Who Invented the Modern Hospital and who Should Tell the Story?

Abstract

Between 1880 and 1920 the center of medical practice in the United States moved from the home to the general hospital. The home ceased to be the normal place for birth, serious illness, and death as the family yielded another of its functions to strangers and experts. Morris J. Vogel's The Invention of the Modern Hospital is the first sophisticated historical monograph on one central aspect of the process of social differentiation in the United States. As Vogel demonstrates, the development of scientific medicine cannot, by itself, explain the rapid institution building in Boston, and presumably other urban centers, at the end of the nineteenth century. Rather, the modern hospital was, in part, another of the social welfare institutions, including public schools, orphanages, prisons, and insane asylums, created to serve the needs of a geographically mobile, urban population. Medical advances, and the needs of physicians intent on raising the status of their profession, did play a role in the rise of the modern hospital, but, to Vogel's credit, he is able to provide a complex explanation for the emergence of a now-familiar institution, and in doing so he reminds us that our social landscape was not shaped by technological imperatives but by conscious choices and by intense struggle between competing interests. In 1870 Massachusetts General Hospital resembled in essential respects the hospitals of thirteenth-century Europe as well as roughly one hundred other institutions in the United States. It was a charity whose patients were overwhelmingly the poor and those without roots in the community; dependence, as much as disease, distinguished them from the public at large (p. 1). Those who had families able. to care for them avoided hospitalization and the paternalism of Brahmin philanthropists, who debated the propriety of admitting the Irish in the 1860s but opened their wards to them when it became apparent that they provided a proportion of the industrial accident cases that could not be refused. The doctrine of Christian steward-