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 32X 
 
 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 6 
 
ANSWER 
 
 OF 
 
 THE TRUSTEES 
 
 OF TlIK 
 
 TORONTO GENEKAL HOSPITAL 
 
 roTHE HEPOirr 
 
 OF 
 
 THK INSl'ECTOl! OF PRISONS, KTC, 
 
 LAIKLY I'UKSK.NTKl) To 
 
 THE LEGISLATnn^ ASSE:MBLY 
 
 «. ( 
 
 T ORG X T : 
 
 PRINTED AT THE LEADER OFFICE, G:? KIN'Ci STREET EAfiT- 
 
 1871. 
 
TO 
 
 3 
 
 PRl 
 
 K^h ifiS^-^ 
 
ANSWER 
 
 or 
 
 ■■■; 
 
 rl^ 
 
 IHE TRUSTEES 
 
 OF THE 
 
 m 
 
 TORONTO GENERAL HOSPITAL 
 
 U 
 
 TO THE REPORT 
 
 OF 
 
 THE INSPECTOR OF PRISONS, ETC., 
 
 LATELY PEESENTED TO 
 
 THE LEGISLATIVE ASSEMBLY. 
 
 TORONTO: 
 
 PRIKTBD AT THE LEADSR OFriCS, 63 Kl.Va 8TRBET EAST. 
 
 1871. 
 
(( 
 
I 
 
 ^0 
 
 r 
 
 ANSWER TO THE REPORT 
 
 OF 
 
 THE INSPECTOR OF PRISONS, &c., 
 
 RELATIVE TO 
 
 THE TORONTO GENERAL HOSPITAL. 
 
 The Trustees of the Tororto General Hospital have 
 lately seen the Report of Mr. Langmuir, the Inspector of 
 Asylums, Prisons, &c., presented to the Legislative Assem- 
 bly of Ontario, during the present Session, in which it ia 
 stated : "I visited the Hospital on the 8th December, on 
 " which day there were 94 patients in residence. Although 
 " perfect cleanliness and order cannot be looked for, or ex- 
 " pected, in an Institution of the kind, still I think a good 
 "deal more miglit be done to improve matters in this 
 " i espect, particularly on the male side of the house. The 
 "bedding in the male wing ward was far from clean, 
 " although the supply was sufficient. The revising of the 
 " dietary lists does not apparently receive sufficient atten- 
 " tion. The allowance, in many instances, on the day of 
 " my visit, was in excess of what was used. The practice 
 " of serving the whole bread rations for the day, at one 
 " time, is also objectionable ; some patients leave it until it 
 " becomes dry and unpalatable. From the accounts ren- 
 " dered to me, it appears that the cost of food, medicines, 
 " and medical comforts, is very much greater than the 
 "same service costs in the Hospitals at Kingston* and 
 " Hamilton, although the dietaries in the last-named Hos- 
 "pitals are quite as liberal, and better served, than in 
 "Toronto. 
 
 " The annexed statement exhibits the cost of each Hos- 
 " pital in respect to this service : — 
 
 
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 From this extract, it is to be collected from the Inspec- 
 tor's Eeport : 
 
 1st, — That there is a want of cleanliness and order in 
 tho "Wards. 
 
 2nd, — That there is a want of cleanliness in tho bedding 
 in the male wing ward. 
 
 3rd, — Th?<- the dietary lists do not receive sufficient at- 
 tention. 
 
 4th, — That the allowance in many instances, on the day 
 of his visit, was in excess of what was nsed. 
 
 5th, — That tli3 practice of serving the whole bread ra- 
 tions for the day, at one time, is objectionable, some pa- 
 tients leaving it until it becomes dry and unpalatable. 
 
 Cth, — That from the accounts rendered to him, the cost 
 of food, medicines, and medical comforts, is very much 
 greater than the same service costs in the Hospitals at Ham- 
 ilton and Kingston, although the dietaries in these Hospitals 
 are quite as liberal as they are in Toronto. 
 
 Tth, — That the meals are better served in these Hospitals 
 than they are in Toronto. 
 
 This Report is either correct or incorrect. If it be cor- 
 rect, and if the returns of the other Hospitals bo correct 
 also, the management of the Toronto Hospital, so far as the 
 cost is concerned, must be too extravagant and must be re- 
 formed. If it be incorrect, it is the place of the Trustees 
 to point it out. 
 
 As to the alleged want of cleanliness of the wards, and 
 as to the eervice and distribution, and alleged waste of 
 food, the Trustees entertain no doubt they can Eatisfactorily 
 answer these matters. These charges, too, even if well 
 Ibundcl, are very easily answered. More vigilance, and a 
 little more trouble taken, will at any time quite remove 
 them. 
 
EXPENSE OF MANAGEMENT. 
 
 Tho Trustees arc concerned more particularly in deal- 
 ing with the imputed expcnsiveness of their Trust, as 
 that is tho most serious charge, and the one in which the 
 public may probably take the greatest interest. The Trus- 
 tees have, since the appearance of the Eeport, examined 
 the details of the return which was made by the Secretary 
 of the Hospital to the Inspector. This return they did not 
 see before it was sent in. Tho Trustees find that a serious 
 mistake was made in the number of days which the stay of 
 the patients in tho Hospital for the year amounted to. 
 
 The number returned was 21,348. while tho true number 
 was and should have been 28,659. As the total number of 
 days is the division in all computations affecting the ex- 
 penses in question, an error in it must materially affect the 
 results produced. The mistake, tho Trustees believe, 
 originated in this manner : 
 The number of patients in the Hospital on the 1st of 
 
 October, 1869, was 63 
 
 The number of patients admitted to the Hospital 
 from the 1st October, 1869, to the 1st October, 
 1870, was 669 
 
 Total during that year 632 
 
 The number returned was 634 
 
 The 63 patients were in the Hospital after 
 
 the 1st October, 1869 7,783 days. 
 
