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From the Newsletter of the Philadelphia City Archives (# 38, October 1979)


by Ward J. Childs

In an era when the "New History" has all but overshadowed plain, old fashioned History and when the computer has supplanted the index card as the major tool of historical research, the concepts of profession and occupation, and the emoluments that are derived from them, have become benchmarks, used by historians, to measure mobility and social stratification or to interpret politics in terms of economic class. In Philadelphia these studies have tended to be focused on the period between the late 18th Century and 1854, the only period, outside of the 20th Century for which a reasonably large, continuous body of tax records is extant; and, particularly, the earlier half of this period when the lists show the strongest degree of continuity for any political subdivision. This availability of a convenient, compact body of financial information about Philadelphia's population at large for a period long enough to permit the interpretation of historical trend unfortunately has deflected researchers from other equally valuable sources in the City Archives, especially for the later periods of the City's history. These sources not only provide income data which can be used in conjunction with data from other sources to provide a picture of the City's wage and salary structure; many of them also provide information concerning the milieu in which the wages or salaries are earned.

A pertinent example is the medical profession. Philadelphia's City government has a long tradition of public hospitals which began in the 18th Century with the Alms House (later, Philadelphia General Hospital) and the Lazaretto or Marine Hospital (later, the Philadelphia Hospital for Contagious Diseases.) and which only ended recently. The records of these institutions not only include a very substantial body of information about the population served by the staffs of the hospitals but, also, about the-staffs themselves. From records of the Alms House, such as "Bills and Payrolls Passed by The Board", 1836-1887;" "Committee On Accounts, Bills and Payrolls Approved", 1843-1900; "Accounts Ledger", 1788-1887, "Treasurer, General Ledger," 1789-1900; and "Item Book", 1858-1906, it is possible to reconstruct the structure of salaries and wages of the Alms House Hospital for most of the 19th Century, not only for the medical staff, but also for a large supportive staff including carpenters, plumbers, painters, mechanics and a variety of other jobs. The broad significance of this type of income data is not only that it can be used to determine occupational wage levels for professional and blue-collar workers at one public institution but that such data, used in conjunction with similar data from other public and private institutions, such as prisons and hospitals, or with data from private sources such as business archives, could be used to determine the geographical wage and salary levels of almost the whole spectrum of the labor force for an extended period.

The other advantage of records from such a large, long-lived institution as the Alms House is that the researcher may perceive some of the setting in which income is earned. The most obvious element of this background is the population served by the Alms House physician. Did Philadelphia General Hospital continue to serve just the poor for which the Alms House originally was established, or, with its network of district physicians, did it develop into another major medical institution that served the public at large? And, if so, why did the transition take place, And how, if at all, did it affect the quality or size of the institution's medical staff? Answers to questions like these are important not only because they contribute to an understanding of the development of local medical care from the 18th to the 20th centuries; they also would help to explain the former appeal of the large municipal hospital as a training ground for interns and resident physicians. We know that, before the advent of Medicare, part of this appeal was the wide range of disease and injuries available for study, but we do not know whether other factors, such as a prestigious medical staff played a part.

The records providing data about patients are so abundant and detailed that even a brief description would be beyond the scope of this article. However, we do wish to mention some pertinent records series which reflect medical practice at the Alms House Hospital. Case records for the following departments: Medical, 1815-1893, Surgical, 1816-1885; Maternity, 1885-1898; Nervous, 1883-1896; Mental; 1908-1938; Obstetrical, 1865-1885; Venereal, 1864-1885; and Paralysis of Adults, 1883-1939, provide information about the backgrounds of patients, diagnosis or symptoms of their illness, a daily history of the medical treatment of each patient and an indication of the results. In cases where treatment was unsuccessful and a patient died, reasons for the failure may be inferred from autopsy findings in the Case Book or in the "Post Mortem Examination" volumes, 1867-1920. Treatment often implies the prescription of medicines. Pharmalogical practice and the use of alcohol for medicinal purposes in the 19th Century are reflected in the "Drug and Laboratory Supplies Purchases Journal ",1860- 1914, "Drug Item Issues Ledger", 1885-1892; "Drug Inventory", 1873- 1899- "Drug Item Purchase Ledger", 1858-1914; Apothecary's "Ledger" and "Journal", 1805-1806 and 1804-1809; and "Liquor Book", 1808- 1916. The "Journal, Drugs Furnished Insane Department", 1874-1887, provides insight into a special application of pharmacology, while the "Philadelphia Hospital Formulary", 1899, provides formulas for pharmacological preparations and rules regarding their use. Elections and appointments of medical staff may be found in the Minutes of the Guardians of the Poor and Bureau of Charities, 1788-1899; the "Staff Register", 1890, 1891- 1893; and "Appointments and Resignations of Visiting and Resident Staff", 1914-1931; the names and dates of service of interns and their course of study, in the "Records of Interns Terms of Service", 19081925- and "Intern's Service Books", 1916-1927. The "Staff Register," these two intern series and the compilation, "Resident Physicians of Blockley and Philadelphia General Hospital", 1836-1920, also provide information concerning the medical education of physicians and interns. Information concerning the education or history of practice of the Philadelphia medical profession at large, and related professions, is included in diplomas of physicians, 1850-1870; and dentists, 1883-1903 within the record group of the Recorder of Deeds, and in medical, 1881-1939; dental, 1897-1946; osteopathic, 1909-1951; midwife, 1920-1934; and veterinary, 1889-1907, registers, which are among the records of the Prothonotary of the Court of Common Pleas. The "Board of Physicians Minutes", 1809-1845; "Rules Adopted By The Board" of Guardians, 1844, 1856, 1861, 1868, Chief Resident's "Letter Book", 1896-1898, and ''Memos", 1897-1904; and 'Rules For The Government Of Interns", 1901-1902 not only include regulations governing medical activity, but also give us a sense of a hospital as a functioning organism. "Hospital Reports. . . ", 1890-1916, present the Hospital as a research institution.

