TEHRAN — Among the tens of thousands of mourners gathered in central Tehran for the funeral of Ayatollah Ali Khamenei are families of the schoolchildren from the southern city of Minab who, like the supreme leader, were bombed to death on the first day of the U.S.-Israeli war against Iran.
At least 175 civilians were killed at the girls’ elementary school, most of them students, in what appeared to be a strike by a U.S. Tomahawk missile. So far, the United States has not taken responsibility or released the results of any investigation. In Iran, the children’s deaths have become a potent symbol for U.S.-Israeli brutality and an unjust war.
Parents and other family members made the 800-mile trip to the Iranian capital by train, car, and bus, and on Sunday, they were brought to the Grand Mosalla religious center for the funeral prayers. The crowd swelled in size ahead of the prayers, with tens of thousands packing into the open-air complex.
Many mourners had hoped that Khamenei’s son and successor, Mojtaba Khamenei, would appear in public for the first time since his father’s assassination to lead the prayers, but he did not show, probably because of concerns for his safety.
Ayatollah Jafar Sobhani, a prominent theologian and member of the Council of Experts that chose Ali Khamenei’s successor, led the ceremony instead.
Also present Sunday was Ahmad Vahidi, the recently appointed commander of Iran’s powerful Islamic Revolutionary Guard Corps — a key member of the surviving regime, which has emerged emboldened and even more hard-line after months of attacks by two of the world’s most powerful militaries.
Vahidi, too, had been in hiding since the war. A shudder rippled through the crowd as people recognized him. After the prayer concluded, isolated chants broke out, invoking his name: “Vahidi! Vahidi! Revenge! Revenge!”
The Minab school attack occurred on Feb. 28, the same day that Ali Khamenei was killed at his leadership compound, along with other members of his family and other senior officials.
Hanzaleh Salehi, 43, whose son was killed in the school strike, said he remembers hearing confirmation of the supreme leader’s death while he was in the morgue identifying his child’s body. Experiencing the two losses back to back left him feeling frozen, he said.
“We want to send our voice to the world,” Salehi said, wearing a T-shirt that showed his son’s framed portrait. “I want the world to realize how the Iranian people are treated. This was not the first crime, and it may not be the last.”
An invitation from the Iranian government to attend the proceedings, albeit under restricted conditions, including accompaniment by a government-provided guide and interpreter, has allowed the Washington Post its first opportunity to report from Iran since the war began. The views of people interviewed at the funeral events are unlikely to represent all of Iranian society, given the risks posed to those who have opposed or been critical of the government.
While the U.S. has not accepted responsibility for the attack, video evidence and Post reporting found that the school was on a U.S. target list, suggesting it was carried out by U.S. forces. The Pentagon said it launched an investigation, but more than four months later, no findings have been published.
In Iran, the strike is a national tragedy. Memorials to the children have been installed in government offices and businesses and at Iranian embassies abroad. In Tehran, an installation of backpacks, flowers, and children’s shoes commemorates those killed in Minab at the capital’s international airport.
One of the Minab booths set up for Khamenei’s funeral displayed dozens of portraits of the children above a chalkboard, exercise books, and school desks.
Fatimeh Yavari, 39, from Semnan, east of Tehran, stopped to take pictures of the display with her two children. The Minab children “are like my own children. I cried for all of them like I was burying my own child,” Yavari said, growing emotional behind her sunglasses. “It was a great tragedy.”
Minab is a small town that’s home to large military installations in a province, Hormozgan, that is a critical export hub near the port city of Bandar Abbas.
Yasir Pour Jomeh, 39, a dock laborer, traveled 24 hours by bus and private car to Tehran so he could help oversee a Minab booth during the funeral. He said that after the Minab attack, there was a surge of support for the government in the area.
“People realized how supportive the supreme leader was of the people,” Jomeh said. “Even some who were against the establishment turned back.”
After the public viewing of Khamenei’s body ends on Saturday evening, his casket will be carried on an hourslong funeral procession through the Iranian capital.
That procession is expected to draw even larger crowds that those at Mosalla, and the daylong event could prove to be one of the most logistically difficult portions of the ceremony.
After the funeral procession, Khamenei’s body will be flown to the Iranian city of Qom, a center of Islamic learning, before it is brought to the Iraqi cities of Najaf and Karbala, both homes to holy Shiite shrines that are pilgrimage sites. Finally, Khamenei will be buried in his hometown, Mashhad, in eastern Iran.
SEATTLE — U.S. men’s soccer team star striker Folarin Balogun will be available to play in Monday’s World Cup round-of-16 game after all.
FIFA announced just before the team’s practice on Sunday that the one-game suspension that came with Balogun’s red card against Bosnia in the round of 32 has been suspended “for a probationary period of one year.” The governing body said it invoked Article 27 of its disciplinary code, which says, “The judicial body may decide to fully or partially suspend the implementation of a disciplinary measure.”
It’s a special treatment that world soccer’s governing body has only given twice in its history.
At the 1962 World Cup, Brazilian star Garrincha had a red card overturned after lobbying from his nation’s federation and host Chile’s president — and, allegedly, a potential bribe to a referee, allowing him to play in the final.
Last November, FIFA suspended two games of a three-game ban given to Portugal’s Cristiano Ronaldo after he elbowed a Republic of Ireland player in a World Cup qualifier. That allowed him to play in two group games this summer that he otherwise would have missed.
“In line with article 27 of the FIFA Disciplinary Code, the implementation of the match suspension is suspended,” the governing body’s statement said.
Balogun was ejected during the U.S. round-of-32 win for running the studs of his right cleat down Bosnia’s Tarik Muharemović’s right calf before catching the back of his foot.
Referee Raphael Claus didn’t call it at first, but the video review officials saw it and recommended that Claus take a second look. Once he did, the red card felt inevitable.
FIFA does not allow appeals of red cards, but the governing body can decide on its own to suspend a suspension.
Referee Raphael Claus (left) showing Folarin Balogun the red card in Wednesday’s game.
There’s some irony in the fact that when the ejection happened, FIFA was criticized for Claus’ use of a slow-motion replay that might have been against the rules of video reviews. But FIFA’s announcement made no mention of that.
“We accept the decision of the Disciplinary Committee and are pleased that Folarin Balogun is eligible to compete [Monday],” U.S. Soccer said in a statement. “Our full attention is focused on the round of 16 match against Belgium in Seattle, and we look forward to the continued support of our amazing fans.”
Confusion over the rules
Star playmaker Christian Pulisic opened a can of worms when he said, “Obviously we made that appeal, and felt like there was a good chance, because anyone can look at that and say it was super harsh.”
A U.S. Soccer spokesperson was asked if there was, in fact, an appeal or if Pulisic misspoke, given the federation’s previous statement that no appeal was possible. The response was that U.S. Soccer was “engaged in the process” with FIFA’s disciplinary committee, but no details were given.
Christian Pulisic (right) consoling Folarin Balogun after the ejection.
U.S. players found out about the decision on the bus ride over to Friday morning’s practice. Balogun was not among the players who spoke when they arrived. He said on Saturday that he disagreed with the decision, but had moved on in part to be a role model for fans watching.
“We weren’t quite sure if it was true or not,” centerback Chris Richards said of the moment he heard the news. “I think everyone knows with AI and with this and that, [there] can be a few question marks. But ultimately we found out through social media, so it was cool to finally get the confirmation that it was true.”
Asked what it means that Balogun got treatment only previously accorded to Ronaldo, he said: “I don’t know what goes on behind the scenes — I don’t know if they’re comparing Flo to Cristiano Ronaldo or what’s going on. I try to focus on what goes on on the field, but clearly they saw something in the decision that they thought deserved to be overturned.”
Fellow defender Alex Freeman said, “I had no clue” that it was in the works.
Folarin Balogun working in a drill with teammates on Friday.
“I think it’s a little strange for us,” he said. “I have no clue how it happened, but for us, we’re just happy that it happened, and happy that we’re able to go in and have a phenomenal player like Balogun to be able to go in and play.”
A statement from Belgium’s federation said it was “astonished by FIFA’s decision,” and that “in order to safeguard the legitimate rights of all participating teams and to protect the fundamental principles of fair play in our sport, both at this FIFA World Cup and at future editions of the tournament,” it was “investigating all potential options.”
