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REPORT 
 
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 IvlEDICAL FACUI 
 
 ,TY. \ 
 
 1 
 
MONTREAL GENERAL HOSPITAL. 
 
 '^^'^0^**~ 
 
 REPORT 
 
 Off 
 
 COMMITTEE OF MANAGEMENT. 
 
 The undersigned, who were appointed by the Committee 
 of Management of the Montreal General Hospital to con- 
 duct the enquiry ordered by a resolution of the Board of 
 Governors, as to the cost of carrying on the Hospital, now 
 beg to make their report. 
 
 They have made an extended enquiry into the matters 
 referred to them, have personally inspected the working 
 of tho Hospital in all its details, and have examined the 
 different members of the Hospital staff. 
 
 Mr. Pimsoll kindly undertook to compile from the 
 books detailed statements of the working of the Hospital 
 for the last eight years, and they proved of great use to 
 your Committee in conducting their enquiry. 
 
 The general position of the Hospital funds appears to be 
 as foUows : 
 
 On the 1st May, 1870, the hospital owned various secnrities and 
 mortgagesof the value of $83,500 
 
 On the 1st May, 1877, the value of the securities held by the 
 Hospital amounted to 79,966 
 
 »-. Reduction $ 3,534 
 
 '^CL^X'l 
 
The following statement shews the receipts during the 
 last eight years and the total expenditure : 
 
 REVENUE. EXPENDITURE. 
 
 — -♦- 
 
 1870 
 1871 
 1872 
 1873 
 1874 
 1875 
 1875 
 1877 
 
 Ordinary. Extraordinary. Total. Ordinary. Extraordinary. 
 
 ,;0 
 
 20,741.83 
 25,812.58 
 28,771.68 
 32,342.93 
 29,916.46 
 40,746.70 
 30,199.48 
 35,749.63 
 
 6,611.94 
 6,214.46 
 5,930.00 
 3,586.66 
 8,987.12 
 5,971.60 
 
 =ac: 
 
 $244,281.29 1 36,301.68 
 
 20,741.83 
 25,812.68 
 34,383.62 
 38,.')57.39 
 35,846.46 
 44,333.36 
 39,186.60 
 41,721.13 
 
 19,727.42 
 19,837.77 
 22,413.13 
 24,423.74 
 33,797.10 
 34,073.35 
 38,206.24 
 42,861.97 
 
 280,582.971 235,340.72 
 
 6,651.94 
 484.55 
 
 6,847.05 
 11,216.17 
 25,161.18 
 
 7,410.35 
 
 9,222.32 
 
 Total. 
 
 19,727.42 
 25,489.71 
 22,897.68 
 31,270.79 
 45,013.27 
 69,224.53 
 45,616.69 
 52,084.29 
 
 65,983.56 301,324.28 
 
 From this it appears that the ordinary expenditure in 
 the eight years amounted to a total of $235,340.72, or 
 au average of $29,417.66 per annum. 
 
 The expenditure in 1870 was $19,727.42, whilst in 1877 
 it had risen to $42,861.97, or more than double. 
 
 The total number of in-door patients treated in 1870 
 was 1392 and in 1877 a total of 1907, or an increase of 
 515, or about 37 per cent. (See table A in Appendix.) 
 
 The cost per patient in 1870 was $14.17 and in 1877 
 it was $22.47. (See table B in Appendix.) 
 
 The total ordinary revenue for the eight years amounted to 
 $244,281.29, or an average of $30,535.16 per annum. 
 
 The extraordinary revenue in the eight years was 
 $36,301.68, and the extraordinary expenditure in the same 
 perioc*. was $65,983.56. 
 
 This last amount includes the entire renovation of the 
 existing buildings, the balance of the cost of the Moriand 
 ■sving, and i-he purchase of the additional property acquired 
 for the proposed extension of the Hospital. 
 
 There is still due in the shape of mortgages on the 
 property purchased the sum of $18,248.80. 
 
