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Developing the Pennsylvania Hospital Residency Program

In the early years, there were no medical residents at Pennsylvania Hospital. Physicians and surgeons would sometimes be assisted by their own private medical students and apothecaries or apprentices were sometimes indentured to the hospital, but there was no formal training program established for physicians.

In 1773, it was decided to receive medical apprentices into the hospital, and a "European scholar-turned-Philadelphia-tavern owner" (Jacob Ehrenzeller, Sr.) apprenticed his son to Pennsylvania Hospital on June 1, 1773. Jacob Jr. was 16 years of age, and his indentureship had the following stipulations: he was forbidden to fornicate, play at cards, buy or sell goods or run away. This particular agreement was similar to the ones made with former apothecaries or apprentices, but with an important difference. The hospital's Board of Manager's minutes from June 26, 1773 records this historic precedent:

Jacob Ehrenzeller, Jr., Indenture to serve five years and three months being executed on the 1st of the last month in the presence of his father and Samuel Coates was now produced and read and deposited with other papers by the clerk, the Terms agreed on with his Father, besides what is generally expressed in the Indenture are as follows: viz. That he shall have leave at his own or his Father's expense to attend the lectures of the Medical Professors out of the Hospital during the two last years of his apprenticeship; to attend the Surgical Operations and Lectures in the Hospital free of any expense; and that the Apothecary for the time being shall duly instruct him in Physic and Surgery.

Ehrenzeller's internship at the hospital created a first for the colonies, combining clinical training at Pennsylvania Hospital with a medical school education at the College of Philadelphia (later known as the University of Pennsylvania). Unfortunately, the Revolutionary War brought difficulties for the hospital and the College of Philadelphia, and the latter had to temporarily close during the conflict. Jacob Ehrenzeller was eventually awarded a certificate of medical competency from Pennsylvania Hospital, but was unable to obtain a formal degree in medicine from the College. He served five years, but no successor to his position was appointed until William Gardner was indentured to the Hospital in 1786.

After that point, there was a regular succession of apprentices until 1824; many took medical classes at the University of Pennsylvania while serving the hospital, and some received their degree of medicine before the completion of their indenture. In 1824 the Board of Managers decided do away with the "apprentice arrangement," and to limit residencies to those who had already received their M.D. degrees. This practice has continued with the hospital to this day, as well as the tradition of inscribing the names of our resident physicians -- now both male and female -- on brass plaques that are displayed on the first floor of the hospital.

Ehrenzeller's certificate enabled him to become an assistant surgeon for the American Army during the Revolutionary War. At the end of the war, he left the army and practiced medicine in Goshen and West Chester, small towns outside of Philadelphia. Ehrenzeller was not only the nation's first intern, but one of the few 19th century "village physicians" able to support his family through the practice of medicine exclusively -- without having to resort to a second occupation.

Information regarding Dr. Jacob Ehrenzeller, Jr. was gleaned from the essay, "Jacob Ehrenzeller, 1757-1838," by Dorothy I. Lansing, M.D., Section on Medical History, College of Physicians of Philadelphia (1976).

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