But it did not say what those options could be.
Belgium manger Rudi Garcia said, “the Belgian federation isn’t just defending itself — it’s defending football in general.”
Belgium manager Rudi Garcia was even more blunt in his news conference Sunday afternoon.
“I didn’t know that at FIFA’s headquarters, July 5 is the same thing as April 1 in Europe,” referring to a calendar date that also applies in the United States. “I think you should refer to the statement by my federation … The Belgian federation isn’t just defending itself, it’s not just defending the national team. It’s defending football in general. It’s defending its integrity, defending its ethics.”
Another question on the subject drew a quick “Don’t waste your time asking about it” answer. And when Garcia was asked if he believed his star striker Romelu Lukaku would get the same treatment from FIFA, he answered: “Ah, I can’t answer that question.”
But those reactions were just the tip of the iceberg.
FIFA president Gianni Infantino (right) giving U.S. President Donald Trump the men’s World Cup trophy at the White House last year.
Trump lobbied his friend
A source with knowledge of the matter confirmed reports that President Donald Trump personally called FIFA president Gianni Infantino to lobby for Balogun’s suspension to be overturned.
A request for further comment from FIFA has not yet been returned.
Sources in Seattle said there was a point in the past few days when Trump or Vice President J.D. Vance might attend Monday’s game, with authorities in town preparing for them to visit. But it was confirmed on Friday that they are not.
U.S. manager Mauricio Pochettino said he wasn’t involved in any lobbying by U.S. Soccer, though he named CEO JT Batson as someone who was. Pochettino also said he didn’t know about Trump’s involvement until reporters told him at his news conference.
“No, we cannot mix that,” he said. “That is a decision from FIFA with the evidence that happened before, and that’s it.”
But he was, of course, very happy that the decision went his team’s way.
United States head coach Mauricio Pochettino said, “I think it’s fair, the decision, to not punish us more.”
“It’s not only because I am the coach of the U.S. men’s national team that I need to defend my side,” Pochettino said. “I think it’s 100% — or 99%, because there are always some people, 99.9% — we all agree that was an unfair red card.”
He also was not surprised that it became such a big deal.
“I come from cultures in Argentina [in] Europe where fútbol, soccer, is more than a religion. It does not surprise me that in this country, that feeling has started to grow.”
Pochettino spoke repeatedly of his respect for Garcia, whom he has known a long time. But beyond that, he said “I think it’s fair, the decision, to not punish us more. Because I think it was enough. And now focus on the game.”
Staff writer Dugan Arnett contributed to this article.
For all the power he has flexed over the past year and a half, President Donald Trump could not control the scorching, dangerous, record-shattering weather in the nation’s capital for the 250th anniversary of America’s independence, or the lightning strikes in the distance that prompted officials to evacuate the National Mall ahead of his planned speech.
But nearly every other aspect of the celebration in Washington bore Trump’s imprint, as decisions he made transformed an official commemoration of American history into another polarizing moment in American politics.
After a chaotic scene unfolded early Saturday evening, with Secret Service officials forcing defiant Trump supporters to flee the president’s Salute to America event as severe weather loomed, Trump told them all to come back. The show would go on.
His supporters, wearing gear bearing his name and slogans, trekked back to stand in security lines again in the rain.
“I said, ‘There’s no way — if we have to speak in front of one person at 4 o’clock in the morning, I’m going to be here,’” Trump declared when the rain had stopped and he began speaking after 11 p.m. to a crowd half the size of what it had been earlier. “There’s no way we can be deterred.”
“This is an evening for the ages. I believe this is something very special,” Trump said into the night, describing the attendees’ perseverance and late-hour return as “bigger than if we didn’t have the lightning blaring.”
“But this is bigger. A little more inconvenient, but it’s bigger. I think, in its own way, it’s more beautiful.”
It was but the latest twist in a national celebration that Trump defined in his terms — and for which the president has called the shots.
Ever the showman, Trump throughout his speech brought notable Americans out onto the stage with him — war veterans as old as 107 who saluted from wheelchairs, astronauts from the Artemis II and Apollo 17 missions, and families of soldiers killed in battle.
He praised the “unstoppable spirit that created the world’s most powerful industries and built the strongest military anyone had ever seen‘” but also reprised his political grievances.
Trump joked that he was serving his third term as president, a reference to his false claims that the 2020 election was stolen from him. He prompted cheers from his supporters as he touted his bill to assert federal control over election rules — legislation that Senate Republican leaders have repeatedly told him won’t pass as it is currently written. And he lobbed several verbal attacks at “communists,” his label for the democratic socialists who have won several recent Democratic primary elections.
Before Saturday night’s rally, Trump didn’t pretend that the celebrations would be anything other than his usual unapologetic rhetoric.
“Has anyone ever seen a Happy Dumocrat?” the president wrote of his opposing political party on social media on Saturday morning, his first Fourth of July greeting of the day. Weeks earlier, Trump had abruptly announced that he would also serve as the headlining act of a rally kicking off the two-week Great American State Fair on the National Mall, calling himself “the Number One Attraction anywhere in the World, the man who gets much larger audiences than Elvis in his prime.”
“Only Great Patriots invited” Trump wrote of the launch of a fair that was, in theory, open to all, later billing the kickoff to the 250th anniversary festivities as a “Trump rally.”
Milestone anniversaries like the semiquincentennial present rare moments of shared civic ritual, occasions when presidents are widely expected to place themselves within the sweep of the American story, rather than at the center of it. This year’s celebration, instead, reflected both Trump’s vision of America, and America’s divisions over Trump.
The decision to have Trump speak late Saturday also reshaped a long-standing July Fourth tradition. Security restrictions prevented attendees from bringing coolers or arriving throughout the evening, and the speech was already set to delay the fireworks until after 10:30 p.m.
The pyrotechnics finally began moments before midnight, with Trump remaining in a climate-controlled box at the National Mall to watch. The massive show set a record, organizers said.
As Americans sweltered through a dangerous heat wave, with Washington’s heat indexes reaching 115 degrees, Trump had warned that he planned to “make a really long speech … just to show that I can do anything.” Organizers instructed those attending not to arrive too early to limit their time outside.
In the end, the late-night speech was about 35 minutes long.
The National Mall fair itself, long touted as a showcase for American greatness and national unity, instead became a Rorschach test. Trump supporters praised the patriotic atmosphere and military flyovers.
His critics, meanwhile, pointed to images of sparse crowds, a mock-up of Trump’s proposed triumphal arch on the grounds, and administration officials touting their accomplishments as evidence that the president’s personal involvement had undercut what might otherwise have been a broader civic celebration.
With just months to spare before the occasion, Trump had pushed aside America 250, the long-standing bipartisan commission tasked a decade ago with planning anniversary festivities, replacing it with his own group of political allies, Freedom 250. His advisers argued the move was necessary because the commission had become bogged down by bureaucracy.
But as Trump’s chosen planning organization became increasingly seen as a partisan entity, vendors and performers alike ultimately pulled out of the fair, which has struggled to draw large crowds for much of its first week.
Besides supplanting the bipartisan commission, Trump has increasingly put his imprint on other aspects of this year’s commemoration. His face appears on a commemorative gold coin marking the anniversary and on limited-edition “patriot passports.” Administration officials have pushed for a $250 bill bearing his portrait, and Trump this week posted an image of a $100 bill featuring his autograph — marking the first time a sitting president’s signature has been featured on U.S. currency.
As he has throughout the anniversary celebration, Trump cast himself as central to the story he wants the country to tell about itself: that America was diminished before him, revived by him, and is now celebrating its founding through his restoration — a promised “Golden Age.” At Mount Rushmore on Friday night, he told the crowd that he “saved, almost single-handedly,” the Second Amendment and that he was going to “give our country its identity back.”
“We never had the American Dream, however, like we have it right now,” Trump said Saturday on the National Mall. “The American Dream is back. Very strong. Beautiful.”
Republican President Gerald Ford took a different approach during the nation’s bicentennial celebration in 1976, even as he was running for reelection in the aftermath of Watergate and the Vietnam War. In his remarks, Ford made no mention of the campaign, the Democratic front-runner Jimmy Carter, or his GOP primary challenger, Ronald Reagan.
