Community Roots, Global Reach: The Hospital as Academic Medical Centre

THERE IS LITTLE NEED TO REMIND CANADIANS that in 2017 we are in the midst of a big birthday bash to celebrate 150 years of nationhood. Without sounding too mawkish, there are many good things to reflect on and be grateful about; but amidst the official hoopla, not many people might consider hospitals in Canada to be one of them. Yet, in a relatively short time, by historical standards, several Canadian institutions have evolved to become monumental successes. Not surprisingly, these institutions are located in the premier cities of Montreal and Toronto: the Montreal General Hospital, the Montreal Neurological Institute, and the Hospital for Sick Children (now "branded" as SickKids) in Toronto. All three are fully deserving of sophisticated historical analysis, but unfortunately, as this essay demonstrates, not all of them receive it.¹

The General: A History of the Montreal General Hospital, under the editorship of Joseph Hanaway and John H. Burgess, is based on the accounts of about 60 contributors, all of whom were associated with the Montreal General Hospital (MGH).² Given the breadth and richness of the clinical and administrative experience of these men and women, a well-rounded comprehensive survey of the MGH might be expected. However, instead of a tessellated panorama, this book ends up being an uneven patchwork. Too many misspellings and typographical glitches further mar this work. Similarly, the book's problematic organization tests the patience of a serious reader. Opening with an homage to the Molson family prominent for its longstanding support of the MGH is understandable, but it is a problematic way to begin a book. Rather, it might have been better to have integrated the major instances of Molson support into the text as appropriate, thus avoiding the impression of kowtowing. The following chapter by the editors, in which they present a review of events related to the history of medicine and their connection to the MGH for the period 1819 to 1885, is laudable but remains unfocused. A reader might be better advised to skip first to chapter 48, on MGH governance, to receive a better grasp of situating the hospital in historical context, before tackling these introductory sections.

The bulk of The General is divided into five sections that reflect the departmental clinical structure and power base of the institution, with medicine and surgery taking up the lion's share of space. Each of these departments is subdivided into analyses of their respective divisions (for example, cardiology, dermatology, geriatrics, nephrology, rheumatology, general surgery, cardiovascular and thoracic surgery, neurosurgery, and plastic surgery). Another section, somewhat dismissively entitled "Other Departments," considers fields such as anesthesiology, dentistry, obstetrics and gynecology, pathology, psychiatry, radiology, and urology. Nursing gets its own section, and these chapters add to our understanding of changing norms of education and labour practices in Quebec. These contributions augment the growing literature on regional nursing history and show how this occupation can be greatly influenced by provincial politics in addition to national trends. The final section addresses the MGH Foundation, along with the hospital's role as the collective team doctor for the Montreal Canadiens. This organizational breakdown into so many subsections results in repetition, for too often the discussion of the specialty at hand overlaps with that of others. As the book makes little attempt at any overarching institutional chronology, each chapter is a micro-chronology and thus one is left with the impression of multiple starts.

Moreover, the historical content of chapters often only extends as far as the contributor's personal memory or experience; at other times it take on shades of the Old Testament with lists of who clinically begat whom. This approach allows many people to be included in the narrative, but overall it takes on too much of an insider's perspective, or old boys' club, and often at the expense of patients who for the most part are noticeably absent from the study. A few examples will suffice to make these points. When recounting the first "code 99" (cardiac resuscitation using a defibrillator) at the MGH in 1964, the physician-author wrote that when...