 The amount expended out of the funds of the Hospital 
 for the completion of the Moriand wing has amounted to 
 the sum of $13,106.87. 
 

 The valuation of the real estate and buildings now 
 amounts to the sum of 8151,000, as against 8100,220 in 
 1870. 
 
 The improvements effected in the Hospital, althou*:;!! 
 costing a very large sum, have been most important and 
 beneficial. The basement has been entirely relaid witli 
 cement, and has very largely improved the sanitary condition 
 of the Hospital, liie wards have been very greatly im- 
 proved in size, ventilation, warmth in winter, and in all the 
 conveniences required in a Hospital. In fact the present 
 Hospital has been immensely improved in every respect by 
 the expenditure of the last eight years, and is now in a 
 good and useful condition for the work it has to do. 
 
 The detailed statement of the extraordinary expenditure 
 is given in table C in the Appendix, and also the extraor- 
 dinary revenue. 
 
 This may be summed up as follows : 
 
 Commutation of ground rent $5,011.02 
 
 Morland vring 13,106.87 
 
 Purchase of property 25,266.00 
 
 Improrementa in old Hospital 22,554.67 
 
 Total $65,938.56 
 
 Having thus explained what may be called the Capital 
 account of the Hospital, the Revenue account will now be 
 dealt with. 
 
 In table D, in the Appendix, the details of the sources of 
 the ordinary revenue are given, amounting in eight years 
 to a total of 8244,281.29, or an average of 830,535.16 per 
 annum. 
 
 In table E in tlie appendix the details are given of the 
 yearly expenditure, amounting in the aggregate to the sum 
 of 8235,340.72, or an average of 829,417.66 per annum. 
 
ar 
 
 6 
 
 It may be as well to give, for convenience of comparison, 
 an abstract of the total cost for each year, the number of 
 indoor patients treated, and the average cost per patient, 
 
 Ftar. N). qf Patitnti. Total Cott. Avtraga. 
 
 m ■ ■ ■■ t 
 
 1870 1,392 fl9,737 fl4.l7 
 
 1871 1,559 19,837 12.72 
 
 1872 1,695 22,413 14.05 
 
 1873 1,821 24,423 13.41 
 
 1874 1,918 33,797 17.62 
 
 1875 1,966 34,073 17.34 
 
 1876 1,970 38,206 19.39 
 
 1877 » 1,907 42,861 22.47 • 
 
 From this it will be seen that the great increase of cost 
 has taken place in the last four years, and especially in the 
 last two years. To a considerable extent, no doubt, this 
 may be attributed to the increased cost of many of the 
 articles used in the Hospital, and to the greater comforts 
 and care bestowed upon the patients. 
 
 On the other hand the improved physical condition of 
 the Hospital should tend to diminish the cost of carrying 
 it on in some respects. 
 
 An examination of table E will shew that the principal 
 increase in cost has occurred in the following items : 
 
 1. Insurance from S175.27, in 1870, to $796.93, in 
 1877. The last sum includes the premium for three 
 yeart. 
 
 2. Salaries, non-medical, from $1,020 to 81,852. 
 
 3. Food, milk, &c., from $8,417.12 to $14,944.98. 
 
 4. Bedding, linen, &c., from $414.52 to $1,687.03. 
 
 5. Fuel, water, gas, &c., from $2,777.69 to $3,698.73. 
 
 6. Servants' wages from $1,776.73 to $7,237.48. The 
 great increase in this item has been during the last two 
 years. 
 
 7. General expenses from $509 in 1872 to $5,912.«,7 
 in 1877. ". „ . -^ 
 
 I 
 
 . 
 
 r*:*. 
 
f 
 
 V. 
 
 Items 1 and 2 are hardly capable of much improvement, 
 except that proper care would probably reduce the conaumi^ 
 tion of gas. 
 
 The great improvement in the mode of heating, adding 
 so very greatly to the comfort and health of the patients in 
 winter, has increased the consumption of fuel. 
 
