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'"T '■^r;TF„i
FOR PRIVATE CIRCULATION.
I. K 1^ r K H
ON
HOSPITAL EXPENDITURE
ADURKSSKD TU
PETER RKDPAPH, ESQ.
^fi;i'*ii<lciil (Moiittical (Penetial .Ijiospital.
UY
MR. ANDREW ROBERTSON,
^tieasuiie^.
Monfrcdl :
PRINTED AT THE "UAZETTE" PRINTING HOUSE
FOR PRIVATE CIRCULATION.
LET T E R
I '
V-vfrV
ON
HOSPITAL EXPENDITURE
ADDRESSED TO
PETER REDPATH, ESQ.,
I^t;e$ident ^ontt]ea) (|lenei;a) l^oapita].
BY
MR. ANDREW ROBERTSON,
^tteasuiteir.
PRINTED AT THE "GAZETTE" PRINTTNO HOUSE.
1877.
'bC
PETER UKDPATJI, Esq,
1 Resident
MONTHEAI, (rENEHAL Ho.SPITAL.
My Dear Sir,— I deeply regret that iinavoidable
absence from town prevented my being at the Annual
Meeting of the Governors in May, and also that, from
the same cause, I could not attend the last Quarterly
Meeting, nor the Special Meeting of the Governors,
held in September.
At the Annual Meeting of the Governors in May, a
resolution was passed directing the Committee of
Management to inquire into Hospital Expenditure.
This report was discussed at the special meeting
of the Governors, and was by them referred back
to the Committee of Management for further action.
This Report, as presented to the Governors, has
been printed, but, so far as I am aw \ has
not been circulated. My object in thus aO Iress-
ing you is to say that, perhaps through my
fault, I may have been the means, in consequence of
th</way the Yearly Statements have been presented,
especially in the item of " General Charges," of perhaps
misleading the sub-committee in arriving at a proper,
conclusion, and that the deductions drawn from these
figures will have to be modified accordingly.
You will no .doubt rememb.'r that our mutual
friend (and who, while in Montreal, took such an
active part on the Committee of Management), Robert
Muir. Esq. finding tht» finan<-ial accounts very
incomplete, prepared the Financial Statement of 1872,
modelled upon that of the Glasgow Infirmary Keports. '
No *' General Charges " appear in that Report, but we
'^C^^t)
h
find them in 1873, the year previouH lo rny nccepting^
office, and they h:\vo been since continued, It was my
intention this year to have had the Report Ibr 1877 as
compk'te in this respect as that of 1872, hut because of
my absence, as already mentioned, I did not hco the
report till it was printed and circulated.
In justice to myself I must here romark that seeing
"General Expenses" had so much increased, being
nearly one-seventh of the total expenditure, and this
account having b^en introduced into the annual state-
ments by one of themselves, I regret lliat the sub-com-
mittee did not call my attention to it, be<'rtu«e, although
absent from the meetings already referred to, I was
repeatedly at the meetings of the Committee of Manage-
ment, besides being in Montreal for a considerable
period during the time the inquiry wa» being made.
I may further say that on applying to the Accountant
for an explanation why he used the term '• General
Charges," he replied that he had been ordered to do so
by the Committee of Management at the time.
Having said this much, let me draw your attentioiit
to the following remarks on pages 6 and 7 of aaid
Report — the comparison being made betNveen the years
1870 and 1877 : — " It will be seen that the cost of food,
" milk, &c.,— from $8417.12 to 114,944,98— has very
" nearly doubled, and appears to your Committee to be
" excessive.
"The items of 'Servants' Wages* and 'General
" Expenses ' have very greatly increased — servants'
" wages by no less than $5491, or upwards of 800 per
" cent., and the cost of general expenses by $6408, or
" upwards of 1000 per cent."
This statement seemed so very alarming, that it in-
duced me at once to look into what was included under
the head of "General Charges." An eiamination
shelved me that ovorythin- which had not Immm. dotuilod
under its proper headinjr was included here.