 The 669 patients were in. 20,876 " 
 
 Making the total number of days. . . . 28,659 
 The Secretary, it is believed, must have omitted from his 
 return the stay of the 63 patients, and taken merely the 
 stay of the 569 patients. His return of 21,348 days does 
 not quite square with the 20,876 for the year patients, but 
 it is not very seriously different from it. It formed, no 
 
63 
 
 569 
 
 632 
 634 
 
 doubt, the basis upon which he made his return. This, at 
 all events, is our conjecture. The 63 patients in question 
 were in Hospital, it will be seen, on an average of 123 days 
 each ; several of them were in for considerably more than 
 200 days. A list ot tho time that each one was in ward 
 has been carefully made up. 
 
 The mistake referred to, which no doubt is a very serious 
 one, is not, it is plain, attributable to the Inspector. He 
 acted on the figures given to htm. The error, however, 
 attaches to the Eeport in fact, and tho results dependent 
 upon the former return must therefore be amended. The 
 same statement also shows $932.20 expenc'ed in Toronto 
 for milk, and nothing whatever for it is stated in the res- 
 pective Keports for Kingston or Hamilton. There is a 
 return of $55.39 made from Kingston for milk, but not 
 copied into the Inspector's tabular statement. The return 
 from Hamilton is, " Other expenditure, including milk, 
 $493.13." But how much of tliat is for milk is not stated 
 in the return, and no amount is stated by the Inspector for 
 the consumption of milk against the Hamilton Hospital. 
 It may be stated as at least $100. It appears in the same 
 statement also that there is a sum of $300 expended in 
 Toronto for water, and nothing whatever is paid for it in 
 Hamilton. The item of milk, before mentioned, the 
 Trustees will have to refer to when they explain the large 
 expenditure for beer and spirits. 
 
 The tabular statement, as amended in the number of 
 
 patients treated and the total days stay in the Hospital, 
 
 will be as follows : 
 
 Patients. Days. 
 
 Toronto 632 28,659 
 
 Kingston 504 14,743 
 
 Hamilton 466 19,572 
 
 It is singular, while Kingston had more patients treated 
 
 than Hamilton, that Hamilton should have 5,558 more 
 
 days stay in Hospital than Kingston had. 
 
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8 
 
 It is, perhaps, to be accounted for by the fact that in 
 Hamilton there is an outer ward, or thed, where persona 
 who require no nursing are kept in fooJ and medicii.e, but 
 wait entirely on themselves. There Avere IG such persons 
 hi that ward when Dr. Hampton, the Medical Superin- 
 tendent of the Toronto Hospital, lately visited it. These 
 persons, he represents, are not properly Hospital patients, 
 Vut are more fitted for a Poor House. The ward is not 
 properly an Hospital ward, but a poor ward attached to 
 the Hospital. These 16 persons, having nothing but the 
 Hospital regular allowance^ can be kept at a minimum cost. 
 Their support should not be estimated on the same scale as 
 those who are proper Hospital patients, who require extras 
 and special medical treatment. 
 
 The number of persons who passed through the Hospital 
 at Hamilton, in the year, is stated in the Inspector's 
 tabular statement at 476. In the Hamilton return it is 
 stated once at 466, twice at 476, and once at 486. From 
 the return 466 appears to be the proper number. The 
 return made is as follows : 
 
 In Hospital 1st October, 1869 38 
 
 Admitted during the year 428 
 
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 466 
 And the average number of days is stated to be 42 per 
 patient. The figures, 466 x 42—19,572 days. 
 
 The statement shows also an expenditure for Medicine 
 Medical Comforts for Toronto of $500.68. It should have 
 been $754.81, as the difference in amount had been sup- 
 plied, but not paid for when the return wa? made. 
 
 The following tabular statement, counting the persons in 
 the outer ward or shed at Hamilton as Hospital patients, 
 and amending the facts according to the preceding figures, 
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 Taking Kingston as a test of expenditure "witli Toronto, 
 it will be found that the latter, with nearly double the 
 number of days, has an expenditure of nearly double the 
 amount of Kingston for butchero' meat, groceries and 
 water, while fur butter, Kingston exceeds Toronto in ex- 
 penditure ; nearly equals it as to vegetables; and is two 
 thirds of it as to bread and flour. 
 
 As to these items the Toronto expenditure is $i:,008.10, 
 and the Kingston $2,374.09, the Hamilton expenditure as 
 to these items is by the preceding table $2,293.93. The 
 proportion between the Toronto and Hamilton days is 
 nearly as 3 to 2. Tlie Toronto expenditure should, there- 
 fore be one-half more than in Hamilton. That will make 
 the Toronto allowable expenditure $3,440.90, but as will be 
 seen it is $4,038.10, or $597.20 in excess of what it should 
 be taking the Hamilton expenditure as the proper test. 
 This last sum makes a difference of a little more than 2 
 cents per day per patient against Toront:. As to these 
 articles, Toronto is more below Kingston in expenditure 
 than Hamilton is below Toronto, 
 
 But if the shed, or outer ward, at Hamilton, be filled 
 with persons not properly patients, and receiving nothing 
 but the ordinary diet and medical treatment, and no 
 nursing or other attendance, the difference in economy 
 will probably be found to be very little, if any, in favour 
 of Hamilton. It is manifest then, that the chief difference 
 in the preceding corrected tabular statement in the expendi- 
 ture of these three Hospitals, does not arise from the items 
 last mentioned. 
 