 The items of bedding and linen (4) must be considered 
 as necessary, and likely to be heavy in future. 
 
 This outlay has greatly improved the condition and com- 
 fort of the patients. 
 
 The cost of food, milk, &c., has very nearly doubled and 
 appears to your committee to be excessive. They will 
 deal with this at length hereafter. 
 
 The two items (6 and 7) of servants' wages and general 
 expenses have very greatly increased, — servants' wages by 
 no less than $5,491, or upwards of 300 per cent. ; and the cost 
 of general expenses by 85,403, or upwards of 1000 per cent. 
 
 It is in the opinion of your committee, mainly in the 
 items of food, wages, and general expenses, that room for 
 considerable economy will be found to exist, provided a 
 proper system of management is laid down and enforced. 
 
 The present system of ordering the food required by the 
 patients is unsatisfactory. 
 
 The practice appears to be, after the physicians have 
 made their rounds, for the nurses to meet and give infor- 
 mation to the Lady Superintendent, from which a slate is 
 made up, to instruct the Steward what .o supply. 
 
 At each patient's bed a Ci • i is affixed on which the 
 physician prescribes the diet to be given. 
 
 No effort is made apparently to compare these cards 
 with the verbal reports of the nurses, and your Committee 
 are satisfied, from the enquiries they have made, that, as a 
 £ule, much more food is supplied than the directions of 
 
w—""" jr""^i^" 
 
 /\ 
 
 s 
 
 •jmz 
 
 the physicians call for. The Medical Board appear to be 
 of the eame opinion, for they lately sent to the Committee 
 of Management, a resolution upon the subject, of which 
 the following is a copy : 
 
 " That it having come to the knowledge of the Medical 
 " Board that unauthorized depail/Ures from the ordinary 
 " dietary of the Hospital have occurred, this Board requests 
 " the Committee cf Management to issue such orders as 
 " shall ensure, that only such diets and extras shall be 
 " issued to the patients, as are ordered by the attending 
 " physicians and entered on the diet books." 
 
 Your Committee recommend that the present practice 
 be at once altered. 
 
 That the nurse of each ward hand in^ on a printed list, 
 the diets ordered by the physicians. 
 
 That these lists be handed to the Steward, who shall 
 verify them daily, by comparing them with the cards 
 affixed to each patient's bed. 
 
 That the quantity of food, etc., supplied, be strictly in ac- 
 cordance with the result of these lists thus properly 
 checked. 
 
 That it shall be the duty of some one person, to super- 
 intend the cooking in a proper manner of the food in the 
 kitchen, and to be responsible for its proper distribution 
 to the different wards, and its proper use there. 
 
 These latter duties, and which are most important, 
 appear to have been entirely omitted. 
 
 Your Committee believe that this system properly carried 
 out, will result in a very considerable saving. 
 
 The consumption of milk appears to your Committee to 
 have been very large, and beyond what was considered 
 necessary by the medical officers. 
 
 The next important increase, is in the cost of salaries 
 and wages of nurses and servants. 
 
 i 
 
 ♦ % » 
 
aK 
 
 ji 
 
 \ ■ y 
 
 
 The salaries paid in 1875 were $1,700 and in 1877 
 82,656. 
 
 The wages paid to men servants in 1875, amounted to 
 $951, and in 1877 to $1,963. 
 
 And the wages paid to women servants, inducing the 
 nurseu, amounted to $2,587 in 1875, and to $4,159 in 1877. 
 
 The total number of servants in ivlay, 1874, was 30, and 
 in May, 1877, it was 49. 
 
 Undoubtedly the system of nursing, especially by the 
 introduction of trained nurses, has been very greatly im- 
 proved, to the manifest advantage of the reputation of the 
 Hospital, and to the comfort and care of the patients. But 
 it appears to your Committee, that there is considerable 
 extravagance in the staff of servants, as well as in the 
 supply of food, &c., and, that the supervision in both cases 
 is inadequate and inefficient. 
 
