The Genealogy Of Mass General

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Mass General was, in many ways, the perfect expression of a peculiarly Bostonian conception of charity. It maintained the appearance of engaging an entire community in its efforts and of offering care to all and sundry, within the limits of its charter. The contribution of twenty-five cents given by a poor Negro was duly recorded, and so was a three-hundred-dollar pledge from Abraham Touro, head of the first Jewish household in the city and brother of the New Orleans philanthropist Judah Touro (both of these remarkable men would also leave Mass General large sums in their wills). Nevertheless, control over the hospital remained firmly with the city’s aristocrats. As the historian Ronald Story points out, “Of the twenty-three officers of the hospital from 1820 to 1850, the names of all but four appear on available lists of Boston’s wealthiest 200 individuals.” And although the state donated income-producing land as well as convict labor for construction, the major sources of income to the hospital were donations from Boston’s commercial aristocracy—a million dollars between 1800 and 1860. Only Harvard, with about $1,180,000, received more.

 

BESIDES THE principal donors, one of the hospital’s most important sources of funding was the Massachusetts Hospital Life Insurance Company, which was granted by its charter a monopoly on sales of life insurance in Massachusetts in return for giving a third of its net profits to the hospital. This firm grew to be the largest financial institution in New England, one more example of enterprise and charity properly meshed to do God’s work.

Yet another means to raise funds—one that would be unthinkable in today’s hospitals—was the “free bed.” Anyone who donated one hundred dollars gained the right for a year to have one patient of his choosing in the hospital at any one time. The free beds were often used for the victims of industrial accidents, which grew increasingly common in the nineteenth century, and they may have helped soothe the consciences of factory owners. This practice was still accepted as late as 1888, when the American Bell Telephone Company contributed the “use of 14 telephone sets in consideration of the right to the use of a free bed at the hospital by the Company.

No matter how lofty the hospital’s benefactors were, the day-to-day life there was solidly working class. Patients and caretakers came to form a social network of their own. The routine workings of the institution were supervised by the nursing staff under the superintendants direction. They provided food, support, and a clean environment that might at least allow the patients’ natural defenses to effect a recovery. No doubt this little society was relatively autonomous, except for the periodic intrusions of the trustees and doctors.

The physicians and surgeons who served at the hospital, though apparently less wealthy than the trustees, were largely from the same aristocratic families. Mass General had twenty-one attending physicians and surgeons in its first three decades; eight of them were relatives of the trustees; others married into the first families. The doctors thus had high standing in the community, and most of them left large estates. As the system was practiced, working at Mass General did not enrich these physicians directly—they were required to provide their services free of charge for nearly a century after the hospital opened—but the association did indeed enhance a doctor’s standing. At a time when the profession of medicine in America did not enjoy anything like the respect it does today, such enhancement helped in the competition for patients.

One major reason for this lack of respect was that, in the early 180Os, physicians’ techniques and knowledge were severely limited, and they insisted on treating diseases for which they had no effective therapy—pneumonia, for example. Of 187 cases that would be admitted to Mass General between 1822 and 1850, nearly two-thirds were treated with bloodletting, a cure-all that was actually used relatively sparingly in Boston by then. Boston doctors, having been exposed to the pioneering statistical study of Pierre Louis of Paris, which demonstrated that pneumonia victims recovered at least as often and as fast whether or not they were bled, gradually retreated from the use of bloodletting. In Benjamin Rush’s Philadelphia, on the other hand, where the aggressive influence of Edinburgh was felt more strongly, the therapeutic hemorrhage continued much longer.

 
 
 

SURGERY IN THE nineteenth century was also severely limited in what it could accomplish. Lack of anesthesia meant that operations had to be kept as brief as possible; ignorance of infection meant that wounds often became purulent. If death did not follow, recovery was likely to be very slow. What we now would call major surgery, particularly operations that required entry into the abdominal cavity, was then called capital surgery—in the same sense as “capital” punishment. The risk of death was so high that Mass General’s rules initially required an independent second opinion before the trustees would approve such an operation on the premises.