Ford’s only reference to electoral politics came as a broader reflection on self-determination: “This November the American people will, under the Constitution, again give their consent to be governed,” he said, outside Independence Hall in Philadelphia. “This free and secret act should be a reaffirmation by every eligible American of the mutual pledges made 200 years ago by John Hancock and the others whose untrembling signatures we can still make out.”
But comparisons with past presidents are complicated by the fact that patriotism itself has become more polarized, said Tevi Troy, a presidential historian and senior fellow at the Reagan Institute.
“There’s a feeling out there that Republicans are more patriotic than Democrats, or that the patriotism gap can differ depending on which party is in the White House,” Troy said. “While Trump does things in terms of partisanship that you can safely say are unprecedented, he is also president in a more divided time.”
A recent Gallup poll found that national pride has fallen to its lowest point since the organization began asking in 2001 how proud respondents were to be an American. Just 33% reported being “extremely proud,” down eight percentage points from a year ago and 37 points since a high in 2003. The partisan gap there is wide, with Republicans reporting much higher American pride while Democrats and independents have hit record lows for their respective groups, Gallup found.
John Pitney, a former national Republican official who now teaches political science at Claremont McKenna College, said Trump is diverging from the tradition of presidents who have used moments of national triumph and tragedy to speak as Americans first, not as partisans.
“I remember Reagan at Normandy in 1984 — the 40th anniversary of D-Day, surrounded by people who were veterans of that war,” Pitney said. “There is a reason why that speech is still remembered. It wasn’t about him.”
This weekend, the Descendants of the Signers of the Declaration of Independence (DSDI) gathered in Philadelphia as they do every July Fourth. This year’s Semiquincentennial events kept them from meeting in the room in Independence Hall where their direct ancestors met as America was born. But their children still participated in the annual symbolic tapping of the Liberty Bell ceremony.
National Park Service ranger Maggie Burkett gives a tour of Independence Hall in June. Fifty-six delegates to the Second Continental Congress signed the Declaration of Independence.
Everyone knows about Thomas Jefferson, John Hancock, and the Adams cousins. But few know much about the other 52 delegates to the Second Continental Congress. These men all had interesting lives, and we hardly know them — especially our signers from Delaware, New Jersey, and Pennsylvania (well, except for Ben).
GEORGE ROSS, PENNSYLVANIA
Stacie Pagano and her children, direct descendants of Declaration of Independence signer George Ross of Pennsylvania, at Carpenters Hall.Helena, 3, and Theodora, 11, look for their father Richard’s name of the Carpenters Company list of members.
George Ross studied law with his half brother John and was admitted to the Pennsylvania Bar when he was 20, establishing his own practice in Lancaster.
Like several founders, he started out as a Tory, representing the British Crown as a prosecutor before gradually concluding that colonial rights could not be protected within the existing system. The brother later married Elizabeth Griscom, known to us as seamstress Betsy Ross.
Stacie Pagano grew up in Lancaster County, where her grandmother told her she was descended from Ross. She rode on a float dressed as Betsy Ross in a 1988 parade celebrating the 200th anniversary of the town of Columbia, but never gave it much thought.
It was while she was in her 20s and met her husband Richard, who is a member of the Carpenters Company — where the First Continental Congress met — that they started to explore her ancestry.
As a DSDI member, she coordinates the annual ceremonial tapping of the Liberty Bell by junior descendants. Her 11-year-old daughter Theodora was one of the kids who tapped the bell 13 times on July Fourth for the 13 original colonies.
The gravesite of signer John Hart. His remains were moved there in 1864 and a granite draped obelisk erected as a memorial monument.
JOHN HART, NEW JERSEY
Greg Munro, a direct descendant of signer John Hart, at the cemetery of Old School Baptist Church in Hopewell, N.J. He was there to read the Declaration of Independence at the town’s USA 250th Town-Wide Block Party. Hopewell Museum executive director Asher Lurie portrays a Continental soldier during the Town-Wide Block Party.
John Hart was a farmer, unlike most signers, who were lawyers, merchants, or wealthy intellectuals, but he earned a reputation for integrity rather than brilliance or eloquence. Fellow signer Benjamin Rush described him as having no formal education but possessing exceptional judgment and virtue.
Descendant Greg Munro’s sister in-law was into genealogy, and she was tracking her husband’s family. When he was in his 30s, she said, ”You know what, Greg, you’re related to John Hart.” Munro said, “Who was John Hart?“
Decades later when he retired, it gave him something to do. Munro’s first step was joining the Descendants of the Signers of the Declaration of Independence, something he thought would be easy. His brother’s wife had already documented his family tree, and the organization told him he had to document every step back to maybe three, four generations. From there, the DSDI had records that go back to Hart, who had 13 children.
But Munro’s birth certificate did not have his father’s name on it. Once he got all the right papers together, he was admitted and is now spreading the word.
He recently wrote and helped produce a documentary on his ancestor’s life, and worked to reprint a Hart biography originally published for the Bicentennial.
After Hart signed the Declaration, he became a wanted rebel leader. When British troops occupied parts of New Jersey in late 1776, he fled his home while it was looted, spending months separated from his family and sleeping wherever he could.
In June 1778, Hart invited George Washington and roughly 12,000 Continental soldiers to camp on his New Jersey farm — right at the height of growing season. When the troops left, they fought and won the Battle of Monmouth.
FRANCIS HOPKINSON, NEW JERSEY
Sally Hopkinson, a direct descendant of signer Francis Hopkinson of New Jersey, sorts through her father’s old filing cabinet. She is still unpacking from her recent move.The home in the painting at right is the 1750 Georgian style mansion of Francis Hopkinson, a National Historic Landmark in Bordentown, N.J.
Sally Hopkinson is a descendant of Francis Hopkinson, something she learned when she was in the fifth grade. “My name appeared in a history book, and I was like, why is my name here?”
Her father was actually the DSDI’s treasurer for years, until he died. “I had no idea back then. I didn’t know anything about this.”
Later on, though, she really got into genealogy and started questioning her grandmother. “And then I found all this stuff when finally it came on line after 2000.” But the most information came from her dad’s papers. “I found he had this treasure trove in his filing cabinet. Wow. Everything I was trying to figure out.”
Francis Hopkinson’s father died when he was 14, but his mother, determined to ensure that her son had a good education. enrolled him in the brand new College of Philadelphia (later the University of Pennsylvania) when he was 16, making him a member of UPenn’s first class of students.
Many historians now believe Hopkinson — not Betsy Ross — was the principal designer of the original Stars and Stripes. He submitted a bill to Congress seeking payment — “a Quarter Cask of the public Wine” — rather than cash as compensation. He never received it.
He also was an accomplished organist and a harpsichordist, and, as early as 1759, he had composed the song “My Days Have Been So Wondrous Free,” considered the earliest surviving American secular composition.
On Sunday, July 5, Hopkinson and descendants of New Jersey’s four other signers are scheduled to throw out the ceremonial first pitches and participate in an on-field reading of the Declaration at TD Bank Ballpark in Bridgewater. The New York Yankees’ Double-A affiliate there — the Somerset Patriots — is temporarily rebranding as the Somerset Semiquincentennials to commemorate America’s 250th anniversary. The players will wear red-and-blue pinstriped jerseys with the original signers’ signatures written in gold on the sleeves.
GEORGE READ, DELAWARE
Richard Rodney Cooch, a direct descendant of signer George Read of Delaware, in New Castle. He, like Read, lives and works right in town.
Richard Rodney Cooch, a retired Delaware Superior Court judge and direct descendant of signer George Read, lives across the street from Immanuel Episcopal Church on the Green in New Castle, his ancestor’s final resting place.
His mother’s family has lived in New Castle since the church’s first rector, Rev. George Ross, came from Scotland in 1703. His son, George Ross, later moved to Philadelphia and signed the Declaration as a delegate from Pennsylvania. Read and Ross were brothers-in-law. Cooch is also related to Delaware’s two another signers; through marriage to Thomas McKean, and through a cousin, to Caesar Rodney.
He is the eighth and final generation of his family to have lived at the family’s namesake property south of Newark. It was the site of the state’s only Revolutionary War battlefield — Cooch’s Bridge — a week before the Battle of Brandywine in September, 1777.