 It must, therefore, arise from the other items under the 
 heads of beer, wine and spirits, medicine and medical 
 forts and milk : — 
 
 The Toronto expenditure for these articles was $2,463 54 
 Kingston " " " 420 93 
 
 Hamilton " " " 586 55 
 
 u 
 
 i 
 
11 
 
 1 Toronto, 
 3ouble the 
 :louble the 
 ieries and 
 nto in ex- 
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 8^,038.10, 
 nditure as 
 
 03. The 
 n days is 
 Lild, tliere- 
 will make 
 : as will be 
 
 it should 
 roper test, 
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 i to these 
 il^endlture 
 
 be filled 
 ? nothing 
 , and no 
 
 economy 
 in favour 
 difference 
 ! expendi- 
 :he items 
 
 nder the 
 medical 
 
 2,463 54 
 42G 93 
 586 55 
 
 < 
 
 Now doubling the Kingston expenditure would mako 
 that of Toronto, in the ratio before mentioned as to 
 Kingston $853.86 and by adding half to the Hamilton ex- 
 penditure, would make that of Toronto $879.82. But the 
 Toronto expenditure is nearly $1,600 above either ot 
 these sums. 
 
 It is in consequence then of the very large outlay for these 
 three items that the Toronto expenditure is raised above 
 that of the other two Ilospitnl-^. The prescriptions ot these 
 articles, as is evident, is and mii t be under the sole direction 
 of the Visiting Medical officers. The articles are used for 
 patients only — the medicine is given to out-door patients as 
 well, averaging about live per day — the spirits are nsed 
 also in making up medicines. The Trustees now show the 
 allowances ordered in the month of December last, 
 for beer and spirits and for milk, by the different 
 medical officers. The milk is the extra quantity beyond 
 that which every patient in the Hospital receives in the 
 daily distribution. The cost of the beer and spirits and 
 milk for Toronto was $1,708.73. 
 
 Dr. Aikins, to 19 patients, ordered 
 
 Dr. Berryman, 13 
 
 Dr. Rowell, 9 
 
 Dr. Richardson, 11 
 
 Dr. Thorburn, 7 
 
 Dr. Geikie. 25 
 
 Dr. Canniff, 22 
 
 Dr. Cassady, 20 
 
 Dr. Hodder, one f f the consulting 
 Physicians, ordered to one of the 
 patients 24 
 
 Dr. Hampton, Resident Medical Offi- 
 cer, ordered to patients in emer- 
 gency, and to some who were ad- 
 
 (i 
 
 u 
 
 u 
 
 (( 
 
 a 
 
 (( 
 
 li 
 
 it 
 
 « 
 
 u 
 
 i( 
 
 (( 
 
 Milk. 
 
 Beer. Whiskey. 
 
 pts. 
 
 pts. 
 
 0Z1. 
 
 558 
 
 177 
 
 810 
 
 262 
 
 74 
 
 848 
 
 340 
 
 61 
 
 424 
 
 412 
 
 62 
 
 990 
 
 389 
 
 102 
 
 386 
 
 1057 
 
 124 
 
 3100 
 
 712 
 
 64 
 
 994 
 
 774 
 
 136 
 
 1696 
 
13 
 
 mitted after the ordinary admis- 
 sion hours, until they could be at- 
 tendid t) by a visicin^ Physician.. 
 Used in Dispensary 
 
 lilk. 
 
 Beer. Whiskey. 
 
 pte. 
 
 pta. ot(. 
 
 f • 
 
 160 
 
 • • 
 
 360 
 
 Total 4,523 800 9,768 
 
 Equal 
 
 to, of 
 
 gallons, 
 
 tt 
 
 Milk, 56a 
 Beer, 100 
 "Whiskey, 76 gals. 2^ pts 
 
 (( 
 
 at 
 
 12ic. $70 75 
 25 25 00 
 
 85 64 86 
 
 Total expenditure $160 61 
 
 One of these patients, besides the ordinary Hospital diet, 
 received for the whole month as extras, daily, 2 pints of 
 milk and 1;^ pints of whiskey. 
 
 Another received for eight days, daily, 3 pints of milk 
 and li pints of whiskey. 
 
 Other two for some days received 3 pints of milk and 
 1} pints of whiskey. Another 4 pints of milk and 1 pint 
 of v/hiskey. Several got 4 pints of milk and some 
 whiskey, and so varying in quantities and times both as to 
 milk and whiskey. 
 The total cost of the month for these articles was $ 160 61 
 
 At an average for the year of $1,927 32 
 
 Which would be in excess of the 12 months from October^ 
 1869, to October, 1870, given in the tabular statement at 
 $1,708 73. 
 
 The great outlay which is made for beer and spirits and 
 for milk, and which, with the amount tor medicine, occa- 
 sions the real diflference of expenditure between this and 
 the other two Hospitals referred to, is a charge for which 
 the Trustees cannot rightly be deemed responsible; they 
 have invited and obtained the best medical advice and 
 skill to be had in the city, and they must, as they ought to 
 
eer. Whiskey. 
 
 Pt9. OM. 
 
 160 
 360 
 
 too 9,768 
 
 $70 75 
 25 00 
 64 86 
 
 . $160 61 
 ipital diet, 
 
 2 pints of 
 
 3 of milk 
 
 milk and 
 tnd 1 pint 
 nd some 
 30th as to 
 
 $ 160 61 
 
 11,927 32 
 
 October^ 
 
 ;ement at 
 
 irits and 
 30, occa- 
 this and 
 )r which 
 le; they 
 'ice and 
 ought to 
 
 13 
 
 do, trust that these gentlemen will order tl ..t which is right 
 and not more of anything than is necessary. 
 
 Whether a smaller niiml)er than eight visiting physician^ 
 would be a check upon any extravagant prescriptions in any 
 respect, may be a question, however, that may be the 
 Trustees must equally trust in the professional character and 
 experience of the medical men whom they appoi t, be they 
 few or many, in the due dispensation of every article which 
 they prescribe for the relief of their patients. 
 
 All the Trustees can be answerable for in this respect is, 
 in economically caryring out the medical directions, and 
 that, they believe they have honestly and successfully done. 
 