This examination also showed mo how easy it wtw
jo give sensational ligurcs, and as an exampl,, IVom th(»
Income side of the account, take the ordinary DonationH,
—that IS, the free-will and unsolicited oiieriny-s. of the
public, which were in 1870, $l,247,and in 1877, 15,277
or 36t per cent of increase. From the E.nployoN."
mSxn 1870, to $l,218in 1877, or 291 per cent. increa«o.
Irivate patients, $52 in 1870, to $1,574 in 1877, or up.
wards of 302G per cent. I would not call your atten-
tion to such figures were it not that I desin^ to show
how unfair it is to draw such arguments, or as 1 nm
It to encourage a feeling against the Hospital, that, if
allowed to go on or remain uncontradicted, would
imperil the best interests of our noble Institution.
I have, therefore, prei)ared Statement (See Appendix
A) shewing the amounts expended during the yeurM
I have been Treasurer, as Ihey appeared in the Annual
Ualance-sheets, and another statement with fuller details
(See Appendix B) which will show, by reference'
one to the other, where the "General Charges"
should have been . :tributed. Thus, for example
the cost of food, milk, &e., which in the llrst
statement is $14,944.98, is in the second increased to
$17,0.:>4.88, the dilferenco being included under the
heading, "General Charges" in the first statement.
This will illustrate the principle upon which I have
attempted to apportion to their proper accounts thin
Item of General Charges. What is not so apportioned
IS included in the second statement under the head of
" Other Expenditure."
In servants' wages, the Statement divides them into
four divisions, instead of three as formerly ; thus, take
the year 1877, and the wages of workmen employed
6
was $8G0..''>2, and should luon* i)iopi'rly have hcoii
chai^'(MHo "Repairs" account.
For ]iurpos('s of comparison, it stMMns to mo that to
compare thiM'xpcnditurc of 1S70 with that of 1H77 is
apt to mish>ad. I think comparison should lit- nuulo at
Home later i)crio(l. If you will refer to the Kcport lor
1870, you will lind it there stated —
The expenditure of the v<'ar is ^<2;{01.7H less than
that of th(
preceetlin
ar
the 15oard of Mi
irement
"havinn^ thouj^ht it necessary, owinu' to the limited
"resources of the iSociety, to restrict the daily number
" of in-door patients to oiu' hundred."
"The expenditure of the year has neen §10,727 42,
" the details of which may he seen in tin- book for
" that purpose placed on the table.
"The undertakini? to raise $10,000 from the citizens
" by special subscription has not been proeeedinl with
" this year, as, owing to the depressed state of the mer-
"cantile interest, it was held not to be a favorable
" time."
It is, therefore, my intention to deal with this <|uestion
mainly as it existed during the last four years, and for
purposes of comparison, chielly with 1875 and 1877
(say the financial years ending April 30th).
In 1874 it will be seen that the Total Expenditure
was $33,797.10.
When I assumed office I found that the usual
practice was to pay the balance of the lust quarter's
account of the previous year in the first quarter of the
following one. The amount remaining unpaid of 1873
was $3910.75, and believing that it would be better
that each year should stand complete in itself, I
included the whole expenditure in 1874, so that
deducting the sum $3910.75, would leave the actual
expenditure for
1^74 at $29,880 34
1875 " 34.073 35
1870 " 38,206 24
I^y tills It will be seen thut duriiiu- thu hwt lour vears
our ordinary working oxponses have yratlually oone up
about i„ur thousand dolhirs per annum. The increase
betwe.Mi 1874 and 1875 may b.» rou-hlv stated -
provisions. #1.500: .oul. «1,000 ; medic'al salaries.