George Read initially thought independence was a mistake and hoped reconciliation with Britain was still possible. He voted against independence but after the measure passed, he signed, supporting the new nation. He was also one of only six men who signed both the Declaration and the U.S. Constitution. At the Constitutional Convention, Read wanted a stronger national government and even suggested eliminating state boundaries altogether.
Coins placed on the gravesite of signer George Read at the Immanuel Episcopal Church on the Green Cemetery in New Castle, Del.Read was also president of Delaware and served the state as a U.S. Senator and chief justice.Cooch is also related to both of Delaware’s two other signers and to Pennsylvania’s George Ross.
JOHN MORTON, PENNSYLVANIA
The memorial for signer John Morton of Pennsylvania at the Old Swedish Burial Ground (also known as the Old St. Paul’s Episcopal Churchyard) in Chester, Delaware County.Rick Morton and his sons, all direct descendants of signer John Morton of Pennsylvania, at his gravesite.Rick and Nealla Morton with their sons Josh (left), 21; and Sketch, 24, at Chester’s Old Swedish Burial Ground.
John Morton is also an important figure in Finnish American history, as his family roots go back to the Finns who lived in New Sweden, the colony of the Swedish Empire settled in the mid-1600s along the lower Delaware River.
Generations of Mortons have lived in Delaware and Chester Counties since, including descendant Rick Morton, who says of his lineage: “It was so well known in the family that it’s almost like I came out of the womb with the knowledge.”
He remembers as a kid placing wreaths with his sister at the Old Swedish Burial Ground in Chester and getting their picture in the Delaware County Daily Times.
Both of his sons have participated in the annual DSDI ceremonial tapping of the Liberty Bell by young descendants on Independence Day. His oldest son, Sketch, was named after John Morton’s son Sketchley.
The Pennsylvania delegation in the Second Continental Congress was deeply divided and Morton was the “swing vote” for independence.
It is said his deciding vote is why the Commonwealth is nicknamed the “Keystone State” as without Pennsylvania, the Declaration might not have been adopted.
Morton died before the Revolutionary War ended — the first signer to die — even before the new nation was fully established. As a result, he left fewer writings and had less opportunity to shape the country’s early growth.
GEORGE CLYMER, PENNSYLVANIA
“The Signer” statue in a garden across the street from Independence Hall is modeled on George Clymer of Pennsylvania, one of six delegates who signed both the Declaration and the U.S. Constitution.Life-size bronze stature of signer George Clymer of Pennsylvania in Signers’ Hall at the National Constitution Center. Plaque for George Clymer of Pennsylvania, one of 56 memorials for the signers of the Declaration of Independence in the sidewalk along the 600 block of Chestnut Street. Most of the plaques have been stolen over the years.
George Clymer, orphaned before his first birthday, was raised by a wealthy uncle. Although that uncle helped found Philadelphia College, which later became the University of Pennsylvania, Clymer received little formal schooling and was largely self-educated. Through reading and his uncle’s training for a career in business and commerce, he became a successful merchant and statesman.
In 1773, George Clymer led efforts that pressured British-appointed tea agents in Philadelphia to resign. As a result, Philadelphia avoided the kind of confrontation that later erupted at the Boston Tea Party.
Before independence became mainstream, Clymer was already arguing that the colonies should separate completely from Britain. His views put him in frequent conflict with the more cautious Quaker-led powers of Pennsylvania who initially hoped for reconciliation.
Brett Clayton Johnson grew up not knowing he was a descendant. When he found out from his grandparents, he wondered why there was nothing about Clymer in any of his history books in school.
Johnson visited Philadelphia once with those grandparents, but he was too young to really appreciate what those men did. “It was brave,” he says. “Every freedom we have is because of those guys in the room,” adding “I now know and it is the proudest thing of my life.”
BEN FRANKLIN, PENNSYLVANIA
Sarah Miller, a direct descendant of signer Benjamin Franklin of Pennsylvania, visits Signers’ Hall at the National Constitution Center. Six men, including Franklin, signed both the Declaration of Independence and the U.S. Constitution. “Bolt of Lightning,” a 1984 memorial to Franklin, is a 102-foot-tall stainless steel lightning bolt, kite, and key by sculptor Isamu Noguchi at the base of the Ben Franklin Bridge.Neon art in the Benjamin Franklin Museum gift shop in Independence National Historical Park. A faded Franklin portrait on an interpretive panel in Independence National Historical Park.The Franklin statue on the campus of the University of Pennsylvania in front of College Hall. It was commissioned in 1896 by Justus Clayton Strawbridge, of Strawbridge’s department stores, and created by sculptor John J. Boyle as a gift to the City of Philadelphia. A 1779 bust of Franklin by Jean-Antoine Houdon at the Philadelphia Museum of Art. It was made while he was minister from the American colonies to France.A display of an original 1833 printing of the Declaration of Independence.Miller and her husband, Michael DiMarzio, in Signers’ Hall. Six men, including Franklin, signed both the Declaration and the Constitution.
Benjamin Franklin is one of the most recognizable figures in American history, and much is known about him because he left behind such a detailed record of his life.
Even before he arrived in Philadelphia as a teenager, Franklin was already a “best-selling” humor writer, known for the witty and satirical letters he secretly submitted to his older brother’s Boston newspaper, the New-England Courant under the pseudonym Silence Dogood, pretending to be a middle-aged widow.
Growing up in South Philadelphia, Sarah Miller heard the stories passed down for generations. “All the parents would tell the kids we were related to Benjamin Franklin,” she says, “but then no one really looked into it. It was kind of like, Is that true? Is it just a story?”
It was her mother, who was not a direct descendant but was really into ancestry, who started looking into it. “She used to drag me to the National Archives [then in the Robert N.C. Nix Federal Building — the old U.S. Post Office at Ninth and Market Streets] when I was in high school to search through their microfiche,” she recalls.
During a recent visit to Constitution Center’s Signers’ Hall — Franklin was one of six who signed both documents — and seeing his life-size statue, Miller said it seems like it was a long time ago, “but it really wasn’t. We all still live in the same area.” It really puts the Declaration of Independence in perspective she says. “It’s really only a few generations back. America is still very young.”
CAESAR RODNEY, DELAWARE
The base of a monument in Wilmington’s downtown Rodney Square features a low-relief sculpture showing him casting his vote for independence.The base of a monument for signer Caesar Rodney, an enslaver, remains in Wilmington after the statue it held was removed in June 2020, amid nationwide Black Lives Matter protests.
When the U.S. Mint produced the statehood quarters from 1999 through 2008, it issued the coins in the order that the states ratified the U.S. Constitution or joined the Union. Delaware was honored on the first coin, and it shows a man on a galloping horse. People assumed it was Paul Revere, as he is the most famous Revolutionary War horseman.
That man was Caesar Rodney.
At home in Delaware recuperating from painful facial cancer, Rodney left on a stormy night, riding the 80 miles from Dover to Philadelphia on horseback to cast Delaware’s tiebreaking vote for independence on July 2, 1776.
Rodney served Delaware as a judge, sheriff, military officer, legislator, and governor but was also a plantation owner who relied on enslaved labor. In 2020, amid nationwide Black Lives Matter protests, his equestrian statue was removed from the park that is named for him in downtown Wilmington. It remained in storage until President Donald Trump had it installed in May 2026 in Freedom Plaza in Washington.
GEORGE TAYLOR,PENNSYLVANIA
Independence Hall (Pennsylvania State House).
George Taylor arrived in America as an indentured servant to an ironmaster near Philadelphia. Working off the debt involved manual labor in iron production, making him one of the most working-class signers.
He worked his way up into management and when the forge’s owner died he married the widow and took over running the ironworks.
His furnaces produced castings, and stoves, including Franklin stoves. In August 1775, Taylor secured a contract from Pennsylvania for cannonballs and later made grape shot, bar shot and cannons for the Continental Army.
When several Pennsylvania delegates chose not to vote in favor of the Independence on July 4, the Assembly chose five replacements: George Taylor, George Ross, George Clymer, Benjamin Rush, and James Smith, all of whom signed the Declaration of Independence when the engrossed copy of the document was ready on August 2, 1776.
GEORGE WILSON, PENNSYLVANIA
Life-size bronze statue of George Wilson of Pennsylvania in Signers’ Hall at the National Constitution Center. He was one of six men who signed both the Declaration and U.S. Constitution.