We would be the first to admit that the medical profession, in many ways, is an extraordinary example. We realize that a public hospital is a self-contained world which reflects a profession in the main stream of the work force and that it may be impossible to find an analogy in some other kinds of institution, such as a prison. At the same time we also are aware that the monetary rewards of hospital work represent but a portion of the total income of the staff physician with an

established private practice, that such figures often are more representative of the income of the physician on a beginning or apprentice level and that data from such an institution very often must be amplified by information from other sources in order to obtain a true picture of the range of income of the medical profession. We recognize these limitations. It would be, and is, impossible for every, or for that matter, any occupation or profession to be completely mirrored in public records. And, of course, the reflection varies with each profession

Take the law profession, for example. It is very easy to get a general idea of the operation of the law by examining the dockets and papers of the County Courts. Some records like the Minutes of the Court of Common Pleas 1789-1874, and of the District Court, 1811-1875, or "Notes of Testimony", 1875-1913, of the Court of Quarter Sessions even allow us to peek behind the curtain of formality of most court records and get an idea of the attorney as courtroom advocate. Other records of the Courts, like the "Law Students Register", 1823-1873 of the County District Court take us into a world of legal education in which a law student served his three year apprenticeship by reading law in the office of an attorney who served as his preceptor and could be used as a basis for the study of the continuity of the legal profession and its various philosophies in the 19th Century. By analyzing the dockets of the courts it even would be possible to determine the volume and type of cases handled by a given attorney. However, public records tell us almost nothing about the emoluments of the profession, with exception of salaries of the staffs of the City Solicitor's and District Attorney's offices, which hardly could be used as a standard by which to measure the income of the City's legal profession as a whole.

Of course, our two examples are atypical, vestiges of an earlier economic system. As the Industrial Revolution entrenched itself in the 19th Century American economy, population shifted to the cities and we became a nation chiefly of wage earners and salaried employees. The ever increasing complexity of the economic system was paralleled by the evolution of municipal governments from small groups of elected and appointed public officials, who contracted for public services, into complex departmental bureaucracies employing the permanent skills of thousands to serve the needs of their citizens. In Philadelphia this evolution is amply documented by appropriation bills and ordinances included in manuscript and published minutes, journals and, ordinances of Councils, and by the financial records of the City Treasurer and City Controller.

More important for our purpose is the fact that the expanded corps of City employees, though still largely clerical, included workers in jobs corresponding to many levels of the occupational hierarchy of the City as a whole. Consequently, in the first budget passed by Councils after the Bullitt Bill came into force we find not only clerks, bookkeepers, messengers, doorkeepers, engineers, policemen and firemen on the City's payroll, but also landscape gardeners, carpenters, plumbers, painters, electrical linemen, farmers, bakers, blacksmiths, boilermakers, wheelwrights, patternmakers, riggers, architects, quarry and masonry supervisors, a railroad superintendent, chemists, a moral instructor and an organist. And since social emphases are continually changing and society continually re-evaluates government's duty to its citizens, I would venture to guess that examination of appropriation ordinances for the first year after the 1919 Charter came into effect, and examination of the first operating budget after the Home Rule Charter was adopted would, in each instance, produce even more diversified examples. Even if we took our investigation a step in the other direction, to the post-Consolidation period, we also would probably discover City payrolls more occupationally diversified than we expected.

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