The answer depends on how you define “hospital.” Bellevue Hospital in New York City traces its roots to 1736, when a six-bed infirmary opened on the second floor of the city’s almshouse. That makes it the oldest institution in America with a continuous line to a modern hospital. But Pennsylvania Hospital in Philadelphia, founded in 1751 by Benjamin Franklin and Dr. Thomas Bond, was the first institution in the colonies specifically chartered and built to function as a hospital.
Bellevue: The Oldest Roots
On March 31, 1736, New York City opened a small infirmary inside its Public Workhouse and House of Correction, the almshouse where the city housed its poor. The infirmary had just six beds and existed primarily as a ward for sick indigent residents, not as a standalone medical facility. It wouldn’t be called “Bellevue” until decades later, when the operation moved to a farm estate by that name on the East River. Today, NYC Health + Hospitals/Bellevue identifies itself as the oldest hospital in America, and it has operated continuously in some form since that 1736 opening.
Six weeks after Bellevue’s infirmary opened, New Orleans gained its own hospital. Charity Hospital was established on May 10, 1736, funded by the estate of a boat builder named Jean Louis. His will directed that his remaining property be sold to finance “a hospital for the sick of the City of New Orleans” in perpetuity. Charity Hospital served the indigent population of Louisiana through epidemics, wars, hurricanes, and pirate raids for nearly three centuries, making it the second oldest continuously operating public hospital in the country.
Pennsylvania Hospital: The First True Hospital
What set Pennsylvania Hospital apart from the almshouse infirmaries was intent. Dr. Thomas Bond, a Philadelphia physician, recognized that the city’s existing options for the sick, its almshouse and a quarantine station called the lazaretto, were hopelessly inadequate. He recruited Benjamin Franklin to help petition the Pennsylvania Assembly for funding to build a dedicated hospital, one designed from the ground up to treat patients.
On January 23, 1751, Franklin presented the petition. He proposed a matching-funds scheme: if citizens could raise £2,000 in private subscriptions, the Assembly would match it with public money. Opponents in the Assembly considered this “a most extravagant supposition, and utterly impossible,” but Franklin proved them wrong. The citizens subscribed, and on May 11, 1751, the Pennsylvania legislature granted a charter to establish a hospital “to care for the sick-poor and insane who wander the streets of Philadelphia.” Franklin and Bond chose the parable of the Good Samaritan as the hospital’s official seal, with the motto “Take Care of Him and I will repay Thee.”
A temporary facility opened in 1752 with Elizabeth Gardner, a Quaker widow, as its first matron. The first patients were admitted on February 11, 1753. Construction on a permanent building at 8th and Pine Streets began shortly after, with patients moving into the new facility in 1756.
Why the Distinction Matters
Bellevue started as a few beds inside a poorhouse. Pennsylvania Hospital was conceived, funded, chartered, and constructed specifically to be a hospital. That distinction is why most historians credit Pennsylvania Hospital as the first hospital in the United States, even though Bellevue’s infirmary predates it by 15 years. Pennsylvania Hospital was the first institution in the colonies with a dedicated medical mission, a formal charter, and a building designed for patient care.
The difference matters because it shaped what came next. Pennsylvania Hospital became the training ground for American medicine. In 1765, the University of Pennsylvania established the first medical school in the thirteen colonies, and its founders specifically chose to pair classroom lectures with bedside teaching at Pennsylvania Hospital. In 1766, Dr. Thomas Bond began giving clinical lectures at the hospital, the first formal medical instruction at a hospital bedside in North America. The model of linking hospitals to medical education, something now standard across the country, started there.
Early Psychiatric Care
Pennsylvania Hospital’s charter mentioned caring for “the insane,” and the institution’s early treatment of mentally ill patients reflects a difficult chapter in American medicine. Psychiatric patients were housed in the basement of the temporary hospital, in cold, dark cells with weak window bars. Patients who weren’t passive were chained to the walls using iron manacles and forced into “madd-shirts” that restrained their arms. Keepers carried whips and were permitted to use them.
Treatment was brutal by any standard. Patients had their scalps shaved and blistered, were bled until they lost consciousness, doused alternately with warm and cold water, and purged repeatedly. The cells had no effective heating, and escapes through the weak window bars were not uncommon.
Conditions improved significantly under Dr. Thomas Story Kirkbride, who championed what was called “moral treatment,” a philosophy centered on mild kindness and sympathy rather than restraint. Kirkbride believed patients needed a natural environment away from the pollution and chaos of urban Philadelphia. He developed a building plan for psychiatric hospitals, known as the “Kirkbride Plan,” that became the blueprint for asylum construction across the country. Under his leadership, the staff who supervised patients were no longer called “keepers” but “companions.” He even used a device called a “magic lantern,” an early slide projector, for patient entertainment and education. Pennsylvania Hospital also became one of the first institutions anywhere to use photography in psychiatric care.
The Original Building Today
The Pine Building at 8th and Pine Streets in Philadelphia, the original permanent home of Pennsylvania Hospital, still stands. It now houses a museum focused on the history of Penn Medicine, launched in connection with the hospital’s 275th anniversary. The building serves a dual role: a historic landmark and a functioning part of a modern medical campus. Pennsylvania Hospital itself continues to operate as part of the University of Pennsylvania Health System, making it not just the first purpose-built hospital in American history but one that has never stopped serving patients.