On September 22, 1859, 30-year-old Margaret Merchant of Philadelphia was admitted to the obstetrical ward at the Blockley Almshouse. She was pregnant with her sixth child — a boy, though with the ultrasound almost exactly a century in the future, Mrs. Merchant could not have known that at the time. A mother of five, Mrs. Merchant surely did know that her due date was over a month away, but she was admitted nonetheless. The women’s receiving register notes the fact, along with the admission of eight other women, including a syphilitic black Irish prostitute, several alcoholics, a 49-year-old diagnosed with dementia, and one woman whose birthplace was listed as “almshouse,” suffering from the ambiguous yet ubiquitous 19th-century complaint of “hysteria.”
Historians have agreed that Blockley was typical of early American public hospitals — in that it was barely a hospital at all.1 The old English institution of the poorhouse had been transplanted onto American soil along with public hanging, smallpox, and the humble turnip, and in 1732 Philadelphia opened its almshouse in the city center, taking in the poor, the insane, and anyone incapable of caring for themselves. As the city grew — and it did, from about 12,000 at the time of almshouse’s creation to over 80,000 a decade later — so did the group of unfortunate citizens swept under the amorphous designation of “the poor.”
In 1834, the Guardians of the Poor whisked the almshouse away from the city center to a tract of farmland in Blockley Township to the west of the city, giving it the name that would stick for decades: Old Blockley. Administered in four buildings around a quadrangle, the Blockley Almshouse was really neither hospital nor almshouse. A more apt definition, as historian Charles Rosenberg has argued, would be a “dumping ground” for prostitutes and criminals, lechers and lunatics; an understaffed, overcrowded combination of workhouse, hospice, lying-in ward, orphanage, drunk tank, and asylum. It was, in short, in the words of Dr. Isaac Ray, “one seething mass of infirmity, disease, vice and insanity.”2
Married, sane, and “temperate,” Mrs. Merchant had little to do with the visions of madness, debauchery, and horror usually associated with “Old Blockley,” but she went anyway, evidently leaving her husband and children at home. For over a month, Mrs. Merchant stayed in the almshouse awaiting the birth of her sixth child. Perhaps she worried about the family she had left alone; perhaps she was grateful for the respite from responsibility, though no doubt the almshouse found plenty of light labor to occupy her time. Around one in the morning on November 2nd, she felt the first telltale pain. Five and a half hours later, as the sun rose over Blockley, she gave birth to Samuel Merchant, 21 inches and 11.5 pounds. In the margin of the hospital’s weighty birth register, 22-year-old Dr. John W. Lodge wrote, “Longest & heaviest child for many years.”
Margaret Merchant is only one of the thousands of women and children whose names and lives are captured forever in the birth register of the Blockley Almshouse Hospital of Philadelphia.3 Heavy, unwieldy, and disintegrating into ochre dust at the edges, the 1855-1864 volume in which her name appears now sits, along with six similar registers, in the City Archives of Philadelphia, across the street from the Market-Frankford Line’s 30th Street stop. Fill out the archive’s entry form to ask for a volume, and it will arrive wrapped in yellow paper that catches the dust sifting away from the spine.
When you open the antique pages, you’ll discover that the birth register is essentially a collection of statistics. Some of the figures are historical (date of birth); some are demographic (age, marital status, number of births, number of abortions); others are clearly of medical significance (weight and length of newborn, duration of labor, length of gestation). Together, they make up a picture of the Blockley obstetrical ward on the eve of the Civil War. Claudia Goldin and Robert Margo graphed this picture in 1989, observing that the almshouse mothers were 37.2 percent married, 69.8 percent foreign-born, and generally in their twenties (64.7 percent). For 59.1 percent, the birth recorded in the register was their first, and for another 20.2 percent, it was their second; under 20 percent of almshouse mothers had already given birth twice.