 There is no charge of nee less or excessive expenditure 
 which can be made against the Trustees. Nor have the 
 Trustees any reason to believe that there is any which can 
 be made against the Medical Officers. 
 
 The nature of the cases requiring such extraordinary 
 treatment as that which is before referred to, may be 
 altogether different from the cases which prevail in the 
 other hospitals. The Trustees are bound to believe 
 that the gentlemen composing the Toronto Hospital Staff, 
 the best or among the best and ablest in their profession, 
 have acted wisely and well in their own special department. 
 
 The Trustees believe they have now shown that the ex 
 penditure tor all the articles in the Tabular Statement of 
 the Inspector before mentioned, excepting the particular 
 items of beer and spirits and of medicine and milk, is pro- 
 portionately below that of the Kingston, and is but little 
 above that of the Hamilton Hospital. And from the special 
 cause before mentioned, it is perhaps not higher than it is 
 .even at Hamilton. They have shown that the princi- 
 pal groimd of difference is occasioned by the large outlay 
 for beer and spirits and for milk and medicine, and that for 
 such special expenditrue they are not accountable. But 
 that the medical visitors are alone answerable for it, they 
 
u 
 
 have also shown that the propriety ot that expenditure, 
 they do not and cannot dispute. They depend upon the 
 Medical officers for protection in that respect. And they^ 
 no doubt, can vindicate themselves if their practice or pre- 
 scriptions be called in question. 
 
 DIKT LISTS. 
 
 The charge respecting the dietary lists, the Trustees 
 think, have been very properly made by the Inspector. The 
 difficulty is how to deal with the subject. 
 
 The lists are settled by the Medical Visiting officerj for 
 their respective patients, and they should in general be 
 revised daily. 
 
 The Medical officers, however, though they should by the 
 present Rules of the Hospital, attend daily, do not do so. 
 Some of them have not attended and do not attend for three 
 or four successive days. The dietaries which they last 
 directed are, nevertheless, continued. The Resident Physi- 
 cian finds it a an exceedingly delicate act to interfere with 
 these prescriptions. 
 
 It happens, therefore, thai,t in many case the allowances 
 which ought to be altered, are not altered by reason of non- 
 attendance of the Medical Visitors. 
 
 The Trustees have had occpsion to complain of this, and 
 they endeavoured to remedy it, they suggested it would be 
 better to require only two or three of the Medical Staff to 
 attend daily, and to take upon themselves the entire medical 
 charge of the Hospital, tor some certain period, say for a 
 month. 
 
 So great a number as eight is not really required to attend 
 at one time. But the whole number would be required to 
 assume duty in rotation, in relief of tneir colleagues, if the 
 plan of the Trustees were adopted. 
 
 The medical gentlemen, however, with one exception? 
 rejected the suggestion proposed to them. 
 
 T 
 
 rule 
 
 T 
 
 oft 
 
 Insj 
 
expenditure, 
 
 d upon the 
 
 And they^ 
 
 tice or pre- 
 
 officerj for 
 general be 
 
 )uld by the 
 not do so. 
 id for three 
 they last 
 ent Phvsi- 
 irfere with 
 
 allowances 
 on of non- 
 
 ' this, and 
 would be 
 tl Staff to 
 re medical 
 say for a 
 
 to attend 
 quired to 
 les, if the 
 
 xception> 
 
 15 
 
 The Trustees believe it may be necessary to alter the 
 rule according to their own judgement. 
 
 The present system does not work properly. The opinion 
 of the Trustees coincides in this particular with that of the 
 Inspector. 
 
 It is right, however, to add, that the want of due atten- 
 tion to the diet rolls, does not in any serious degree increase 
 the expense of the Hospital. 
 
 The Trustees pressed the change upon the Staff as well, 
 for the purpose of securing to many patients in the Hospital 
 a daily visit of his Physician, so as to keep the unnecessary 
 expenditure down. 
 
 CLEANLINESS AND OEDEB. 
 
 Then as to the alleged want of cleanliness and order in 
 the wards : — 
 
 The Trustees must express their surprise, that so serious 
 a charge should have been made. They cannot suppose 
 that the Inspector desired to misrepresent any thing, but 
 they are sure, if he found the Hospital as he says he did, 
 that he must have seen it at a time when from some singu- 
 larly exceptional cause, the general condition of things was 
 not, as it usually is, both cleanly and orderly. There are 
 many ladies who visit the Hospital frequently in the course 
 of the year, and at all hours of the day, who can testify to 
 the cleanliness and order of the wards. They can speak with 
 effect on these matters, for they do not make a hasty nor a 
 single or cursory visit, and they would as housekeepers be 
 especially prompt in discerning such defects as the Inspector 
 has referred to, if they had found them. 
 
 But not only have these ladies neither seen nor spoken of 
 any want of cleanliness and order, but they have on many 
 occasions expressed themselves as much pleased with the 
 cleanliness and good order which they observed. Many of 
 them have, after their tour of the wards, eaid they were 
 quite surprised at the cleanliness and order obserTcd 
 
16 
 
 
 .ill 
 
 
 I '. : 
 
 throughout, and at the great comfort of and attention paid 
 to the patients, as thej had gone there under the impres- 
 sion, by some unknown means acquired, of matters being 
 very differently conducted. Eeference may be made to 
 these ladies, and their names wjll be given to any one 
 anxious for the truth, by the Lady-Superintendent, if it 
 should be desired. It is extraordinary that there should be 
 any prevailing notion of disorder, neglect and incompetency 
 ruling in the Hospital, when it is considered that it is open 
 every day of the year to all comers, who may get their in- 
 formation by direct personal observation, and whose attend- 
 ance has been urgently invited at different times by the 
 Trustees, for the very pu.pose of seeing how everything is 
 carried on. 
 