»l,000 ; men and women's waives, $775. For the sak.'
ot argument I th.-relorr inf-.-r. th.t 1875, with an
expenditure of $.'U.073, was ior that vear considered to
be a reasonabl,. expenditure, and siiall now endeavor
to point out, HO far as I can, some of the points of
ditteren... b.-tween 1H75 and 1877. so a.s if possible to
produce a better understanding- of the subject, and
lead to *,uch con.lusions as may seem likely to result
I'l H reduction of tlie expenditur.', whi.h is no doubt
much to b(! desired.
h\ the year 1875, as you will remember, th.- Hos-
pital proper .ontaiued Ki wards with 110 beds, giving-
a cubic space to each bed of about 8!)8 feet We had
also the small-pox Hospital, conta" ^- 17 beds and 3
private wards, thus givino- e<iual ti ^39 beds as the
total in the Hospital.
In June of the year 1875 (but which comes under
the financial year of 1S7.J), the Morland wino- was
opened, and in October of (hat year the svstem of trained
nurses was introduced, .so that tlic vear 1870 was prac-
tically half of the old, and half of the new system.
In the year 1877, the Hospital j)roper was almost en-
tirely gutted, and the wards .M.larn-ed as much as pos-
sible, and wheiv there were Id wards with 111) beds
their are now 10 wards with lOtJ beds, and with other
arrangem<Mits the Hospital has to-day IGV beds in the
public ward.s, with 1,035 leet of cubic space per bed.
besides 5 private wards or 172 beds in all. If the
same space only were allowed as we gave in 1875 we
oould put ii. 107 beds, beinu- about 21 per cent, more
8
beds with 15 per cent, moro space, or about 42 per cent
more beds with the same cubic space.
This increased room necessarily requires more ser-
^ants, on the same principle that a man necessarily
spends more in a larger (han a smaller house even if
^m other things are equal. But besides the element of
increased space and number of beds, there is also an-
other element which must not be overlooked viz • The
increased cost of labor.
was .8 and their wages $2,796; the same num-
ber in 1875, $4,562, and in 1877. $5,632; that is to
say the same number of servants in each of these years
performing the same, or nearly the same, services, cost
so much more in 1875, and so much more again in 1877
but comparing these two latter years we find that
the number of servants in 1875 was 36, and the
wages per annum $5,186; the same 36 costing in 1877.
^6 .90. an increase of $1,404. The increase of wage.
lat"'"V. Ji "^' '''' '^"^^ ^^^^"y <!- t« -e^in
r , , n '^''^'''' ^^''^ ''^^^^ 1^77, chiefly due to in-
creased skill.
The number of servants added since 1875 seems to
have been 1 day nurse, 3 night nurses, 2 asssistant
n Z'' \''r"T'' ^ ^""'"'''^'y maid, 5 ward scrubbers,
inak ng 13 female servants in all. Two servants, anight
doorkeei>er, and a messenger, have been added to the
male stati.
t n° t'o.^' '^'"''' ^^ '''''^'''' "^ 1877, the wages
>eiiig $8,222; increase, $3,036, which increase may
be apportioned as aln^ady mentioned. $1,404, to in-
creased ski 1, the balinrp \l MO t • V /
,, ' "' '^"^lance, !S1,632, to increased number
oi servanfy.
In connection with the increase of servants, it na-
tuially follows that there should be an increased
The ,1 ..;!h ', ? ""°"T "' '••5«' "• »">°nt 2J per cent
mM .not^.s^T \r;-' -f-«' fro".^.2-. in
o«csHl 1 , seeing tlierelbre there was only ISO beds m.