Goldin and Margo’s table of “Characteristics of Almshouse Mothers” translates the rich columns of variables that make up the birth register into a visual representation of the population antebellum Philadelphians associated with Blockley. Blockley was a place where a poor, unsupported woman without a better hope for salvation might disappear to give birth to her baby in anonymous safety.
But Goldin and Margo’s table leaves out two columns. The first column on the verso lists the full name of every mother who gave birth at the almshouse; on the recto, the final column holds the signature of the physician who attended the delivery, along with notes like John Lodge’s observation on baby Samuel’s impressive size. Most of this commentary was strictly obstetrical. In December of 1858, D.D. Richardson noted for George P. Norris, M.D., that Mary Alden (single, 21, her first pregnancy) had “had profuse hemorrhage — which continued for an hour and a half at intervals.” On April 6, 1859, Thomas L. Taylor recorded that after a three-hour labor, the daughter of Mary A. Williams (single, 22, Irish, her first pregnancy) had been born dead. He added that “[t]he appearance of the child indicates that it has been dead for some days. The woman says nine.”
Not all of the physicians’ annotations were so dispassionate. At times, humor, surprise, and awe bleed through in language and punctuation, so much so that you can imagine the writer’s raised eyebrows as his pen worked. Just two weeks after Margaret Merchant gave birth, an Irish girl named Ann Murray gave birth to a 7-pound boy in a carriage that was carrying her to the Hospital. When she arrived, both newborn and placenta were lying in the bottom of the carriage. Two days later, recording the case in the register, Peter F. Whitehead observed that “both mother and child [are] doing well being of that species that arsenic won’t kill.” When Mrs. Anna McLaughlin delivered a 9-pound boy in just twenty minutes the previous summer, Dr. Whitehead wrote in the margin, “The quickest case on record — all right.” In late August, a 15-year-old girl named Sarah gave birth at Blockley after a 10-hour labor that ended around midnight. In the margin, the attending doctor wrote, “The Father of this child is also Father of its Mother!!!”–and underlined every word.
Dr. Whitehead and Mrs. Merchant are statistics, fitting neatly into the picture of Blockey sketched out by historians. Whitehead, like much of Blockley’s medical staff, was a recent medical graduate getting in his clinical experience at a hospital that would take anyone before moving on to more gratifying endeavours. Mrs. Merchant was white, likely poor, and probably had no mother or sisters to assist her in the impending birth of her son. Like the other women who turned up at Blockley’s doors, she would have been alone and desperate.
Yet even as Dr. Whitehead and Mrs. Merchant confirm Rosenberg, Goldin, and Margo’s image of Blockey, the book that gives us their names poses a curious contrast. In what was supposed to be a madhouse run by corrupt bureaucrats and undertrained doctors, the birth register seems to reflect physicians’ earnest engagement with patients, their concern for the women in their care, and their dedication to adding to medical knowledge. Their annotations were thoughtful, often extensive, and frequently enthusiastic. Their patients were never nameless — indeed, the birth register probably preserves more information about these many of these women than any other document in their lives.
The value of statistical analysis, and the excitement of encountering data that allows for such analysis, can sometimes obscure the significant nature of the very documents that bring us that data. The Blockley birth register doesn’t contradict the reality that the almshouse hospital served a population of poor, unhealthy women, often young, often unmarried, and always desperate. What it does is to suggest that desperate did not always mean doomed; that untrained did not always mean inept; that overcrowded did not always mean dehumanizing. Above all, it is a humanizing document, a crystallized image of a thousand souls passing together in a thousand ways through the mystery of Blockley.
- Harry Dowling’s City Hospitals: The Undercare of the Underprivileged (1982) is an excellent overview of the patterns of development of the United States’s public hospitals, including Blockley. Return to text.
- Charles E. Rosenberg, “From Almshouse to Hospital: The Shaping of the Philadelphia General Hospital,” The Milbank Memorial Fund Quarterly. Health and Society 60 (1982): 125; 134. Return to text.
- Register of Births, 1855-1864, Guardians of the Poor, Alms House Hospital, Philadelphia City Archives. Return to text.