 '''■ would be but common fairness that those who condem 
 should first inform themselves of the facts on which they 
 assume to pronounce judgment, and that a public charity, 
 should not be impeached by what has been very vaguely, 
 though quite safely called " a good many about Toronto." 
 It may be tasked who are the good many ? What did they 
 complain of? To whom and when did they complain? 
 And what was done or what was desired to be done upon 
 their complaint? 
 
 These matters must not be suggested, they must be spoken 
 plainly out. 
 
 The administration of a public trust deserves plain and 
 open dealing. The public are entitled to know all about 
 their charities. If they are not well administered speak 
 out, that enquiry may be made, and amendment obtained. 
 The Trustees and other Hospital officials, do not ask and 
 are not entitled to get any improper indulgence or forbear- 
 ance ; their conduct is open to, and they invite, enquiry. 
 It is not fair to resort to suggestion or insinuation on the 
 authority of so intangible a complainant as " a good many 
 about Toronto." 
 
 
 
i 
 
 ention paid 
 ihe impres- 
 ■ttera being 
 e made to 
 to any one 
 dent, if it 
 > should be 
 ompetency 
 it is open 
 >t their in- 
 ose attend- 
 es by the 
 'rything is 
 
 10 condem 
 hieh they 
 c charity, 
 
 vaguely, 
 Toronto." 
 
 did they 
 omplain ? 
 •ne upon 
 
 >e spoken 
 
 lain and 
 
 11 about 
 d speak 
 btained. 
 ask and 
 forbear- 
 enquiry. 
 
 on the 
 many 
 
 17 
 
 No complaint of any kind has ever been made to or of 
 the Trustees or officials of the Hospital, excepting by the 
 Inspector, and it is not likely that " a good many about 
 Toronto" could have ever made any complaint of the kind 
 without the knowledge of the Truritcos. The omplaint of 
 the Inspector requires, of course, a special con, ideration. 
 He visited the Hospital, as he says, on the 8th of December. 
 That day was on Thursday. The Medical Resident-Super- 
 intendent, who had long been sutferingfroui a severe illness, 
 and who then had not quite recovered from it, was absent 
 for a few days in the country. The Lady Superintendent 
 and an assistant of the Medical Superintendent, were then 
 in the Hospital. The Inspector did not ask for nor did he 
 see the Lady Superintendent, who is the person principally 
 answerable for the cleanliness and order of the wards and 
 for the condition of the bedding. 
 
 If he had seen her, and shown to her, what it was he 
 he found fault wdtli, it is very probable, and as the Trustees 
 think, it is absolutely certain, that she could have given a 
 most satisfactory account for the state of things, if they 
 were as he represented them. He has said that the bedding in 
 Male Wing ward was far from clean. The sheets and 
 pillow cases in the wards are changed every Saturday 
 morning, though in special cases, they have to be changed 
 every day, and sometimes two or three times in the day ; 
 now the sheets cannot be expected to be quite so clea:: on 
 Thursday after nearly a weeks' use, a? tliey are on Satur- 
 day. Then again the sheets of an hospital must not be 
 tested by those of a private family, nor even by those of 
 a gaol or lunatic asylum or poor house, for in these cases 
 the sheets are not subject to more than the ordinary use of 
 them by occupants of the beds. But in the case of an 
 Hospital, the sheets (and whether it be the newest and best 
 it them or iuc oldest and worst, makes no difference.) arc 
 stained and discolored by all kinds of medical applications, 
 

 18 
 
 and by blood and nlcoroiH niiittor, find from otlicr canses 
 \,hicli it is manliest ctmnot bo avoided from sick and 
 weekly patients. Tlicsc shoots tliongh thoy may be anc' 
 are carefully cleaned and pui-itied, cannot have their stains or 
 discolorations removed, nor can thev be cast aside — thc^ 
 must continue to be used so loiiu' as thoy are lit for the pur- 
 pose, for the sheeting is a costly item in Hospital ex])endi 
 ture, and if it continues to be used, it is plain, it will not 
 look so well or so clean as an unstained article. Then let 
 it be considered what class of persons many of those in the 
 nosi)ital are. A class that it is dillicult and in some cases 
 impossible to make cleanly or to keep clean, and Avho are 
 not very considerate as to the use they ])Ut any artice to, 
 whether of bedding or otherwise, which is not their own 
 property. These stained sheets and pilloM' case< are apjDro- 
 priated chiefly to what is calleil the lUind Avard, the very 
 ward in which the Inspector said to the Hospital Medical 
 Assistant, who was with him in liis round, that the bedding 
 was not clean, and of which he says in liis Keport that it 
 was far from clean. 
 
 The ward in which the l)edding was said not to have 
 been clean, was in the Blind ward, not 'oi the Male Wing 
 ward, as he has stated. The IJlind ward is t'le one in 
 which the most uncleanly and most troublesome of the 
 male patients are put, and in which the worst of the bed- 
 ding is used. The bedding, by wever, is clean, all that can 
 be said of it is that it has had more use, and worse use than 
 that which is appropriated for the olier wards. 
 
