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SURGICAL AMPHITHEATRE

Pennsylvania Hospital is home to the oldest existing surgical amphitheatre in the United States. It was constructed in 1804 and is located in the center portion of the Pine Building. The initial portion of the hospital, the East Wing, had been completed earlier in 1755 but had no provision for surgical operations; all available space was designated for housing patients and staff of the hospital. Forty-nine years after the initial construction project, when all other parts of the hospital were finished, a large circular amphitheatre opened on the third floor.

The amphitheatre is approximately 30 feet high and 28 feet in diameter. The upper gallery has rows of wooden benches that hold approximately 130 students and observers, but it was often over-crowded when an unusual operation or particularly popular lecturer was scheduled. Since the skylight was initially the only source of lighting, operations were scheduled for mid-day and preferably during clear weather. Procedures were performed in an unsterile environment, since the sterile technique was not mandatory in American hospitals until the turn of the century (1900). In addition, until about 1840, operations were performed without the benefit of anesthesia; patients were given a choice of opium, liquor or a knock on the head with a mallet to render them unconscious.

The surgical amphitheatre helped to inaugurate American clinical teaching by bringing the patient into the lecture room with the students. Dr. Benjamin Coates initiated the practice of demonstrating with patients in 1834. This approach followed the earlier example of Dr. Thomas Bond's bedside clinical teaching, which had been carried on in the wards since the earliest days of the Hospital. Several other distinguished physicians made use of the amphitheatre over the years, such as Dr. Phillip Syng Physick, Dr. George W. Norris, Dr. Joseph Pancoast, Dr. D. Hayes Agnew and Dr. Thomas G. Morton.

In the early 19th century, Philadelphia became known as the "Athens of America." The city had begun to attract students seeking medical education and clinical instruction not available anywhere else in the United States. The opening of the amphitheatre marked the establishment of surgery as a recognized discipline. Prior to its inception, what little surgery had been taught was done so as a practical aspect of anatomy classes. The amphitheatre filled a long-held desire of the University of Pennsylvania's faculty for a place in which a large class of students could receive formal lectures as well as witness surgical operations.

The surgical amphitheatre has been continually used for a variety of purposes since it ceased to function as a clinical amphitheatre in 1868. Immediately after a larger amphitheatre opened in another wing, the room served as a dining room for nurses and patients. It later served as a lounge for the house staff. In 1976, funds were raised to renovate the space, and the amphitheatre was returned to its original state; visitors are now welcome to visit this "time capsule of surgery."

Information for portions of this essay was gleaned from the article, "A Note on the 'Circular Room' of the Pennsylvania Hospital" by Alfred R. Henderson, Journal of the History of Medicine and Allied Sciences, 1964, Volume XIX, Number 2.

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