The General: A History of the Montreal General Hospital ed. by Joseph Hanaway and John H. Burgess (review)

The Montreal General Hospital (MGH) is the oldest of its kind in Canada; however, it has not received its full due by historians. Joseph Hanaway and John Burgess have helped significantly in filling this lacuna. The General is the culmination of a 10-year project that brought together more than 50 former employees of the MGH, including administrators, doctors, nurses, and surgeons. The book is divided into chapters, typically written by individuals with first-hand knowledge, which address a specific moment or department in the MGH's history. The advantage of this approach is the preservation of anecdotes and personal accounts that, outside of a memoir, would likely be lost to scholars. The disadvantage is that the tone and voice of the collection becomes somewhat top-down. From this vantage, the perspective of patients and society more generally are somewhat difficult to discern.

Chronologically, the volume is organized around four periods that Hanaway and Burgess argue distinctly influenced MGH policy. The first section comprises the years 1819–85, which revealed a struggling institution "run by business people and staffed by family practitioners who practised the medicine of the day with limited surgical capabilities. Which offered little help to their patients" (xvi). They refer to the second period – 1885–1957 – as the "rise of specialization," which coincided with scientific advancements in Europe, the refinement and acceptance of antiseptic and anaesthetic techniques, and the entrenchment of germ theory. The third period consists of the government takeover of health care in Quebec between 1961 and 1997, with a special focus on Bill 22 (1974) and Bill 101 (1977). The fourth period concerns the emergence of the concept of a united hospital centre for all of McGill's hospitals. In 1997, the McGill University Health Centre arose due to financial pressures to keep half-filled hospitals open. Initially, these institutions were going to be amalgamated at a new site in Notre-Dame-de-Grâce. Financial concerns led to reconsideration, and in 2003, a new decision was reached to keep the Cedar Avenue site and instead pursue major renovations.

The focus of most chapters is a department and is authored by a physician or surgeon who worked there. As such, there is a tendency for them to emphasize internal politics or advancements in the medical field. Important as such phenomena were, they cannot tell the whole story of what was at its core a community institution. The chapter on ophthalmology by Sean B. Murphy and Duncan Cowie, for example, is comprised almost exclusively of short biographies. In contrast, some chapters press beyond the hospital's walls. Sandra Richardson and Jacqueline McClaran's chapter on the development of geriatrics incorporates questions relating to medical ethics and explains how the social work department helped with community outreach to seniors. Likewise, Shirley Woods examines the Molson family's charitable and administrative involvement since 1819, and Douglas Kinnear and David Mulder analyze the relationship between the MGH and the Montreal Canadiens hockey team. Rather than looking inward, these broader topics begin to branch out beyond the institution's boundaries to examine its role in society more generally.

Several of the chapters about nursing provide something of an inadvertent foil to the dominant doctor narrative of the book by exposing unequal power relations among the staff. Margaret Hooton's chapter on nursing in the 1950s argues that increased education and responsibility did little to improve working conditions or expand nurses' professional autonomy. Hooton notes how, in 1953, most nurses were "single, lived in residence, and accepted long hours of work, split shifts, and low salaries. Even the preparation of the nursing budget was the jurisdiction of the hospital administration" (612). Another such example comes in Michael Churchill-Smith's chapter on the emergency department, where he describes the case of an adolescent who fell into a silo and was submerged in grain. When the patient...