 Duriuo- the last vear, not less tliiMi 'JiX) slieets have been 
 rendered unserviceable bv ill usnaiie and stains, ancl have 
 
 been a'iven up fur bandai>-ef 
 
 ind at this moment a laro-e 
 
 supply of new sheeting i^ absolutely re(piircd. If the 
 Inspector had cnc|uire<l for, and had seen the Lady Super- 
 intendent, she could have informed him of all these matters, 
 and -we should not have had so sei'ious a charge '^ade 
 
 i 
 
lU 
 
 I 
 
 til or causes 
 I siek and 
 ay l)e anc' 
 t'ii" .stains or 
 iside — tliei 
 for tlic i)iir- 
 1 ox])eiKli 
 it will not 
 Then let 
 liuse in the 
 some eases 
 (1 wlio are 
 ' artico to, 
 their own 
 are appro- 
 , the very 
 al Medical 
 he beddinj; 
 
 I O 
 
 ort that it 
 
 )t to have 
 [(de Wing 
 the one in 
 nie of the 
 f the bed- 
 II tliat can 
 ;e nse than 
 
 have been 
 and have 
 it a large 
 1. U the 
 dy Saper- 
 m matters, 
 iro-e '^ade 
 
 a^-ainst the nianii^'oment of tlic Hospital in this respect. 
 If the blankets or coverlids be meant a.s having been u»- 
 cleanly, and it must iKMlillicult tosavc them altogether il 
 the sheeting be treated ho badly, the Trustees can only say, 
 they were there as they are now, and as they nniy be 
 seen any day in llu^ year by any one who chooses to judge 
 for himself 'i'lie coverlids are light cuk>red and are in use 
 ni'dit and (lav. \\\ the Kinu'st(»n Hospital, it Is believed, 
 the coverlids are used only during the day, aiid are 
 removed at night. In Hamilton there are no light coverlids, 
 and the blankets are all gray. 
 
 Gray l)lankets, as cxqvw one knows, show the eifectof use 
 or ill nsaire mncli less thin white ones, such as are used in 
 Toronto will. If there bo uncleanliness, imputed by the 
 Inspector, in any other ])art!cular, the Trustees are not 
 aware in what it consists or to what it refers. 
 
 It may be that at times an iros]ntal is not in the same 
 orderly state that it usually is. The same nuiy be said of a 
 private residence. Let the case of a p .vate family be taken, 
 in w'hich one of the members is sick. Is that sick room at 
 all hours of the day in the same orderly condition which 
 commonly distinguish it '. Are there no arrangements to be 
 made — this thing to be smoothed — that thing to be removed 
 — another thing to be put on — chairs, tables to be placed in 
 order — same sweeping or tidying to be done, before a visitor 
 or even the doctor is introdnced i 
 
 JS^ow apply that to a large ward containing thirty or forty 
 patients, of not the cleanest or most considerate class, and 
 it w'ill be evident that too much mav be occasionlv exacted 
 of the public sick room, with a scanty force of nu'ses, 
 when so much has to be done for the private sick room with 
 its one patient, and all the family lor nurses at command. 
 The wards of the Hospital are open at all times, and to all 
 respectable persons, and they are always in a good and 
 orderly condition and fit for inspection. But if they are 
 not so at any particular time the Trustees are sure the 
 
I 'pi 
 
 1 1' !" 
 
 .\'y. 
 
 ■ ii 
 
 V I 
 
 SO 
 
 occasion of it can bo niul ■will bo tound to be fully capiiblo 
 of the most Btitinfiictctry explanation. TIm^ Trustees now 
 submit to every tliiiilviiii;; and considerate person'ti mind, 
 how far the hasty examination of an imur (n* so, of even tho 
 most careful and competent ofllcial, fan be liila'ii to bo a 
 correct representation of the true condition of aifairs in tho 
 Hospital, opposed to the opinions of those persons whose 
 opportunities for judgiui^ arc so much letter tlian his, or 
 whose duties enable them to form at least as sound an 
 opinion as it is possible for him to do. 
 
 The Trustees have not yet spoken of the spor>ial fitness of 
 the Resident Medical Suporintendant, Dr. Jlaiiipton, and 
 of the Lady Superintendants for their respective \ laces. 
 They do not think it would be proper to close their observa- 
 tions on this part of the Reitort, Avithout referring to them, 
 as they are the persons most immediately interested in the 
 charges which have been made. 
 
 These oflielals wonld not tolerate for a moment any- 
 thing -which was contrary to the ruh^s of the house, and 
 cleanliness and order by these rules, and with these officials, 
 are virtues of the first consequences. They too arc always on 
 duty, they are never relieved from it (except in sickness,) 
 night nor day. They have devoted thenis'-'lves to the full 
 and faithful discharge of their heavy duties, and they dis- 
 charge them perfectly. In this recommendation the 
 Trustees must also include the two very able and zealous 
 Medical Assistants, Mr. Reed and Mr. Taylor. 
 
 It is a matter of concern then to the Trustees that those 
 persons so adcqu.ately performing all that is required of 
 them, and in whom they have the greatest confidence, 
 should be charged without just cause, with neglect in matters 
 of so much consequence as cleanliness and order in an 
 institution of this kind. 
 
 m 
 
21 
 
 SKUVICK OK MKALS. 
 
 An to tlio serving of tlic luviul. It is cliar};;e(l that it ia 
 iiii[iroper to servo to eacli patient his or her ulltjwaneo for 
 the (lay at one time, instead of lialf of it in tlie niorninf; 
 and llie other half of it in the afternoon. It is, if afiuhjcet 
 of iniportanee at all, one mo.st easily corrected. It is not, 
 however, a merely speculative matter ; it is one rather to 
 he determined hy the practical Avorliing and convenience 
 of the onstom. The patients do not complain, and never 
 have complained of the practice, ai'don speaking with them 
 on the suhj ct but a few days ago, they Bay they do not 
 wish it changed. Some of them say it is hotter as it is, 
 others say it is not of the slightest consequence how it is, 
 that they would as soon have it as it is now delivered, as any 
 other v/ay. Is'ot one of them said the bread was over left, 
 because it had become " dry and unpalatable." 
 
 The Inspector does not himself say so. 
 
 He says, " Some patients leave it until it becomes dry 
 and unpalatable." The i)atients, however do not say so. 
 They do not leave it at all. There arc not three pounds of 
 bread carried out of any ward, of twenty -live or thirl y 
 patients, unconsumed, in the whole twenty-four hours. 
 