 Your Committee believe that the number of servants 
 can be reduced, without diminishing the proper efficiency 
 of the Hospital, and they suggest that the Committee of 
 Management be clothed with authority to fix the number 
 to be employed, from time to time, in future. 
 
 Your Committee also consider it v\esirable to remind the 
 attending Physicians, that the Hospital is not a convalesceLt 
 home, and, that however desirable such an adjunct would 
 be, the present funds at the disposal of the Hospital do not 
 permit of patients being retained, after their disease or 
 injury has been cured. 
 
 Your Committee having pointed out, where they consider 
 the expenditure has been excessive, now proceed to suggest 
 the remedies which they think should be applied. 
 
 They believe, that a large part of the unnecessary out- 
 lay has arisen, from the absence of that daily personal 
 supervision of all details, which is so imperatively neces- 
 sary in every large establishment. It is scarcely necessary 
 
10 
 
 to point out, that a large body of servants will nov»aere be 
 careful about economy, if they are left almost entirely 
 without control. 
 
 There are at present, 30 nurses and assistants. In large 
 hospitals elsewhere, one attendant to every 6 patients is 
 considered a very full staff. As the average number of 
 patients in the Montreal General Hospital is less than 140, 
 it is clear that the staff of nurses ought to be carefully 
 considered. 
 
 The trained nurses brought from England have been of 
 very great servivj, and the retention of a certain number of 
 these is most desirable. They should take the lead in the 
 various wards, and be able gradually to train up nurses in 
 this country, whose services, if carefully watched and 
 taught, would prove of very great advantage in future, and 
 by degrees secure a well-trained and efficient staff of nurses. 
 
 The other female servants employed, consisting of cooks, 
 housemaids, laundry women, care of linen, &c., should be 
 carefully looked after, to check extravagance and waste. 
 
 There are at present 10 employed on these duties. There 
 is also a man cook. 
 
 To properly supervise the staff of women employed re- 
 quires not only a knowledge of the work to be done, but 
 considerable physical strength. 
 
 In the opinion of the undersigned, the proper plan of 
 supervision would be to obtain the services of a Matron of 
 the best experience that can be obtained, who should be 
 placed over the nurses and women servants, and held 
 responsible for the proper cleanliness of the Hospital, 
 the efficient discharge of their duties by all the women 
 servants, the proper care of the linen, &c., "ud the economi- 
 cal and proper use of the food required in the Hospital. 
 
 The mere feeding of the 50 servants now employed, 
 alone offers great room for economy. 
 
11 
 
 '• 
 
 In the opinion of the undersigned, it is not necessary to 
 have any one in charge, but an experienced Matron such as 
 h^re spoken of, who will give her personal, hourly attention 
 tct the duties to be laid down by the Committee of Manage- 
 ment. 
 
 The men servants should be placed under the charge of 
 the Steward, who should be held responsible for the pro- 
 per supply of all that is required in the Hospital, checking 
 the consumption in the manner already described. 
 
 The number of men servants appears to be large. 
 
 The mode of keeping tb-^ Steward's books is capable of 
 considerable improvement, and the mode of effecting the 
 required changes is now being carefully gone into. 
 
 The undersigned are strongly of opinion, that the most 
 effective mode of management will be, by the appointment, 
 of an efficient Steward and Matron, with duties well de- 
 fined, and who shall be responsible to the Committee of 
 Management, and act upon their instructions in regard to 
 the number of nurses and servants required ; and also in all 
 other matters. 
 
 The undersigned must now refer to the Lady Superin- 
 tendent, who has been connected with the Hospital for the 
 last two years, and whose term of engagement is about 
 expiring. One of the main objects contemplated when 
 Miss Machin joined the Hospital, was the establishment of 
 a training school for nurses. 
 
 This it has been found impossible to put in force. It 
 would appear therefore, to be undesirable to make any 
 renewed engagement with Miss Machin ; as, in the absence 
 of any training school, the management of the Hospital can 
 be made more effective and economical, by the mode which 
 your Committee have already recommended. 
 
