The Struggle to Serve: A History of the Moncton Hospital, 1895 to 1953 (review)

This volume is one of a handful of academic studies of Canadian hospitals. As the author notes, there are many excellent studies of American hospitals but very few Canadian ones. W.G. Godfrey makes use of both Canadian and American studies to put the Moncton Hospital in perspective. His is not a study of 'progressive' improvement over time but rather a history of struggle among the stakeholders: concerned citizens, politicians (municipal, county, and provincial), hospital boards, and medical staff. Particular attention is paid to the small community-supported hospital in Moncton and the never-ending struggle to raise the necessary funds to keep the institution going. For most of the decades discussed, private funding predominated, with small contributions from various levels of government. By 1954 the author estimates that up to 65 per cent of New Brunswick's hospital funding came from hospital insurance, though government assumed responsibility for hospital construction by the end of the decade. By the 1950s the division of responsibilities for hospitals among provincial, county, and municipal governments had been resolved by federal and provincial government actions.

Several key themes run through the volume: the efforts to obtain community support; the power struggles over who controlled the hospital; the role of women in the creation of the hospital and in subsequent fundraising; the tensions over rural users and their ability to pay; and the key role played by Alena MacMaster as hospital superintendent and head of nursing.

Indeed, women played key roles in the genesis of the institution. An alliance of the King's Daughters, physicians, and religious leaders sparked discussion and eventual establishment of the Moncton Hospital in 1898. In order to staff the hospital, a nursing school was eventually established, graduating its first class in 1909. Though no women were on the first board, the women cheerfully founded a Ladies' Aid and continued fundraising, a key issue over the decades of the hospital's growth. During the First World War, the president and secretary of the Ladies' Aid sat on the hospital's board. The women's organization took special interest in the creation of a nurses' residence and a maternity ward for the hospital.

Perhaps the most important female figure was that of Alena MacMaster. A graduate of the first nursing class of the Moncton Hospital, MacMaster's long service (1919–1947) left indelible marks on the institution. She insisted that the hospital meet the standards for accreditation with the American College of Surgeons (1922) and with the American Hospital Association (1926). She was responsible for suggesting a prepaid hospital insurance scheme that was launched in 1937 and she expanded the number of students and graduates from the nursing school. In 1947, when the old hospital board clashed with municipal politicians over whether to move the hospital to a new site and lost, the old board resigned as did MacMaster. Ironically, she was replaced by two men.

This struggle in the 1940s not only illustrates the active and contentious nature of community involvement, but also points to the major changes noted by Godfrey in the postwar period as both the city and the hospital found themselves at a crossroads. In the case of the hospital it was poised on the brink of expansion and modernization, the result of a shift, first noted by MacMaster and adopted by Godfrey, from philanthropy to government funding. Conceptually, however, such a formulation obscures the role played by paying patients, often through their insurance companies, a point frequently made by the author. Certainly under the Federal Health Grant for hospital construction (1948) and later the federal Hospital Insurance and Diagnostic Services Act (1957), patient costs were subsidized by government, but the process of arriving at government responsibility was neither inevitable nor smooth. This reader would have been gratified to see a discussion of the effects of government funding on the new hospital of 1953, a subject that goes beyond the limits...