 If the patients do not wish any change to bo made in the 
 mode of service, it cannot be objectional, and if they do 
 not leave any of it unconsumed, they cannot leave it because 
 it has become dry and unpalatable. Some patients do not 
 consume their full allowance of bread at times, but when 
 they do not others do it for them, for there are always some 
 in the wards vrho will eat more than their omii share. 
 There is no waste, not a particle of it, and the. c is not a 
 patient who suffers or complains of this alleged objectional 
 method of distributing the bread. The Trustees hope this 
 will be deemed to be a su(licient answer to the charge to Avhicli 
 it applies. Then, it is said by the Inspector, that the meals 
 
ijiil: ! 
 
 f?2 
 
 are " better served" in the Kingston and Hamilton Hospitals, 
 than they are in the Toronto Hospital. This the Trustees 
 understand to mean, not that they are too well served in 
 these places, but that they are not sufficiently Avell served 
 in Toronto. This is an imputation of a very vague and 
 unsatislactory nature. The Trustees can only say, tliat 
 there are nurses in the the Toronto Hospital, who were 
 nurses in the Hamilton Hospital; one of them for two 
 years, the other for nine months, and thoj say there is no 
 difference that they know of in the mode of serving the 
 meals in the two places, excepting that in Hamilton, half 
 the allowance of bread is given in the morning and the 
 the other half in the afternoon (and to that the Trustees 
 have already referred,) and that the meat is divided in the 
 kitchen, and carried up in separate plates to the patients, 
 while in Toronto the meat is taken up uncut into the respec- 
 tive wards, and there carved to the different patients. 
 
 The Trustees suppose that it cannot be of much conse- 
 quence whethor the carving is done down stairs or up 
 stairs. Of the two methods, they believe the up stairs one 
 to be the best, and the most convenient. It is the best 
 because the sup])ly for each patient is warmer, ami it is 
 more convenient because a few large dishes arc more 
 readily handled than eighty or ninety small ones. 
 
 K, then, the dietaries in these Hospitals is quite as 
 liberal as in the Toronto Hospital, which is some praise, 
 though of the faintest kind, for the Toronto Hospital, in 
 what does the ''better service" in these Hospitals consist? 
 In this Hospital everything is given in the usual manner, 
 and in perfect cleanliness, by persons who are anxious to 
 do everything that is beneficial to the patients. 
 
 T he p iblic may, at any time, visit the Hospital, and see 
 in wh.it manner the serving-up is done, and judge for 
 themselves. 
 
23 
 
 The patients, again, have made no complaint in this 
 respect, and they no doubt are better judges of what is best 
 for them in sucli a case. 
 
 The Trustees have also been informed tliat tlie Inspector 
 did not see anything but the common gruel allowance 
 served up in the Toronto Hospital at the time of his visit, 
 so that they arc the more surprised at this disadvantageous 
 comparison. The Trustees have been informed that the 
 Inspector asked many of the patients how they w^ere treat- 
 ed, and they informed him, one and all, that they were 
 treated with great kindness and attention, and that they 
 had no complaint to make. If so, why were tlie.-;e facts 
 not communicated as to this Hospital as well as with res- 
 pect to the Hamilton Hospital ? Why, when so much has 
 been said against the Toronto Hospital, was that which 
 was favorable to it not told too ? This mode of reporting 
 is not satisfactory. 
 
 HOSPITAL TKOPERTY. 
 
 The Report, in another respect, too, is not accurately 
 made. It is not correct in its account and disposition ot 
 the property of this Hospital. And the account which is 
 given of it is expressed, as in other instances, in a depre 
 ciatory and unfriendly manner. It is said the Hospital 
 was endowed " with 386 acros of land in the east of the 
 " City. The site of the Old Hospital containing six acres, 
 " and six acres of land west of Church, on Adelaide, Street, 
 " with other valuable lots." 
 
 " The income received from property belonging to the 
 " Hospital last year amounted to 85,20J:. The income 
 " derived from this source is all that is left of the mafjnifi- 
 " cent endowment of 1819." 
 
 Now, one acre of the six acres of land west of Chui'cli 
 Street, on Adelaide Street, though granted to the Hospital, 
 was taken from it again in 1825, by the Crown, and given 
 
^' I't 
 
 ivm 
 
 24 
 
 to St. James's Cliurcli, which property the Trustees after- 
 wards tried to recover, but failed to do so. The facts were 
 fuUv reported in G Grant 485, in Chancery, and in appeal 
 7 Grant 130, and in the Journals of the House >f Assembly 
 of U. C. of 1830-1840, vol. 1, part 1, fol. 313. 
 
 This accounts for the loss of a very valuable portion of 
 the property. The Trustees are not aware of any other 
 valuable lots which were granted to • the Hospital than 
 those named. There was, however, one valuable lot grant- 
 ed in 1835, containing on acre of land, on the south side of 
 King street and west corner of York Street. A very large 
 portion of the 38G acres of land at the east end of the City, 
 and the whole of the 5 acres of the block on Adelaide 
 Street, were disposed of manv years ago, when property 
 was not of much value. So it cannot be assumed that 
 what would, if held at the present time, be a magnificent 
 endowment, can now, with the present demand upon the 
 fund, and the small sum got for so much of it in former 
 times, be properly described as a "Magnificent Endow- 
 ment." It certainly was so at the time of the grant, and it 
 was thought it would have continued to be such for all 
 time to come. But the income of $5,204 is not all that 
 is left of this Endowment. The Trustees have the Hospital 
 building, and block on wdiich it stands, less the Debenture 
 debt of $56,000 against it. And they have a large undis- 
 posed portion of the Old Hospital block, north of Kmg 
 Street and west of John street ; and they have the capital 
 fund, in the form of real estate, which represents the pro- 
 duct of the $5, 1 04 — which is really worth more than the 
 product capitalized, though more cannot be procured for it 
 at the present time. When the leases of such property 
 come to be renewed, much more than the present yield for 
 it will be obtained. The Trustees estimate the present 
 value of their property, over and above their liabilities, at 
 the sum of $154,000, which is a very different account of 
 
ie3 after- 
 
 cts were 
 
 n appeal 
 
 Lssemblj 
 
 )rtion of 
 ii.y other 
 tal than 
 ot grant- 
 side of 
 ry large 
 ihe City, 
 Adelaide 
 property 
 ned that 
 ^nificent 
 ipon the 
 n former 
 Endow- 
 it, and it 
 1 for all 
 all that 
 Hospital 
 !benture 
 e undis- 
 3f King 
 s capital 
 he pro- 
 lan the 
 id for it 
 roperty 
 ield for 
 present 
 ties, at 
 )unt of 
 
