- Historic Sites
The Genealogy Of Mass General
How a favorite local charity of Boston’s Brahmins—parochial and elite—grew into one of our great democratic medical institutions
October/november 1984 | Volume 35, Issue 6
That the city’s most thoroughly Brahmin institution (after Harvard) would pass over someone with Cabot’s name and qualifications to bring in a complete outsider—this was a remarkable, even a radical, turn of events. It was not quite as revolutionary, though, as rumor had it. Some of Boston society’s more parochial members thought Edsall was Jewish. What else could he be? His first name was David; he had supported Louis D. Brandeis’s appointment to the Supreme Court; and he was known to be a staunch Democrat.
Why had the hospital taken such a drastic step? The reason was, quite simply, that the people who supported and staffed it had always conceived of Mass General as an elite institution. But they feared the rest of the world would soon come to see their hospital as second-rate—a Brahmin backwater with some amusing traditions, but one that was making little contribution to the progress of modern medicine. It was not that the hospital had changed. What had changed was medicine itself.
Although Cabot had expected throughout most of his career that he would succeed to the top position in medicine, by 1912 even he declared himself eager to persuade the New Jersey doctor to come to Boston. His admiration for Edsall was based on that physician’s identification with the new style of medicine, one that fused modern laboratory investigation with an older tradition of pains-taking bedside diagnosis. Cabot had become so impressed with Edsall’s reputation over the years that he had declared himself “only too happy to serve under him.” And the move that originally had seemed so alarming to some turn-of-the-century Bostonians proved in the end to accomplish exactly what was intended. Under Edsall’s leadership, and with Cabot’s unstinting support, the Mass General staff succeeded in reshaping the hospital to meet new and changing standards. Today it is one of the world’s most famous medical institutions.
Boston was late to establish a general hospital. Both Philadelphia and New York had them by 1800. Boston, despite its importance in the Revolution, had neither a large enough population nor a complex enough social structure to sustain one. The almshouse was the only establishment that served any of a general hospital’s functions. Dr. Josiah Bartlett, writing in 1817, gave this rosy description of medical care at the poorhouse: “The Boston Almshouse has a spacious, well constructed edifice, with kitchens, a well, and forty-six other apartments. It is governed by the Overseers of the Poor, and is conducted by a master with proper assistants. The average number of inhabitants, for the past two years, is about 359 [a year, presumably] of whom 139 are state paupers. The objects of admission are the meritorious poor, unfortunate females, vagrants (who are kept employed), and maniacs. The usual number of sick and infirm is about fifty.”
Another description, however, asserted that the “Almshouse in this metropolis does not pretend to cure ” and “all it possesses is accommodations for eight patients.” Also, its critics contended, “it must necessarily happen that in many instances the worst members of the community, the debauched and profligate, obtain admission into this house. Hence it has become, in some measure, disreputable to live in it; and, not unfrequently, those who are the most deserving objects of charity cannot be induced to enter it …”