The Genealogy Of Mass General

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In another ten years, and just a few months after Roentgen announced the discovery of X rays, the hospital acquired its first X-ray tube, brought back from Europe by J. Collins Warren, grandson of the hospital’s co-founder. The technique of using X rays for diagnosis was slowly developed at the hospital mainly by the hospital photographer, Walter J. Dodd, who had begun his career as a janitor in the chemical laboratory at Harvard. After becoming a self-made expert in the new technique, Dodd went to medical school at the University of Vermont and acquired his degree at the age of thirty-nine. Unaware of how hazardous X rays could be, Dodd suffered severe, unhealing burns and died at the age of forty-seven.

In 1846, Mass General ushered in the era of surgical anesthesia.

Richard Clarke Cabot, who had so selflessly promoted Edsall, was also one of America’s great innovators. Almost incidentally to his career, he reclassified heart diseases according to their cause rather than merely by anatomical abnormality, thus advancing the field of cardiology. But he is better remembered for two new ideas that were not, strictly speaking, scientific. The first was an educational exercise, known as the clinicopathological conference (or “CPC”), which is still a weekly ritual at Mass General. The medical staff assembles and listens as all the details of a complicated case are presented either to one of its members or to a distinguished visitor. The final diagnosis, as established by a biopsy or autopsy, is withheld. The discussant analyzes the facts and offers his or her diagnosis, which, at the end, is compared with the pathologist’s findings. These CPCs, under the title “Case Records of the Massachusetts General Hospital,” are still a prominent weekly feature of The New England Journal of Medicine , which includes, as part of the headline, the phrase “Weekly Clinicopathological Exercises: Founded by Richard C. Cabot.”

Also at Mass General, in 1905, Cabot founded the first full-time social service department in an American hospital. Cabot had always stressed not only the soul but also society as a factor in disease and health, and in teaching his students about tuberculosis, for example, he is supposed to have made the ironic remark, “Taking it by and large, consumption is curable in the rich, incurable in the poor, while in the moderately well-to-do the chances are proportionately intermediate.”

Part of the hope for his social service department evidently was that it would help to make “consumption” curable in the poor. Its first task was to arrange for proper management of tuberculosis patients at the hospital, with such measures as education in hygiene as well as “vacations and country outings for those who need them as part of their treatment. ” Other aspects of medical social work at the time included instruction for new mothers, “the care of unmarried girls, pregnant, morally exposed, or feeble-minded … help for patients needing work or a change of work … provision and provisions for patients ‘dumped’ at the hospital,” and “assistance to patients needing treatment after discharge from the hospital wards.”

At the turn of the century America lagged well behind Europe in its medical research. But there were clear signs of change. The Johns Hopkins School of Medicine in Baltimore had been opened in 1893 and was rapidly becoming preeminent in teaching and research. Then, in 1906, the Rockefeller Institute was opened in New York. At first staffed mainly by alumni of Johns Hopkins or European institutions, the Rockefeller rapidly became famous for truly outstanding laboratory investigation of disease. At these and other American institutions, the understanding of infection grew more sophisticated, and glimmerings of progress in other areas were to be seen.

 

MASS GENERAL was not conspicuous among the new generation of research institutions. It was organized in a way that hampered any efiort that its physicians, all of them part-time at the hospital, might make to carry on sustained laboratory research. Moreover, the staff was inbred and periodically smarted from charges of nepotism. Although the medical staff was no longer drawn exclusively from the Brahmin families, they were still all Bostonians, and almost all received training first at Harvard and then at the hospital itself before joining the staff.