, its almshouse services for the indigent poor and its “lunatic asylum” were transferred to public institutions in the City’s northeast section.^[1] “PGH began to focus exclusively on providing health care,” writes the historian Lisa Levinstein. “In addition to City employees and other special cases, PGH only admitted medically indigent patients, treating one-third of all patients in the City who could not afford to pay for their care.”^[2]

The years of greatest significance in PGH’s history were the three postwar decades, when the Great Migration of African Americans from South peaked (ca. 1950) and then concluded (ca. 1970).  Improvements in PGH’s services, which began in the 1940s, increased significantly in the 1950s and 1960s with the reform-minded Democratic mayoralties of Joseph Clark Jr. (1952–56) and Richardson Dilworth (1956–62), who assigned a high priority to PGH. “Under their administrations,” notes Levenstein, “the hospital hired more staff, provided day care for employees’ children, and opened a new neurological building, tuberculosis ward, food service building, laboratory department, X-ray department, and operating suite. Outpatient visits soared after the construction of a new building with a much larger capacity and a range of new clinics.” Dilworth-era PGH attracted “world class doctors” who in turn attracted talented medical and nursing students. This array of healthcare professionals provided, as a general-rule, high-quality, respectful treatment to poor African American women, who were the hospital’s largest group of patients. For every four whites who chose PGH as their hospital, thirty-five African Americans made it their choice.  More than 71 percent of the latter were women. As Levenstein notes, “gender-specific health concerns such as childbirth, injuries from illegal abortions, gynecological problems, domestic abuse, and rape” brought these women to PGH; they accounted for 94 percent of PGH’s births.^[3]

While their services undoubtedly improved healthcare provision to poor African Americans, the problems the PGH doctors, nurses, and medical interns treated were symptomatic of malign environmental conditions they could not treat—conditions that in one form or another could be traced to racial discrimination and  These well-documented conditions included residential segregation enforced by anti-black housing policies such as redlining and exclusionary zoning ordinances; unemployment and denial of access to job networks that were controlled by white labor unions; segregated education that resulted from school district policies that located new schools in residentially segregated neighborhoods, gerrymandered school catchment areas to maximize the separation of black and white students, and deprived majority-minority schools of educational resources; federal, state, and municipal policies that favored significant investment in Center City and disinvestment in “the neighborhoods”—priorities that included urban renewal incentives and generous tax concessions to “higher eds and meds,” especially the City’s largest private employer, the University of Pennsylvania.^[4] The cruel irony was that policy makers and thought-leaders, much like the race-writers of a bygone century, attributed the conditions they observed in these poor neighborhoods to a culture they described as “a tangle of pathology.”^[5]

Improved healthcare, says Levenson, did not always mean equitable treatment, despite the mandate in the 1951 City charter that “required the public hospital to enforce a clear, non-discrimination policy”: “While white staff members described PGH as a nonracist institution, many black patients . . . did not believe that the public hospital was free from racism.” While Levenstein musters some examples of disrespect and neglectful treatment on the part of the hospital’s physicians, her evidence suggests strongly that PGH was a far greater benefit than a liability for these women. For example, unmarried pregnant women seeking PGH obstetrical care were not “subjected . . . to intrusive and judgmental questioning and reprimands,” which was not the case at many of the City’s other hospitals.  As another example, African American women who chose PGH entered a venue that facilitated social bonding within and across generations: “As African Americans, women repeatedly sought care at PGH and recommended the hospital to their family and friends, they created a strong sense of community at the hospital . . . a culture at the hospital that made it feel more like a vital part of the black community than like some of the alien or indifferent white-dominated institutions in the City.”^[6]

The hard living experienced by impoverished African American women necessitated major adjustments on the hospital’s part. Premature births—linked to poor nutrition, pre-natal cigarette and alcohol use, problems with sanitation, and high levels of stress—was “the most widespread” problem in the late 1950s. Responding to the crisis, PGH opened a high-tech premature nursery, which it expanded within a few years, and a new pediatrics clinic.  Another serious, more horrific problem was “the thousands of women arriving at PGH . . . with severe complications from illegal abortions. They ranged from young teenagers to women in their forties, and many had risked their lives when they or other women had tried to induce abortions by beating their bellies with boards or inserting sharp objects such as knitting needles, bicycle spokes, umbrella spokes, and coat hangers through their cervixes and into their uteruses.” While there is no denying that “some individual PGH doctors and nurses may not have upheld the policies mandating respectful treatment” in illegal abortion cases, Levenstein concludes that “PGH’s institutional commitment provided women with a unique opportunity to receive humane care.”^[7] In many respects, PGH was a progressive “black hospital”—the preferred hospital for the City’s African American residents.