In 1821, the stethoscope was a newfangled French gadget, invented four years before by Laennec. (It was a hollow tube, designed to break into two pieces so it could be carried inside a physician's top hat.) The syringe for injection was a novelty; the clinical thermometer would not be introduced for another forty years; and X-ray diagnosis was nearly a century off.

In 1821, the average physician's list of drugs contained many substances of doubtful value, including live worms, oil of ants, snakeskins, strychnine, bile, and human perspiration. Not so long previously, Governor John Winthrop had accepted powdered unicorn horn as a valuable addition to his pharmacopoeia. And if all this seems an exaggeration, it is worth remembering that as late as 1910 some doctors at the hospital still regarded strychnine as good treatment for pneumonia.

In 1821, there was no anesthesia, and consequently few operations. The post-operative infection rate was nearly 100 per cent. Surgical mortality was close to 80 per cent. In the first full year of service, the hospital treated 115 patients. Although records from that time are lost, the mortality for the hospital as a whole in its early years was a fairly constant 10 per cent.

Clearly, the hospital has undergone an astonishing growth in size and complexity since those days. That growth generally goes unquestioned; it is a peculiarity of the American mentality that the growth of almost anything is applauded. (Consider the mindless jubilation that accompanied the growth of our population to two hundred million.) One may ask whether there are any drawbacks to the size of today's MGH, and to its current emphasis on acute, curative medicine. The question is difficult to answer.

First there is size. For both patient and physician, the sheer size of the hospital can create problems. The patient may find it cold, enormous, impersonal; the doctor whose patients or consultations are widely scattered may find himself walking as much as a quarter of a mile from bed to bed. The intimate, supportive atmosphere that is possible in a smaller hospital cannot be achieved to the same extent here.