 25 
 
 the " Endowment" referred to in terms which indicate it 
 as almost dissipated, according to the Report of the In- 
 spector. All that remained in 1840 of the 38G acres was 
 about $21,000, representing all that was then outstanding 
 and unpaid on account of sales made before that time, and 
 an unsold portion which did not then exceed 25 acres. 
 That unsold portion is still possessed by the Hospital. It 
 has all been leased, and is yielding rent, though not a very 
 large amount. The Report of the Committee at that time 
 stated " that the principal fund has been very seriously 
 intrenched upon, and if a similar system is pursued, in a 
 few years the whole property will be entirely exhausted." 
 But a similar system has not been pursued. All that did 
 remain of the Endowment at that time remains still. It 
 will not be parted with, but will be let on lease on tenns 
 beneficial to the Trust. 
 
 The fund would, however, have been much larger, if so 
 great an expenditure had not been made on the present 
 Hospital. It was, and yet is, larger than was or is required. 
 The Trustees were providing too bountifully before the 
 time. But let it not be supposed that the building will not 
 be required, capacious as it is. Nor let it be supposed that 
 the price of it has been thrown away. The building repre- 
 sents, in value, the cost of its erection. The rapidity in 
 the growth of the City, and oi the surrounding country,, 
 will yet (and within the present generation) tax its capacity 
 to the utmost to provide for the necessities of the class for 
 which it was founded. "When that time arrives, the fund 
 which yields now only $5,104 wiM, with the letting of the- 
 vacant property still on hand, provide a rental three or four 
 fold the amount of the present income, and that sum will 
 enlarge with every successive renewal of lease. It cannot 
 then be said that a fund which has erected so magnificent 
 a building, and which consists of so large and so improving 
 
26 
 
 a rental, is only $5,104-, and is all that '" is left of the mag- 
 nificent endowment of 1819." 
 
 The ohservation implies waste, miscondncf and misman- 
 agement of the Trust property. The principal of the fund 
 was necessarily used for the purposes of the Hospital before 
 1840, as the Report of the Committee before referred to 
 shows. Since that lime the fund has been carefullo pre- 
 served and enlarged. 
 
 The observation, too, made in this oif-hand mannet, may 
 reflect on the present Trustees, who have been in office not 
 yet three years, and one of them but one year — none of 
 whom have had any hand in the diminution of the Trust. 
 
 If it was any part of the Inspector's duty to exclaim 
 against the misappropriation of the Hospital Fund, he 
 sliouid have called for an account of the property granted 
 to the Hospital, and of its dispobition, and he would have 
 spoken then with authority and effect. 
 
 The following memorandum will show generally in what 
 manner the means of the Trust have been used in the 
 building of the Hospital : 
 
 The cost of the erection of the Hospital has 
 
 been, to date $95,805 54 
 
 Interest on Debentures 52 398 00 
 
 Debentures redeemed s 000 00 
 
 $156,203 54 
 To meet this expenditure there has been : 
 
 Proceeds of Debentures ($64,000) $60,698 00 
 
 Sale of Bank Stock 15 o54 00 
 
 Received on account of sales 14 560 00 
 
 $90,312 00 
 
 "Which leaves a balance ot $65 891 54 
 
 Which has been paid out of the ordinary resources of the 
 Institution. 
 
27 
 
 o 
 
 iisman- 
 jio fund 
 
 before 
 frred to 
 '^o pre- 
 
 't, may 
 ce not 
 one of 
 'I'nst. 
 |xclaim 
 id, he 
 fi'anted 
 iiave 
 
 I what 
 n the 
 
 )5 54 
 
 )8 00 
 '0 00 
 
 3 54 
 
 I 00 
 
 : 00 
 
 00 
 
 00 
 54 
 he 
 
 The Trustees have also made advantageous purchases of 
 property, which yield profitable returns; and they have 
 also erected several houses, which are all under lease. 
 
 The Trustees feel aggrieved by the Report of the In- 
 spector in the parts of it to which they have referred. 
 They have answered the charge of extravagance which he 
 properly made against them upon the erroneous figures 
 which were given to him. And they hope, as they believe, 
 they have fully established their economical management 
 in all matters on which they can exercise their own inde- 
 pendent judgement. They believe also that they have 
 satisfactorily answered the other charges, objections and 
 observations which have been unjustly made against them, 
 and against the Hospital which they represent ; charges 
 which must oi)erate greatly to the injury of the institution, 
 unless they are promptly and eflfectually aiiSwered. 
 
 The Trustees ha\ e been obliged to meet these charges. 
 They desired to do no more than to meet them. They 
 have no wish to make any unjust comparisons, nor to reflect 
 unnecessarily on any one. Their purpose has been defen- 
 sive merely. The public had the right to require of them, 
 as representatives of so important a charity, some explana- 
 tion by way of answer to the serious charges which have 
 been laid officially against them, or that they should sur- 
 render the Trust which, it is imputed, they have not fitly 
 administered. 
 
 By order of the Board. 
 
 J. W. Brent, 
 
 Secretary. 
 Committee Room, 
 
 Toronto, 14th Jan., 1871. 
 
 The Trustees regret they have not been able to publisli 
 their answer at an earlier day.