 That the system of nursing has been greatly improved 
 during the time that the trained nurses have been em- 
 
■iJhaMMiniiViaia 
 
 12 
 
 ployed, is beyond doubt, and your Committee are glad to 
 recognize the fitness of Miss Machin to carry on such a 
 training school as was proposed ; but, as that is now im- 
 practicable, it is necessary that the management of the 
 Hospital in future, should be conducted solely on the foot- 
 ing which the funds at our disposal render not only desir- 
 able, but imperative. 
 
 The undersigned believe fully, that the course they 
 recommend, will result in considerable economy, without 
 at all impairing the e£&ciency of the Hospital. 
 
 CHAELES ALEXANDER. 
 C. J. BEYDGES. 
 JOHN PLIMSOLL. 
 T. M. BRYSON. 
 
 Montreal, September 3rd, 1877. 
 
1 1 mil ■■■■ti in 
 
 3SP^ 
 
 13 
 
 APPENDIX A. 
 
 IN AND OUT-DOOH PATIXNTB. 
 
 .sag. 
 
 So 
 
 1870 
 1871 
 1872 
 1873 
 1874 
 1875 
 1876 
 1877 
 
 103 
 111 
 110 
 116 
 107 
 137 
 149 
 137 
 
 Si 
 
 969 
 
 
 
 1,290 
 
 1,448 
 1,485 
 1,705 
 1,811 
 1,828 
 1,821 
 1,770 
 
 13,158 
 
 1,392 
 1,559 
 1,595 
 1,821 
 1,918 
 1,965 
 1,970 
 
 1,907 
 
 14,127 
 
 11,913 
 11,346 
 11,116 
 11,349 
 13,137 
 15,726 
 15,693 
 
 18,788 
 
 109,068 
 
 u 
 
 1,188 
 1,342 
 1,356 
 
 1,575 
 
 1,621 
 1,648 
 1,672 
 1,630 
 
 o 
 b 
 
 S 
 
 O 
 u 
 
 a 
 
 d 
 
 12,032 
 
 a 
 
 
 
 a 
 
 o 
 Iz; 
 150 
 
 328 
 
 281 
 
 189 
 
 279 
 
 270 
 
 s 
 
 75 
 98 
 74 
 46 
 55 
 74 
 
 1,497 422 
 
 1,188 
 1,342 
 1,131 
 
 1,149 
 
 1,266 
 1,413 
 1,338 
 1,286 
 
 
 10,113 
 
 12,032 
 
 93 
 107 
 123 
 139 
 160 
 
 2 ^ 
 
 1>M 
 
 26 
 
 22 
 
 CO 
 
 C3 
 u 
 
 3 
 4> 
 
 o 
 tz; 
 41 
 
 8 
 a 
 
 168 43 
 
 156 
 139 
 
 1,085 
 
 51 
 30 
 
 u 
 
 3 
 
 2! 
 o 
 Sz; 
 
 33 
 19 
 35 
 45 
 
 oo 
 
 a 
 
 9 
 O 
 
 !z; 
 
 213 
 
 132 
 
 345 
 
 a 
 
 072 
 
 •074 
 
 083 
 
 082 
 
 ■088 
 
 •092 
 
 ■086 
 
 ■079 
 
 APPENDIX B. 
 
 AVERAGE TIME AND COST. 
 
 1870 
 1871 
 
 1872 
 1873 
 1874 
 1876 
 1876 
 1877 
 
 «> 
 
 o aT3 
 
 a-^g 
 
 O M 
 
 a 
 
 .2 a 
 
 03 O 
 
 V Si 
 05 - 
 
 $19,727.42 
 19,837.77 
 22,413.13 
 24,423.74 
 33,797.10 
 34,073.35 
 38,206.24 
 42,861.97 
 
 I 
 
 102 
 111 
 110 
 116 
 107 
 137 
 i9 
 137 
 
 Si 
 
 a 
 
 o •• 
 
 ♦fCLi 
 
 1,290 
 1,448 
 1,485 
 1,705 
 1,811 
 1,828 
 1,821 
 1,770 
 
 OD 
 
 '9 
 
 O 
 
 sz; 
 
 !z;og 
 
 4) OO-S 
 
 bo^oa 
 •^ « 
 
 1,392 
 
 1,559 
 
 1,595 
 1,821 
 1,918 
 1,965 
 1,970 
 1,907. 
 