As a young man in Scotland James Wilson was studying for a life in the church. But as it was the time of the Scottish Enlightenment, he entertained much broader interests, including classical governments and philosophy, and in 1765 sailed to America for more opportunities.
He arrived in New York during the Stamp Tax dispute, and ended up in Philadelphia where he found employment teaching Latin at the College of Philadelphia, the school that later became the University of Pennsylvania. He also prepared to be a lawyer and passed the Bar a few years later.
His writings – while still in his 20s – on the legal relationship between the British Parliament, the Colonies, and the King foreshadowed the content of the Declaration of Independence two years later. Constitutional scholars often rank him among the most influential thinkers at the Constitutional Convention.
ABRAHAM CLARK, NEW JERSEY
Plaque for Abraham Clark of New Jersey, one of 56 for the signers of the Declaration of Independence in the sidewalk along the 600 block of Chestnut Street near Independence Hall. Most of the plaques have been stolen over the years. His has survived by being under a planter.
Abraham Clark was born into a farming family, but his father considered him not made for manual labor, so he had his son trained in surveying, Not content, Clark taught himself law and set up a practice, earning a reputation as “the poor man’s councilor” because of his willingness to defend those who could not afford a lawyer’s fee. His contemporaries said he was “limited in his circumstances, moderate in his desires, and unambitious of wealth.” He refused to wear a wig or ruffles on his shirts.
He consistently argued that the new nation should protect ordinary farmers and working people.
THOMAS MCKEAN, DELAWARE
A replica desk in the Assembly Room in Independence Hall (Pennsylvania State House) where the Second Continental Congress met and the Declaration of Independence was adopted.
McKean voted to approve the Declaration of Independence in July 1776, but he left Philadelphia before the document was signed, to rejoin the fight against the British.
Historians believe he was the last person to sign the Declaration, either in early 1777 or as late as 1781.
One of his daughters married a prominent Spanish diplomat and her descendant — a great-grandson — was born in Europe, growing up to serve as the prime minister of Spain in 1847.
BENJAMIN RUSH, PENNSYVANIA
Portrait of signer Benjamin Rush of Pennsylvania in the Second Bank of the United States in Independence National Historical Park.
Benjamin Rush opened a medical practice in Philadelphia in 1769 and was appointed professor of chemistry at the College of Philadelphia (now the University of Pennsylvania). He wrote the first American textbook on chemistry. He supported the patriot cause and recommended the title “Common Sense” to his friend Thomas Paine.
On January, 1776, Rush married the daughter of his good friend Richard Stockton of Princeton. The minister that married them was John Witherspoon whom he had helped bring to America ten years earlier. Six months later they would all sign the Declaration of Independence.
JOHN WITHERSPOON, NEW JERSEY
Assembly Room in Independence Hall (Pennsylvania State House) Monday, June 15, 2026. This is the exact space where the Second Continental Congress met and the Declaration of Independence was adopted.
Before becoming an American patriot, John Witherspoon was a well-known Presbyterian minister in Scotland. He didn’t move to America until he was 45 years old, when he accepted the presidency of the College of New Jersey (now Princeton University).
The college sent Benjamin Rush and Richard Stockton (also later signers of the Declaration of Independence) to Scotland to recruit Witherspoon for the position.
One of his students was James Madison, often called the “Father of the Constitution.” Historians generally agree that Witherspoon’s teachings on moral philosophy, liberty, and government had a major influence on Madison’s political thinking.
ROBERT MORRIS, PENNSYLVANIA
Copies of the Declaration of Independence for sale ($8.99) in the gift ship at the National Constitution Center.
Historians often call Robert Morris the “Financier of the Revolution” because he used his business connections and personal credit to obtain supplies and loans for the war effort.
During the war he purchased the house at 6th and Market Streets in Philadelphia and later volunteered it to serve as the presidential residence while Philadelphia was temporarily the nation’s capital. George Washington lived there on the site now known as the Presidents’ House, a memorial to the nine enslaved Africans who also lived there.
After the Revolution, Morris speculated heavily in land in New York and the nation’s new capital, Washington, D.C. During the financial panic of the 1790s, he couldn’t pay his debts and was taken to Prune Street debtors’ prison where he remained for over three years. His friend Senator John Marshall helped pass a bankruptcy law and Morris was released, but he was never able to restart his career.
JAMES SMITH, PENNSYLVANIA
Clock tower at Independence Hall (Pennsylvania State House)
Smith was elected to the Continental Congress on July 20, 1776 – more than two weeks after the Declaration was adopted. Like many other delegates who were serving in their state governments or in the military he later signed the engrossed copy in August.
A fire destroyed his office and his personal and professional records simply disappeared. That is one reason he is much less well known than figures such as Thomas Jefferson or Benjamin Franklin.
RICHARD STOCKTON, NEW JERSEY
An original 1833 printing of the Declaration of Independence, by Peter Force currently on display at the National Constitution Center. It was created from the plate engraved ten years earlier by W. J. Stone that was commissioned by Congress for the 50th anniversary of the Declaration of Independence, as by the 1820s the original engrossed version of the document was becoming fragile and faded.
On July 1, 1776, Richard Stockton and fellow New Jersey delegate John Witherspoon traveled to Philadelphia from Princeton during a storm. They were late and caught only the end of a speech John Adams was giving. They asked Adams to repeat what they had missed. He at first refused, but then rose to the occasion and gave a stirring speech in favor of independence. Stockton later declared Adams “the Atlas of the hour, the man to whom the country is most indebted for the great measure of independency.”
After signing the Declaration, Stockton was captured on a trip for Congress to Fort Ticonderoga. He was dragged from his bed, put in irons, and sent to New York’s notorious Provost Jail, where reports describe starvation, freezing conditions, and severe mistreatment. He was released after five weeks, his health ruined. When he returned to his home he found it plundered of its books and furniture by the British army and his horses, cattle, hogs, sheep, and grain had all been taken.
His wife, Annis Boudinot Stockton, was apublished poet and one of the more influential female voices in revolutionary New Jersey. She corresponded with leading figures of the time including George Washington.
When Jared Adkins gets interested in something, he goes all in. That’s how he ended up learning about distilling, opening Bluebird Distilling in Phoenixville roughly a decade ago. Then, he became infatuated with pizza dough.
It’s led to an expansion of the business: Bluebird Distilling & Dough House, which will open its doors officially on Tuesday.
The $2.2 million renovation adds a whole new component to the cocktail bar, which will now offer a “neo-Neapolitan” — a modern, Americanized take on the classic — pizzeria and restaurant. Changes also haveexpanded the bar itself, added to the dining room, and enhanced the retail and bottle shop.
Adding food was something Adkins, Bluebird’s owner and master distiller, didn’t initially anticipate when they opened the distillery in 2015. But in 2022, he started to get the itch. He considered a full-scale restaurant, and began the early planning for one. But then there was just something about pizza dough that caught his attention.
He signed himself up for pizza school, and spent three days in Washington, D.C., learning from chefs about the art of pizza making.
“There was like a light bulb that went off,” he said. “We’re already doing so much fermenting that just seemed the natural next step to get into dough making.”
Bluebird Distilling founder and master distiller Jared Adkins. The expansion has been a year in the making, a longer consideration for Adkins.
As he threw himself into dough-making a few years ago, he connected with pizzaiolo Gregorio Fierro to learn the basics. That helped get his vision off the ground, as he began designing what the kitchen would look like.
DevonMigeot is joining as executive chef to bring the menu to fruition every night. Migeot spent roughly a decade working as sous chef at Philadelphia’s Zahav and Laser Wolf, plus Tresini in Ambler, and as chef du cuisine at Rosalie in Wayne.
Together, they’ll offer pizza made with 100% Petra stone-ground Italian flour, milled from 100% Italian wheat, with no preservatives or additives. The business will have house-baked breads, plus shareable small plates. Offerings will include ricotta gnudi with sweet corn, brown butter, and scallions; meatballs with beef, pork, gravy, and Parmesan; beets and burrata; chicory salad; a snacking plate of meats and cheeses; and more.
The decision to expand into food comes at a particularly salient time, Adkins said. The industry as a whole has been seeing a decrease in people drinking.
