The Necessity Among Us: The Owen Sound General and Marine Hospital, 1891-1985

Peter Strathy is Vice-President Planning, Doctors’ Hospital, Toronto.

Gagan is a professor of History and Dean of Humanities at Ontario’s
McMaster University. He has published two earlier works on Ontario
history.

The book provides a detailed account of the development of hospital
care in a small Ontario city and its surrounding region over a period of
100 years. However, the work has implications far beyond a description
of local events in Grey and Bruce counties. The activities at the
General and Marine Hospital represent in a microcosm the development of
public general hospitals all across Ontario after 1880. Health-care
needs and the political and social solutions developed by communities to
meet them changed often and dramatically during the period in question.
The hospital came into being, grew, and evolved in response to broad
social changes over time.

A description of Owen Sound in 1893, during a period of sustained
economic growth and vitality in Ontario, opens the book. Against this
background of economic prosperity, there existed serious public-health
problems and an absence of charitable mechanisms for meeting the needs
of the poor and the sick. The creation of the voluntary public general
hospital model was initially driven by charitable motives, with the
institution designed to meet the needs of the indigent. The rapid
development of the hospital over the next 100 years as an organization
designed to serve members of all social classes was in large measure
driven by the needs and demands of the middle class, who discovered
hospital-based care as an effective and economical way to deal with
health-care needs.

At the very centre of the hospital’s growth and change since the late
nineteenth century lies an unrelenting struggle by the board, the
community, and all levels of government to identify adequate funds both
for operating expenses and for capital projects related to a steady
expansion of services. Technological progress in medicine and allied
disciplines and the steadily rising demand for services have been and
continue to be an integral part of this process, which will continue
through the 1990s. Technical, economic, and social forces over the
decades redefined the original mandate of the institution, the
hospital’s customers, and the economics of the community hospital. The
debate over funding (who pays for which health services?) mirrors the
debate that continues to this day throughout the human-services field.
Within the overall debate can be found many specific issues that achieve
a resolution for short periods and are then reopened for further
discussion—for example, the role of physician-based care versus the
role of ancillary or alternative models; the best way to train nurses;
and community control versus central government control of hospital
management.

This book is well researched and supports its conclusions with
financial, medical, and demographic data, often organized in tables. It
includes a number of interesting black-and-white photos of the growing
hospital facilities.

The 100-year period covered by this book was one of great and profound
change in the organization and delivery of medical and health services
in Ontario. The historical analysis of the Owen Sound General and Marine
Hospital works well as a model to illustrate precisely this social
history.

This work is recommended as basic reading for all students of
health-care administration. It should be found on the shelves of all
medical and social sciences libraries, and will be of interest to
students of recent Ontario history.