 39,916 
 
 42,884 
 
 44,329 
 44,586 
 49,263 
 50,008 
 51,609 
 61,356 
 
 0) ca 
 
 28-67 
 27-60 
 27-79 
 24^48 
 25'68 
 25-46 
 26-20 
 
 a 
 
 u 
 
 as 
 
 41 
 
 26-93 
 
 $14.17 
 12.72 
 14.05 
 13.41 
 17.62 
 17.34 
 19.39 
 22.47 
 
 
 O 
 
 01 
 
 8 
 
 109i 
 
 117J 
 
 121i 
 
 122 
 
 136 
 
 137 
 
 141J 
 
 140^ 
 
 a 
 
 •5 
 
 a ^ 
 <1 S 
 
 $180.43 
 168.82 
 184.47 
 200.19 
 250.35 
 248.71 
 270.33 
 306.06 
 
u 
 
 APPENDIX 0. 
 
 IXPUfDITUBB BXTRAOBDIVART. 
 
 3: 
 
 18T" 
 18T1 
 1873 
 
 lers 
 
 I87i 
 1870 
 1870 
 1877 
 
 Wo. 
 
 & 
 
 e 
 
 I 
 
 g -a 
 
 •OOP 
 
 1^ 
 
 a & 
 
 OQ 
 
 g 
 
 » 
 
 Ms 
 
 «^ 
 
 I 
 
 470.93 
 484. SS 
 
 160 
 
 0,011.02 
 
 0,700.00 
 
 1,800.00 
 
 700.80 
 
 1,147.00 
 1,360.86 
 89.72 
 1,001.89 
 7,661.42 
 
 1,006.60 
 460.80 
 
 800.01 
 
 00.00 
 
 6,998.71 
 2,488.80 
 2,108.46 
 1,010.90 
 
 21,066 
 4,200 
 
 0,601. 9i 
 484.00 
 
 6,847 00 
 11,316.17 
 20,101.18 
 
 7,410.80 
 
 9,222.33 
 
 8,200.80 11,810.94 980.47 160 0,011.02 1,006.90 400.01 18,106.87 20,266 60,983.06 
 
 RETBNCB KZTRA ORDINARY. 
 
 
 Legacies. 
 
 Extraordinary 
 donations. 
 
 Old 
 
 Building 
 
 sold. 
 
 Morland 
 Wing. 
 
 Specific 
 Purposes. 
 
 Total. 
 
 1870 
 
 $ 
 
 $ 
 
 $ 
 
 $ 
 
 f 
 
 $ 
 
 1R71 
 
 
 
 
 
 
 
 1872 
 
 1,814.00 
 2,850.86 
 2,230.00 
 2,386.66 
 7,841.31 
 2,981.50 
 
 3,797.94 
 8,363.60 
 1,200.00 
 700.00 
 300.00 
 2,990.00 
 
 
 
 
 6,611.94 
 6,214.46 
 
 1873 
 
 
 
 
 1874 
 
 
 
 2,500.00 
 
 6,930.00 
 3,586.66 
 
 1875 
 
 
 600.00 
 
 1676 
 
 846.81 
 
 
 8,987.12 
 
 1877 
 
 
 
 5,971.50 
 
 
 
 
 
 
 
 20,104.33 
 
 12,351.64 
 
 846.81 
 
 600.00 
 
 2,600.00 
 
 36,301,68 
 
I -j e> oi if>- <a ia " o 
 
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 Orant 
 
 
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 Collections 
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 from £m- 
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