“It’s kind of perfect timing that it’s going to fill a niche where maybe people aren’t coming in solely just for drinks anymore as much, but now [we’re] giving another artisan aspect of having pizza, or something that we’re really putting a lot of time in, to craft the best,” he said.
A look at the expanded cocktail bar, part of the distillery’s larger renovation.
The distillery will still, of course, honor its roots with its spirits and cocktails. It’ll feature old favorites, such as Bluebird (a vodka, blueberry, lime, and mint mix) and the Phoenixville Old Fashioned.
But new additions will join too. Customers can try the Huntsman, which will feature French cigar bourbon, morel-infused vermouth, tobacco bitters, and stave smoke; or the Rum Ham, a pancetta fat-washed Bluebird dark rum along with burnt pineapple syrup, and tiki bitters; or Off the Vine, a “garden-inspired” martini composed of Juniperus Gin, basil, lemon, agave nectar, Aleppo pepper, and “clarified” tomato.
The renovation also came with some aesthetic changes. In 2015, they led with a steampunk vibe, Adkins said. They refreshed the interior, using a Japanese-style charred wood that resembles the inside of a barrel.
A transformed Bluebird Distilling will open July 7 after a $2.2 million renovation has expanded founder Jared Adkins’ vision. The space adds a new neo-Neapolitan pizzeria and restaurant, plus a reimagined cocktail bar, dining room, and retail and bottle shop.
The outside patio is now enclosed, featuring a “huge” rectangular bar, which can seat up to 30 people. Adkins described the bar area as light and airy, where it feels communal and social. It feels more “upper casual” than “too-serious speakeasy.” Surrounded by windows, it feels like you’re sitting on the street, in the middle of the action, he said.
When customers are ready for dinner, they can head back to the lounge, which curates a masculine, Western style.
And the kitchen, where customers get to enjoy watching the whole process unfold, embraces that steampunk essence with barrels hanging from the ceiling.
“I feel like as you walk through the area, you’re getting two or three different experiences all at once,” he said.
The bar was open through renovations, but operating with 50% of the facility for the last seven or so months, and maintaining about 80% of their normal crowds. It took some ingenuity, he said.
As they look at the new chapter, it feels like starting all over again, he said.
“I think it fills a gap on one side for us there, of now we have something else that we can present to our customers for an overall experience,” he said. “That’s what we’re going for the most. We’re giving our cocktail experience, our spirits experience, and now a dough side of it.”
This suburban content is produced with support from the Leslie Miller and Richard Worley Foundation and The Lenfest Institute for Journalism. Editorial content is created independently of the project donors. Gifts to support The Inquirer’s high-impact journalism can be made at inquirer.com/donate. A list of Lenfest Institute donors can be found at lenfestinstitute.org/supporters.
Michael Ibrahim, general manager of the Bakery House in Bryn Mawr, said custom orders for dot cakes, the latest viral TikTok food trend, started trickling in at the end of May. By June 1, the Bakery House posted the new menu addition on Instagram and Facebook.
Within 15 minutes, they were sold out.
“We ordered more material, made more the next week, and then we made sure to never run out of it again,” Ibrahim said.
The dessert — a layered cake in a cup coated in nonpareil sprinkles — was created in 2017 by mother-daughter duo Alex and Sondra Posner of the Dot Cakes in Roslyn, N.Y. It reached national audiences this past May when influencers began reviewing the bakery’s dot cakes sold in New York City’s Butterfield Market. In June, the New York Times Style section reported people standing in line at 6 a.m. for a taste of the sweet treat.
Elizabeth Aversa, owner of the Margate location of Aversa’s Italian Bakery, said her shop is now regarded as “cool” after introducing dot cakes.
“I’m getting these new, trendy people that we were never getting before,” Aversa said. “Before, we were just like a mom-and-pop, old-school store … but now they come to us.”
With viral trends appearing and fading almost as fast as they arrive — remember crookies and butter boards? — deciding which fad to hop on can be a challenge for small businesses.
Ray Sheehan, founder of Old City Media, said businesses have to identify when viral trends will stick around long enough to be worth the investment. That most often occurs when they cut across several consumer demographics.
“When things take off like this, it’s almost like pop music,” Sheehan said. “It just speaks to so many different people.”
Lily Diebold assembles dot cakes at the Bakery House.
‘Everybody started calling’
When the Bakery House got its first order for dot cake, Ibrahim thought it was an easy request. The bakery already had everything needed to prepare the dessert: cake ingredients, frosting, and nonpareil sprinkles
“Then, the customers told each other, and then everybody started calling,” Ibrahim said. “All of a sudden, we had about 60 custom orders for dot cake.”
Ibrahim said that the team usually avoids bending to the whims of social media trends — notably, they skippedthe “crookie” despite offering both croissants and cookies on their menu.
“We didn’t do it in the store because we didn’t feel that anybody was asking for it,” Ibrahim said.
Dot cake, however, was so popular among customers that the Bakery House decided to put it on the menu permanently.
According to Sheehan, adapting to a viral trend is one of the best ways for businesses to show consumers that they are relevant.
“If I’m a customer, it feels like this bakery is in tune and that they’re talking to me,” Sheehan said. “I’m resonating with their brand because they understand me, and that this thing is so popular.”
Dot cakes have been around for years, but only recently became popular nationwide due to TikTok.
Ibrahim said the bakery now has two employees dedicated to making dot cakes all day, and the fervent demand has caused a dip in sales for traditional cupcakes.
Though, he says, it’s a net gain. Ibrahim estimated that for every loss of 100 cupcakes, 200 dot cakes are sold. On top of that, dot cakes are priced about $5 more than the bakery’s most basic cupcake, generating greater revenue.
A middle schooler’s suggestion
At Aversa’s bakery, the decision to start making dot cakes was a family affair.
Aversa’s 14-year-old son, Ralph, saw the viral dessert on TikTok and he asked his mother to make dot cakes for a school party.
It was a popular choice: ”He was a rock star at the party,” Aversa said.
Ralph wanted to bring dot cakes to the bakery. His mother let him go for it, thinking it would be a fun summer activity.
Then they flew off the shelves.
“We put 20 out; they sold out. Then 40, then 50,” Aversa said. “Now we’re selling almost 100 a day.”
Aversa said that dot cake sales are not replacing regular items but rather bringing in new customers. The younger demographic, drawn in by the dot cakes, may bring their parents, who then come across Aversa’s chicken salad or Caesar salad wraps.
“Some people maybe never would have come to Aversa’s if it wasn’t for the dot cakes,” she said.
Dot cakes get a layer of icing and then a crunchy topping of nonpareil sprinkles.
Influencer tips
At Sweet Box Bakery on South 13th Street, owner Gretchen Fantini said a well-known social media personality who frequents the shop tipped her off to dot cakes.
Destiny Deniz, a Philly-based creator with nearly 177,000 followers on TikTok, told Fantini that the dessert was blowing up in New York, and Sweet Box should hop on the trend. At first Fantini was reluctant, but then she started seeing it all over her feed.
“We have everything here,” Fantini said she thought at the time. “We should just do this.”
Since the business — and local influencers — started advertising Sweet Box’s dot cakes, Fantini said their Instagram has grown by almost 1,000 followers.
Sweet Box’s feed features collaborative posts with local food Instagrammers showcasing the viral dot cakes, including @josheatsphilly (197,000 followers), @phlfoodstagram (42,900 followers), and @phillyfoodies (135,000 followers).
Fantini said the bakery’s influencer relationships are built organically. Creators may pop into the shop, and she’ll give them a taste of her baked goods for free, but she has not done a paid partnership so far.
Customers line up at the Bakery House in Bryn Mawr, which recently starting selling more dot cakes than cupcakes each day.
“I’m Italian, so if you come into my bakery and I’m baking something, I’m going to give it to you to try,” Fantini said.
Dot cakes are hit at Sweet Box, but so far sales have not surpassed cupcakes, the bakery’s specialty. On a day where the bakery sells 500 cupcakes, Fantini said they typically sell about 250 dot cakes.
“I want to make my customers happy,” Fantini said. “If I can stay true to what I’m making, and if it’s something that they want, I’m going to make it.”
University of Pennsylvania doctor Anuja Dokras spent the last 14 years working to rename a common medical condition that can impact fertility in women, called polycystic ovary syndrome, or PCOS.
Rooted in outdated science, the name often confused her patients into incorrectly thinking they had cysts on their ovaries.
