Joseph Hanaway, John H. Burgess, eds. The General: A History of the Montreal General Hospital. Montreal: McGill-Queen's University Press, 2016. 760 pp. $65.00 (cloth), ISBN 978-0-7735-4685-1.
Reviewed by Annmarie Adams (McGill University)
Published on H-Sci-Med-Tech (January, 2018)
Commissioned by Darren N. Wagner
In 2021, the Montreal General Hospital (MGH) plans to celebrate its two-hundredth anniversary. Although it began in a rented, twenty-four-bed house on Craig Street (now Saint Antoine Street) in 1819, since the mid-1950s the hospital has occupied a monumental brick skyscraper, a major landmark in the city’s skyline. Set against the dramatic backdrop of Mount Royal, it is visible from a great distance, and intentionally located near McGill University, with which it is closely and historically affiliated. For a period between 1997 and 2003, however, it looked like the MGH was going to move into the long-planned and newly merged McGill University Health Centre (MUHC), which opened in 2015, bringing together a handful of McGill-affiliated teaching hospitals in a new building on a new site. It was during this period, when the “history” of the hospital seemed to be at risk, that Joseph Hanaway and John H. Burgess, medical graduates of McGill University, organized this immense seven-hundred-page history of the institution written by more than fifty authors. The resulting book, arranged into six sections and forty-eight subsections, updates the MGH’s story since the publication of Hugh MacDermot’s History of the Montreal General Hospital, which came out in 1950, and begins to chronicle the on-again, off-again history of the hospital as part of a unified health center.
The General is essentially an autobiography of institution. It is autobiographical because it is written by insiders, by the (mostly) physicians and nurses who shaped the institution in the late twentieth century. It is also somewhat self-reflexive in that the book is not organized by historical themes, as one might expect from an institutional history, but rather by the departments and divisions of the actual institution. The colossal Department of Medicine, for example, is the subject of section 2, with chapters dedicated to fifteen subdivisions, such Cardiology, Dermatology, Respirology, and Tropical Medicine. Surgery and its divisions are covered in section 3, while “other” departments are grouped in section 4. The history of nursing at the MGH and some other key themes are the focus of the final two sections.
This self-reflexive structure has advantages and disadvantages. Engaging hospital unit heads and other leaders to write a history of the institution means the book is full of personal insights and important, perhaps undocumented moments that might have otherwise been lost. A disadvantage of getting insiders to write about their own work, however, is that there is a fair amount of navel-gazing. Here is an example: “it should be noted that William Scott is our present-day Harry Scott’s great-grandfather,” writes Hanaway in the section on “Early History, 1819-85” (p. 51). Some chapters read almost like a list of names, with short life histories of doctors, from birth to death. Needless to say, it can be a bit strange when authors talk about themselves in the third person. Samuel O. Freedman, in his piece on Allergy and Immunology, for example, writes: “Samuel Freedman joined the division in 1959, with the proviso that he had admitting privileges for allergy patients only” (p. 97); “Fortunately, Freedman was able to achieve recognition in his chosen field of allergy shortly after his appointment in January 1959” (p. 98); the chapter ends with a list of major awards won by Freedman. Authors boast that they were responsible for hiring this and that successful colleague. Hiring decisions, in fact, are a major theme of many of the chapters.
Another disadvantage of having so many authors (and many with limited experience of the history of medicine) is that they do not seem to have read each other’s contributions. Readers may be disappointed, for example, that there are so few references to the general history of medicine. We learn next to nothing about whether the Montreal General Hospital is typical of other large, urban general hospitals, or how it related to other hospitals of its type. A fascinating exception is an anecdote about the Massachusetts General Hospital, also known as “MGH,” wherein plaques in the lobbies of both hospitals mistakenly cite 1821 as their founding dates, further linking the two institutions outside of their acronyms (pp. 15–16). Additionally, there are editorial issues. The sources for illustrations are not correctly cited—for example, paintings are included without any reference to the artist or collection—and many archival images available in nontraditional sources (postcards, magazines, films) were missed. And then there are sentences that just make no sense. Here is one such passage: “It was a significant help when the reservoir below the Royal Victoria Hospital (RVH) was finally completed in the 1840s” (p. 44). Since the RVH was only built in 1893, a professional historian would refer to the reservoir as the McTavish Reservoir, its actual name.
