The invention of the modern hospital: Boston, 1870–1930

suffer in order to create: hence these authors' lives of migraine, strain, nervous collapse, obsessional overwork, and resort occasionally to alcohol and narcotics but chiefly to medical drugs which they dedicated themselves to. As Professor Williams stresses, they were all "sick men", their true illness being their post-Romantic conception of the artist's role. But, second, Professor Williams is also concerned to chronicle his writers' medical histories, investigating family dispositions to nervous and paralytic disorders, and the dismal stories of their sufferings from prostration, hysterical and epileptic symptoms, and (especially with Jules de Goncourt and Maupassant) mental collapse-with much iatrogenic suffering en route. Above all, he shows in convincing medical and biographical detail that it is likely that the physical decay and death of each of them was hastened if not caused by the tertiary effects of syphilis (and that-although the chronic effects of syphilis were not then medically and scientifically understood-each had a moral-aesthetic grasp of how his own sexual complaints had been at the root of his "horror of life"). Professor Williams has written an absorbing book, marred in three respects. Structurally, five hermetically sealed chapters of biography do not make an integrated book. Tonally, Professor Williams's contempt for his subjects impedes our understanding of them. And there is almost no attempt to use the clinical reconstructions of the dismal lives of these writers as a beacon to illuminate their poetry and novels. Morris Vogel presents a new style in hospital history, which turns away from the limited in-house productions of former years. Influenced by Charles E. Rosenberg, he attempts a history of an entire hospital community, set firmly in its city context. He traces the hospital from its medically and socially marginal pre-industrial position, serving only the sick poor within a framework of paternal stewardship, to its refor-mulation as a modern institution, central to the medical care of all classes. Taking a historical approach which cannot allow such monolithic models as the operation of social control or market forces to be the sole explanations of change, Vogel explores the reasons for increasing popular interest in "going among strangers when ill". He treats a number of important themes in the crucial period 1870-1930, from patronage to patient makeup. Most governors of Boston's early hospitals came from the city's Brahmins, and the primary aim of their philanthropy was social rather than medical. Poor discipline, for example, could be a reason …