It also made people think the disorder — which affects one in eight women — was primarily gynecologic in nature, when it actually has whole-body effects.
“We knew this was a misnomer,” Dokras said.
An international group of experts, including Dokras, announced in May that PCOS would now be called polyendocrine metabolic ovarian syndrome (PMOS), in an article published in the medical journal The Lancet.
The new name is meant to capture the broader hormonal and metabolic effects of the condition.
Dokras estimates it will take another three years to formally classify PMOS as an endocrine condition, change insurance billing codes, and update published literature.
Scientists also need to get the word out to patients, doctors, and the public at large. The previous name had been around since 1935.
The Inquirer spoke with Dokras, director of the Penn PMOS Center, about the name change and the impact she hopes it makes.
Anuja Dokras directs the Penn PMOS Center and played a key role in the renaming process.
What is PMOS?
It’s the most common endocrine disorder in women.
The presentations are typically irregular menses (menstrual periods) and increased hair growth and acne. We also typically see lots of follicles within the ovaries. Those three become the criteria for making the diagnosis.
Research from my group and others has shown that these patients are at a high risk for cardiometabolic complications, including high cholesterol, high blood pressure, diabetes, or problems with their blood sugar and weight gain. They also have an increased risk of mental health conditions like depression, anxiety, and disordered eating.
When did you start to question the name PCOS?
When I began to work in this space, it was clear that women [with PCOS] did not have large cysts on their ovaries. What they had were small follicles, and each of the follicles contain eggs. It’s part of their fertility.
As we asked patients what symptoms they were most concerned about, they talked about ovarian cysts, which was because of said misnomer.
We spend a lot of time correcting that misinformation when patients come to see us. Then we have to reassure them and say, ‘you don’t have a big cyst in the ovary. It’s not going to rupture, it’s not going to twist.’
How did the idea for a name change came up?
The first time it was brought up was when we had a meeting at the National Institutes of Health in 2012. The reviewing panel came back and said, “We suggest you change the name, because the name doesn’t represent everything that you have shared with us about the advances in this condition.” That’s when the journey began.
What did the renaming process involve?
Surveys went out to patients and the providers that offer care. We made sure that there were responses from different world regions as well.
The patients didn’t want a word that would be stigmatizing. If you have a condition that’s going to affect your fertility, that is not viewed favorably by families, and patients were very concerned about the choice of words. They also wanted words where there’s clarity, so you can communicate easily.
Finally, there were workshops where the medical professional societies and patient groups across the globe sent one representative each.
How did the name polyendocrine metabolic ovarian syndrome (PMOS) come about?
This is an endocrine condition, which means that there are certain organs within the body that are making hormones and those hormones are not working well. They’re either over-secreted or under-secreted. The word ‘poly’ was attached, because it was not just one hormone. A lot of different endocrine glands or organs are involved.
Then metabolic was added because there are a number of cardiometabolic abnormalities: the high cholesterol, glucose problems or diabetes, high blood pressure, and obesity.
We left ovarian because we also had marketing input and there were some suggestions to not be completely different (from PCOS) because that’s going to be confusing.
And we needed the word syndrome because it still describes a constellation of features.
How has the response been to the name change?
It was more than what we had expected. I think we live in a very different world now, where communicating with the patients is on a different level. It’s not just through publications. The patient community and the advocates got the news very quickly because of social media. It was lit up.
In terms of getting the information out to the medical community, it’s always going to be a little slower. We’ll continue to do that at different meetings.
We’ve said it may be a three-year transition.
What work remains?
The first step was the communication and getting the message out. Then in parallel, there needs to be a smooth transition in terms of our research publications. We don’t want to lose out what was published under the name of PCOS because now it’s PMOS.
When patients go to see their doctors, there’ll have to be a transition in the electronic health records, in terms of the terminology and insurance companies trying to understand this new word PMOS. The codes for billing will need to change.
We’re also trying to do a research reclassification. PMOS was formally considered an ovarian condition, and we’re trying to switch it now to become an endocrine condition.
What do you hope this name change accomplishes?
I’m hoping that, from the patient perspective, they’re going to be less worried about cysts in the ovaries. I’m also hoping they will get earlier diagnoses because the name includes endocrine and metabolic. Now we’re hoping that all these different specialties will take some ownership of the syndrome, and that way the patient is not hopping between different caregivers.
For the researchers — I’m one of them — I do hope that there’ll be increased funding. We still have a lot of gaps in knowledge, and we need to do a lot more research.
We hope that there would be funding, not just from the institutions that support women’s health, but from those that support diabetes, endocrinology, heart disease, dermatology, and mental health.
We hope that a name that’s so comprehensive and broad gets more people invested in helping answer some of these very important questions.
The bruises didn’t make sense. Neither did her pain. A 16-year-old female came to the emergency department suddenly unable to walk. She had rolled her ankle about a month earlier, but now was experiencing significant pain, along with a rash and bruises all over her legs. She said the rash and occasional bruising had been present over the past two years, but she could not identify a specific pattern and thought the rash was just from shaving.
In the emergency department she was awake, alert, and oriented. She appeared to be a normal weight and was developmentally appropriate for her age. Extensive bruising was noted on the back of her legs and buttocks. She had stretch marks on her lower extremities, but none on the upper extremities. Her rash appeared to be centered around her hair follicles, a condition called perifollicular petechiae.
The physician ordered blood tests and an MRI and admitted her to the hospital for further evaluation since she couldn’t walk. Her MRI revealed generalized fasciitis — inflammation of the muscles which is often attributed to infection. But in her case, there were no secondary signs of infection, such as fever or elevated white blood cell count.
What caused this patient’s symptoms?
Many different diagnoses can cause symptoms of joint pain and rash. Infectious causes such as sepsis (blood stream infection), tick bite infections including Lyme disease and Rocky Mountain spotted fever, and viral infections such as hand, foot, and mouth disease can present with rash and joint pain. However, infections are usually associated with a fever, which this patient did not have.
Rheumatologic (autoimmune) conditions such as lupus, vasculitis, and dermatomyositis can also present with joint pain and rash. Rheumatologic conditions occur when the body creates antibodies that attack the patient’s own cells. These can be more insidious and tend to develop over time rather than all at once.
Other causes of rash and unexplained bruising include nutritional deficiencies such as iron, copper, zinc, vitamin D, and vitamin C. Patients should be evaluated with a detailed dietary history if there is any concern for nutritional deficiency.
Solution
Physicians from numerous subspecialties weighed in on this case, conducting many tests. Finally, the patient was asked to produce a detailed dietary history. She revealed a very limited intake consisting of only five foods, without any vegetables, vitamins, or minerals. The patient was diagnosed with avoidant restrictive food intake disorder, or ARFID, which had caused a vitamin C deficiency also known as scurvy. The patient underwent nutritional rehabilitation to correct her nutritional deficiencies, and anti-inflammatory medication was used to help with her pain. Her pain gradually improved, and within a few weeks she was back to walking like normal.
ARFID
According to the American Academy of Pediatrics, ARFID is a relatively newly recognized eating disorder in which patients severely limit their food intake. This restrictive diet is not due to lack of access to food, and it is not due to negative body image or desire to change one’s body like some eating disorders. Patients with ARFID often avoid foods due to their color, smell, texture, temperature, or taste. Patients often have “safe foods,” or only a few foods that they will regularly eat. This can lead to nutritional deficiencies like our patient experienced.
Scurvy
Scurvy is often thought of as a disease sailors suffered from centuries ago. But in this case, it was masked by a modern eating disorder in an otherwise healthy teenager. The classic signs of scurvy include dry, brittle, and coiled hairs called corkscrew hairs, rashes around hair follicles, and gingival (gum) bleeding. Severe leg pain has been documented in prior cases of scurvy, and scurvy has also been known to mimic rheumatologic conditions. This case highlights the importance of considering scurvy, even in patients with normal growth. Early identification and correction of vitamin C deficiency are essential for a full recovery. Treatment includes vitamin C supplementation, dietary modification and counseling, and feeding therapy.
Katherine Musto is a second year pediatric resident and Hayley Goldner is a pediatrician in the adolescent medicine department at Nemours Children’s Hospital, Delaware.
