The Genealogy Of Mass General

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During the two world wars, Mass General diverted its energy into organizing and staffing a military hospital; between the conflicts, the hospital’s growing research effort received support mainly from foundations and private contributors. The trustees actively sought funds for research and in doing so began to shift away from the traditional concept of charity that had motivated the institution in its first century. Indeed, as early as 1907, the trustees asserted that “those who give money to the Hospital may well feel that they are aiding most intelligent and painstaking efforts to find new agencies to repress and cure disease and pain.” As Morris Vogel observes in his elegant book The Invention of the Modern Hospital , Mass General “directed these pleas toward a much larger public than ever before. Hospitals began to ask for money as participants in a democratic conquest of disease; they retreated from their image as an expression of aristocratic stewardship.”

Today the hospital is a monument of modern scientific medicine.

In part this shift of emphasis became feasible as the whole social role played by the hospital began to change. During its first century a haven for the sick poor, Mass General went on to open accommodations, in 1917, for the wealthy and then, in 1930, for the middle class. The emergence of workmen’s compensation and medical insurance transformed the concept of hospital care from a gift into a paid service. In this same period the hospital gradually expanded the range of services that it offered, despite opposition from conservative practitioners and trustees. Soon, virtually everything that a private doctor might do for a patient, in or out of the hospital, could be done by the hospital as an institution.

Since the Second World War, research at Mass General, as elsewhere, has increasingly been funded by the government or by the national foundations dedicated to eradicating one or another disease. The hospital itself and its supporters no longer play a very prominent role in the support of its research program, nor do they directly pay for most of the care given to patients. Indeed, like many other research hospitals, Mass General must now combat the perception that high-quality hospital care is a drain on scarce resources rather than being a laudable means of sharing the wealth.

Edsall died in 1945, but virtually every active field of investigation at the hospital can be traced back to the clinician-scientists that he installed in his first years there. In a poignant echo of its past, Mass General—formerly charged with social snobbery—is now sometimes accused of having become scientifically inbred, of failing to make key appointments from outside the hospital. But nobody today doubts the hospital’s standing as one of the twentieth century’s monuments of scientific medicine. Whether Mass General, or any hospital, can successfully address the problems that worried Richard Cabot—that poverty makes disease and that suffering is more than physical pain—remains to be seen.