Even more irksome are the repetitions from chapter to chapter. The early years of the MGH, as a philanthropic institution serving poor, sick immigrants, are repeated in several sections. Heroic figures such as William Osler and Thomas Roddick are reintroduced in multiple parts of the book, as if readers do not know of them already. The story of the MUHC merger in the 1990s is retold many times, and with some inconsistencies such as referring to it as the McGill Mega-Hospital Centre (p. 93) and the super-hospital (p. 682). Since the historical scope of the book ends in 2012, the story of the move to the new site is unfortunately not included.
The best sections of The General, in my opinion, are those with a thematic focus. Hanaway’s own chapter on the hospital’s governance brings clarity to a complex history, especially on the transfer of control for healthcare to the Quebec government in 1970 (Bill 65). And a chapter on the unique relationship of the MGH with the city’s beloved hockey team, the Montreal Canadiens, really stands out. When the team was based at the Montreal Forum, players routinely sought medical care across Cabot Square at what was the Western Division of MGH. The hospital and famous hockey team are also linked through the beer-making Molson family, which has owned the team at various times in its history and supported the hospital through seven generations. The Molson family is also the subject of the book’s first chapter, which was “reviewed and approved by members of the Molson family” (p. 3).
The General will be of interest to readers who know the institution or whose interests include the heroic physicians who shaped it. In this limited appeal, it resembles a recent book on the MGH’s sister institution, the Montreal Neurological Institute (MNI), entitled The Wounded Brain Healed (2016), edited by the late William Feindel and Richard Leblanc and also published by McGill-Queen’s University Press. In a review, medical historian Michael Bliss slams it as insider history, made up of “dreary and uncritical summaries of the qualifications, research achievements and later careers of all the scientists who worked at the MNI during its first half-century.” The General suffers from the same problem, with far too much emphasis on the qualifications of its doctors.
Another way to publish an institutional history is from the outside, to commission a professional historian of hospitals to take it on. A recent example is David Wright’s superb SickKids: The History of the Hospital for Sick Children, published in November 2016. This approach is more likely to set the institution in a broader historical context and to take on critical issues. A dedicated chapter on Osler’s presence at the MGH, for example, would be welcome (rather than dozens of references to him that repeat the same information). The hospital’s website claims it “introduced teaching at the bedside,” presumably a reference to Osler, yet the book does not touch on the subject. How did the hospital’s famous rivalry with the nearby Royal Victoria Hospital shape its profile? Is its close relationship with McGill University typical of teaching hospitals? Did the city of Montreal shape the MGH in ways beyond beer and hockey? To give Hanaway and Burgess credit, though, they did include the dark story of Arthur Porter, the hospital administrator who oversaw the construction of the new McGill University Health Centre from 2004–11, in the last few pages of the book. Porter was subsequently charged with fraud and died of cancer in a Panama hospital, after having allegedly taken $22.5 million in consulting fees.
The General is amateurish and poorly organized, with a rather predictable narrative of heroic, life-saving work by gifted healers who write about themselves. Let’s hope the two-hundredth birthday festivities in 2021 (even if it is the wrong birthday!) will bring opportunities to publish alternative histories of this remarkable urban institution.
. In the interest of full disclosure, I co-contributed a chapter to the volume edited by Feindel and Leblanc.
. Michael Bliss, “Brain Surgery: Detailing a Vital Way Station for the Neurosciences,” Literary Review of Canada (May 2016), http://reviewcanada.ca/magazine/2016/05/brain-surgery/
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Annmarie Adams. Review of Hanaway, Joseph; Burgess, John H., eds., The General: A History of the Montreal General Hospital.
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