Boston City Hospital

BOSTON CITY HOSPITAL, an amazing complex of buildings in a dreary corner of the South End, was never really planned. Like the city it serves, "City" grew haphazardly and in quirks through the last years of the 19th century and through the first third of this century. The jumble of buildings, none of them new, each seemingly done in a different architectural mode without concern for the total environment, and all of them connected by a weird system of tunnels, reflects the different plans that different generations have proposed to fulfill the hospital's prime purpose: the service of the indigent sick.

Today City does seem to be filling that need. Its only patients are Boston's poor--Negroes, Puerto Ricans, derelicts, and the whites who have been left behind in the South End. The quality of service is the best the government of Boston can provide. In return for medical care, Boston's medical schools are allowed to use the patients at City as teaching cases. It is a system which was set up at the turn of the century and for most of these years has been the most effective means of providing Boston with charity medicine. From the Civil War through the Depression of the 30's, City thrived. It was the only place where the poor in Boston could go. The resulting variety of cases was immense, and medical students even scrambled to obtain residencies and research posts there.

Rseearch performed at City and social legislation enacted in Washington, however, were by the end of World War II spelling the end of the need for a hospital of City's scope and purpose. The huge, 500-plus-bed South Department gradually became obsolete. Created as a hospital-within-a-hospital, South Department was designed for victims of "contagious diseases." It is physically isolated from the rest of City. Brick walls and iron fences set it off from the neighborhood; entrance to South Department can be gained only through a few central gates.

Vaccines and preventive medicine have eliminated most of the "contagious diseases." Today, South Department for the most part stands empty and closed. Some of its buildings have been put to use as psychiatric and day-care centers, but South Department's basic function is gone.

MUCH of City is that way today: empty and unneeded. But medical research is only partially and indirectly responsible. There are just not enough people left who are unable to go to a private hospital or to choose their own doctors. "Medicare and medicaid have made obsolete the concept of charity medicine," says Dr. Andrew P. Sackett, Boston's Health and Hospitals Commissioner. The fact that City lies in Boston's oldest and most horrible slum somewhat obscures the meaning of this fact. There are people who do need a charity hospital; the small waiting room at City's admitting office is full of confused, bewildered, weary people who are hardly--if at all--aware of medicare.

But to devote the massive plant of City Hospital to the few who still need a charity hospital is to provide them and Boston with a disservice. The care given the poor today at City, while decent, is not adequate. There is no need for a full staff at City anymore, and the result has been that some parts of it are hardly staffed at all. The few patients who must go there suffer.

One obvious suggestion is to close down City completely and replace it with a smaller general hospital for the South End. But a hospital of this scope would not be adequate enough for the clinical training needs of the medical schools that currently service City--Harvard, Boston University, and Tufts.

Solution of these two problems--medical care for the poor, and clinical training for medical students--will not be gained by metaphysical and physical re-construction of the old City Hospital or by construction of a small South End Hospital. The entirely new nature of medical care calls for an abandoning of stop-gap proposals and anachronistic wishes. Boston's citizens and Boston's medical students deserve more than sloppy attempts to avoid some very basic problems.