Three weeks of World Cup excitement in Philadelphia came to a close on Saturday, but not before an announced sold-out crowd of 68,324 sat through 100-plus degree temperatures to watch France move on to the quarterfinals following a 1-0 defeat of Paraguay.
When the final whistle blew, it capped Philly’s first-ever hosting of the men’s World Cup in what was just the second time it’s been played on U.S. soil. Over the course of those weeks, Philadelphia became the world’s playground as our parks were used as staging grounds for thousands of fans, bars and restaurants catered to people from all over the world, and city landmarks received global attention.
The moments the World Cup brought were innumerable, but we compiled a list of the Top 10 takeaways as the lights move away from Philadelphia Stadium and continue at FIFA’s Fan Festival at Lemon Hill, which will keep the party going as the tournament inches closer to a thrilling end at New York/New Jersey Stadium on July 19.
Party on the Orange Line
SEPTA pulled out all of the stops — literally and figuratively — getting thousands of fans to and from Philadelphia Stadium courtesy of both local and express trains on the Broad Street Line that ran frequently and, for the most part, safely and efficiently, with scores of transit police and other officials at the stations.
But while SEPTA deserves a job well done, the heroes are the fans who routinely brought the party on the rides to and from the stadium. For just $2.90, fans heading down were subjected to singing, drums, flag waving, and a whole lot of hugging and high-fiving, whether you wanted it or not. The pre-party might have been at FIFA’s Festival or Stateside Live!, but it was also on many of the matchday trips southbound to NRG Stadium.
On the eve of the FIFA World Cup Group C match between Brazil and Haiti, this fan left a Spanish and English soccer jersey at Rocky’s feet on the Art Museum steps on June 18.
Rocky statue became World Cup lore
World Cup fans not only embraced Philly culture but also embraced our city’s sports culture and its superstitions. No proof of that was bigger than how nations took to the curse of placing a team jersey on the Rocky statue. Ecuador kick-started the notion, and their team lost, causing the planner of the moment to make a public apology.
The Ecuadorian team jersey on the Rocky statue was made by a fan who wanted to bring good luck to his team. That fan later issued a public apology after Ecuador’s loss.
Still, news of our city’s statue went viral and has now become a fan phenomenon, regardless of sport, worldwide.
Members of the Ivory Coast national soccer team react to fans during an open practice at Subaru Park in Chester on June 12.
A second home for the Ivory Coast
The love affair of the Ivory Coast needs to be studied because for the two weeks that the team took up residence at the Hotel DuPont in Wilmington and trained at WSFS SportsPlex and Subaru Park in Chester, they became family. People cooked special meals for the team, fans were buying their signature bright orange jerseys, and they were yearning for autographs at team training sessions.
In return, Ivory Coast advanced to the knockout rounds by winning both of its matches in Philadelphia, against Ecuador and Curaçao. Always remember that the team earned its first-ever trip to the knockout stage via a path forged through the Greater Philadelphia Region.
France’s Kylian Mbappé, reacts after a foul by Paraguay’s Andrés Cubas during the first half Saturday’s round-of-16 World Cup match at Philadelphia Stadium.
Red, white, and blue on July 4
It wasn’t the red, white, and blue of our nation’s colors, but it was somewhat symbolic that those were the colors of the two nations that faced off in Philly’s final game on a day that celebrated America’s independence.
On one side, there was France, a nation whose efforts in America’s independence are well-documented, which arrived with a team viewed as one of the best in the world, with arguably the world’s best striker, Kylian Mbappé.
On the other side sat Paraguay, a nation the U.S. men’s national team has beaten twice in less than a year: first in its Group D opener, then in a friendly last November at Chester’s Subaru Park.
A fan heads for shelter as rain falls at Lincoln Financial Field during a World Cup match between France and Iraq on, June 22.
Singing (and shopping) in the rain
Sure, it was hot, muggy, and wet, but France’s first match in Philadelphia, against Iraq, won’t soon be forgotten. Two storms, one right after the other, soaked Philadelphia Stadium and caused a delay of more than two hours. But while some actually decided to leave, believe it or not, the fans who stayed sang, cheered, and found ways to stay cool and dry.
How? Well, how about ravaging the concourse levels for food, drink, and memorabilia, leaving many concessions out of food and drink by the time the game resumed, and the official FIFA store on the main concourse looking like it got hit by a tornado?
It’s tough to put into words how to describe all of the vibrant colors on display during the three weeks of the tournament. Fortunately, a team of Inquirer photographers not only attended every match, but also were around town capturing moments showcasing the rabid fandom and excitement the World Cup delivered.
There to help
They wore neon green, light purple, and dark blue. They were comfortable being in the backdrop, but seemed ready to step up and support at a moment’s notice. In addition to the familiar faces of fan service representatives on any given Eagles gameday, the thousands of FIFA volunteers scattered both in and out of the stadium and at the FIFA Fan Festival brought a level of comfort simply by being there.
But the great part is that to many of them, it wasn’t just a job. They, too, seemed to be soaking in Philly’s moment in soccer’s sun, or dancing during the rains that fell for some of it, too.
Fan service representatives Robin “Miss Robin” Carter (left) and Maura Jacquinet were dancing in the rain during the delay for the June 22 match between France and Iraq.
And when you remember that mostly unpaid volunteers did much of the work, often through six- to eight-hour shifts, a special hat tip is due to those who helped make the event memorable for hundreds of thousands in attendance.
Fans pack the Broad Street Line ahead of the World Cup game between Brazil and Haiti on June 19.
Brazil vs. Haiti was a vibe
Probably the one match in Philadelphia where the game didn’t matter, the party started the night before with Brazil fans taking over bars, restaurants and the steps of the Art Museum in advance of their match against Haiti. The next day, whether it was on the train, in the parking lots, or once inside the stadium, both Brazilian and Haitian fans alike decided to make the game one big party.
A fan looks on with delight during Brazil’s match against Haiti on June 19.
Money was no object in Philly
In what amounted to the most expensive edition of the FIFA World Cup to attend, ever, fans still found a way to pack Philadelphia Stadium. In all, five of the six matches held in Philly were announced as complete sellouts of 68,324 in attendance. Only the match between Ivory Coast and Ecuador didn’t deliver a sellout crowd, and the margin was just 50 people. The average get-in ticket for a group-stage match on secondary market sites in Philly was $703, according to Front Office Sports.
“It’s been an expensive summer,” said Susan Richman, who attended two matches in Philly with six other family members. “I think all in all we’ve spent close to $15,000 [on tickets]? But for us to say that we’ve attended the World Cup in America is something that personally, I’ll always remember.”
Brazil fan Maninhu and Haitian fan Greguity met at the World Cup match in Philly between Brazil and Haiti. Both said they’ve become “best friends” in the process.
Fans becoming friends
One of the things that this tournament has conveyed is that humanity isn’t gone, as much as our social media algorithms would love us to believe. The colors that have mattered throughout the World Cup have had nothing to do with the color of someone’s skin, or where they’re from. The colors that have mattered have been the ones on the jerseys that have passed through Philadelphia Stadium, ones that have allowed us to ask questions of others, to get to learn more about them, their culture, their nation’s history.
Fans play a soccer game at the base of the Art Museum steps ahead of the FIFA World Cup Group C match between Brazil and Haiti on June 18.
It’s why money was no object to be in that moment, why a bucket list was fulfilled. In the end, that commonality undoubtedly found that strangers become friends, and friends become family, using sport as a connective tissue. In the end, that just might be the greatest takeaway from the three weeks in which the world’s greatest game made a pit stop in Philadelphia.
“This is wonderful for Philadelphia and wonderful for America, welcoming everybody into this beautiful country,” Ivory Coast native-turned-Philadelphian Ahmadou Dia told The Inquirer recently. “The World Cup, the football itself, brings every country, every single person, together regardless of color. It doesn’t matter what you look like, because on the field or in that stadium, we’re family.”
Honorable mentions: The turf laid down at the bubble field at Fan Festival … The Bank of America charm bracelets everyone went wild for at Fan Festival … The VFA-11 and VFA-81 flyover at Philadelphia Stadium on July 4. … Free rides on the Broad Street Line after the game … Ghana and Paraguay fans remaining in the stadium for over an hour after their matches to soak it all in … Lines of fans outside team hotels … The rooftop terrace at Stateside Live! on any given matchday.