The Genealogy Of Mass General


HE WAS A sixth-generation American, white and Protestant, educated at Princeton and the University of Pennsylvania Medical School, which, at the time, was the best in the country. Even in 1912, hiring David Linn Edsall would hardly seem to be a blow for equal-opportunity employment. But the place was Boston, the job was to lead the medical staff of the Massachusetts General Hospital. In the decades since 1821, when the hospital first opened its doors to patients, only Bostonians had been invited to practice at Mass General. Edsall was from Hamburg, New Jersey, of all places. Moreover, his main rival for the position was an ideal candidate—Richard Clarke Cabot, an extraordinary man, a gifted physician, a cousin by marriage of the retiring chief, and a member of Boston’s aristocracy.

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.

ALTHOUGH THE HOSPITAL’S original stone building remains in use, it is now barely visible to passersby. The large, and largely ugly, structures surrounding it provide for the care of some 31,000 inpatients and 144,000 outpatients a year. Many of these people are referred from hospitals elsewhere in the United States or the world in the hope that rare and difficult illnesses will be treated successfully at the “Mecca,” as it is sometimes called, only half-humorously. The visitor who enters this warren of brick and stone can walk from one building to another through a disorienting tangle of corridors that seem to end, as often as not, before a door marked “laboratory.” For it is research, and not only the occasional dramatic “cure” of a difficult case, that supports the enduring reputation of Mass General as a great hospital.

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 …”