The Philadelphia Almshouse (later renamed the Blockley Almshouse), founded in 1729 was the first public hospital in America.The Hospital cared for the sick and mentally ill while feeding the impoverished. In 1767, the facility moved to a larger building and was called the Philadelphia Bettering House.
Eventually renamed Philadelphia General Hospital (PGH) in 1919, the original Blockley Almshouse buildings were replaced with a modern hospital. The original patient wards were 40 beds long, divided into four separate sections on two floors. There was a pharmacy on the first floor, an asylum in the basement, and operating rooms on the third floor.
Due to conditions in Philadelphia during the eighteenth and nineteenth centuries, the Hospital handled seasonal epidemics of malaria, yellow fever, typhoid and poliomyelitis. As a port city, PGH also treated sailors with scurvy, venereal disease, and sometimes leprosy. Tuberculosis, rheumatic fever and diphtheria were more common in the nineteenth century.
Notwithstanding the changes in the environment and demographics, and the medical issues that followed, PGH treated Philadelphia’s poor consistently from the early days of the United States well into the middle of the twentieth century. PGH really had no choice since Benjamin Franklin himself inscribed the rules of the hospital, limiting medical treatment to the “sick poor, and only if there is room, for those who can pay.”
With the beginning of Medicare in 1965, large, open wards were replaced with semi private rooms. The word “poverty” changed, as did the hospital demographics. Before 1965, PGH had a 90% occupancy rate, which later dropped as low as 15%.
In its final years PGH was the victim of numerous, complicated issues, like severe problems in the emergency department, scandals with the local nursing homes, growth in the local homeless population, and the increasing costs of running a public hospital.
With few options, the once vast and indestructible PGH disappeared in 1977, almost like it had never existed.