Partnership for Excellence: Medicine at the University of Toronto and Academic Hospitals by Edward Shorter (review)

Partnership for Excellence is extraordinarily, even dazzlingly indigestible as a read. To attempt to a write a narrative history ofmodern medicine at one of the biggest, best medical conglomerates in North America requires a certain hubris. Over the last century, medical disciplines pursued power and autonomy by making themselves as specialized and scientific as possible, inaccessible to non-specialists, and resistant to narrative coherence. Edward Shorter, frsc, a prolific historian of medicine, manages to integrate these centrifugal forces into one volume, a 930-page door-stopper, with remarkable success, albeit at a price.

His organizing themes – the rise of research and the shift from English education-based to American research-based medicine – around banner discoveries and the core departments of medicine and surgery come close to providing centripetal correction to all that centrifugal specialization. So we get insulin as an early success, one that shaped subsequent research programs, funding, and institutional organization for many years. We also get the agonizingly slow shift from medicine and surgery, oriented toward good generalism and clubbable generalists with almost nominal integration of research, to full-time, high-powered, suddenly very Jewish researchers, who put their newfound academic muscle into strengthening research programs in departments and hospitals across the University of Toronto medical empire.

In the 1940s, Toronto’s Faculty of Medicine was still a poky provincial backwater, behind McGil Gill’s; by the end of the century, it was a “black hole” that drained medical talent from across Canada. Leadership was key, Shorter argues, especially that of the professors of medicine and surgery, who could save struggling departments by bringing them into expansive research programs. The rise of research was not linear: every institution, every department, had its own story, often marked by jealousy and distrust. A well-funded Charles Best gave powerful impetus to physiological research, for example, but his distrust of clinical colleagues obstructed some possibilities. And in i960, when one million dollars in Weston money went to the Banting and Best Department of Medical Research, other departments complained that “there was already too much medical research” (414). Some departments, such as neurology or oncology, were riven by such forces as centralization threatened local fiefdoms. Others, like therapeutics or anatomy, waxed and waned with medical fashions.

Chapter titles like “Medical Biophysics / Biomedical Engineering / Immunology” reveal Shorter’s narrative perplexities, and many figures get only glancing notice. He moves too quickly to interrogate all the data supporting his overarching theses. To take one very minor example, Wilbert Hurst Brown gets two sentences, stating that he became physician-in-chief at the Toronto Western Hospital in 1949-50 and that he “was known for building up research at twh” (624). We don’t learn what he did, or that he worked in Oxford, London, Gottingen, then London again for postgrad work, before the stint at Johns Hopkins that preceded his move to Toronto in 1936 (and his London doctoral degree in 1939). I don’t think Shorter is wrong about the shift to American research patterns, but his evidence is anecdotal rather than rigorously established and seems to suggest that British medicine remained resolutely Victorian, or perhaps Oslerian.

There is a baroque quality to the book: if it were a diagram, it would resemble one of the cosmic diagrams that William Lyon Mackenzie King put at the end of Industry and Humanity (1918) to show how a social-sciences PhD could organize and integrate social forces. Indeed, Shorter and King have comparable aspirations: they make a whiggish case for science’s promise, a promise that they are uniquely qualified to convey. But where King’s baroque style reflected a determination to unite science and social forces, Shorter keeps them resolutely apart. There s lots ofsocial history in the later chapters, addressing the quotas on women and Jews, the social life of students, and the paradox of finding an academic role for community medicine when...