that number t he re ' I„ Ts^T^M ' "."k""'" "''""
■n any „„e day „,. :CT. and !h: Vw^t';?'"' """"^^
venue and e^^e.uUtl'elS:;; ^ . UH 7 "o" -^Ha:
^"^77 T'""" ""■ ^>-^'™ ™- introdL'ed by
«pe.fi ^'"""' "^"'""-^ -'■ extraordinary'
. £f • "iSjvr^- °|™----'-
1874.... ;;•• si'nj; ^^ 24,423 74
. 1870 30 100 Ik '^'^'^ -^
1877.. 35'740r5 38,200 2 [
^ $i97,72b^ $^nn;
.•.xces.s ot ordimny income $1,951 54
allt' wlr'' ""'7^' ''" ^'"^^ ^^^^ -- -» -option-
ally hard year, bat in 1872 it will b. s.on that
bein ^8,007 deficiency m 187(> and $7,112 in 1877- no
aonbt cau.n. much anxiety, because if the .ane^^ o
10
were to continue it would be a verv serious blow to the
Hospital. It is true that, as far as the six years are
concerned, there is a balance of revenue over expendi-
ture of $1,951. But the experience ol the last two
years shows that we must either reduce expenditure or
nicrease revenue, and upon the methods to be adopted
to this end, I shall have somethino- to say further on
in the meantime let me call your attention to the extra-
ordinary revenue and expenditure.
^''•''"- Uevenue.
]^'J 6,214 26
^^^'4 ,-),930 00
]^'^ 3,586 66
J^'^^ 8,987 12
^P^ 5,97150
Morland Wing 7,500 00
Expenditure.
$ 484 55
6,847 05
11,216 17
25,151 18
7,410 35
9,222 32
7,500 00
Total $43,80148 $67,83162
Making- an excess of expenditure of $24,030 14
This sum has been expended, first of all—
For extraordinary repairs to Hospital $21,959 00
;or MoHand Wing- 20,656 00
Ana lor landed property , 25 266 00
The actual property used by and in connection with
the Hospital has been thereby increased by $42,615.
At tho b.'Kinninu: of tlio financial yuar of 1872
the Hos[)ital property was valuorl at ' $100,200 00
Ar 1 the t.wniture at ,0,000 00
]ii .Mlditio.i, the amount of .securities, niort-
p^'' R, Ac., itRJuding ra.sli on hand, wore
in all '
I'eductin.ir tlie Nixon Tuoii^-ajv,. . • ' " ......
And unpaid Quart. ri.y aecounts'.'. ...'.
•t,800 00
3.513 !)3
Which left the Endowment Fimd at.
S 83,GG5 13
8.343 98
ST5,321 15
11
On the I«t May, 1877, the securities an.uuuted
Lots 240, 24l', 242" and'245 "cost $80,258 42
32,200 00
The liabilities duo on lots 240 and 2U $. n^.o -> ^^ ^^'"^'^ ^'^
„. " lot 242 *",''JJ .-
Nixon mortf,'ng(> G 1 2 Oo
Quarterly accounts -^'^^'^ 00
iJorrowed money '?."S9 38
7,809 4D
2C,5G0 55
Leaving the Endowment Fund at ' T
$85,897 87
with this differeucc-that §24,000 of the land is not
^b Is aI:^ ;'■' "°^';;';'' ^'^ »' ^'-y ■-'. -ul rrom the
think a saving can bo ..ffected, and to gnWo you as to
how fav the recommendations of the Sub-commit ee can
b carried into effect. The increase in provision oe
187,,. considering the number of servants additional
Jeast $1,000 or more will be saved in the present year.
Ihe next very important item is the Uru- account
Hos^M : k" V"'^ "'^ *"' "- ^'°™"'<' Genera
ii'owing the exact circumstances, no proper comnari
son can be mad. int vvasdeemed advlal,:\;:. mi: ;
g»e at the Out-door Kelief aU,ice Kmtis and
charge a minimum sum of 10,:. per prescrii'tio, T n
aure this would bring into the'nosXl v S, oo
year; while, at the same time, it wodd Largely p 'e^n
le« hunu, cd dollars more. Jiven if nothing is charged.
-i~^
ir-.i
12
a saving should b. tried to be effected of, at least, S500
or more. Tiiere will b. a savin- in coal this year of
about $1,000; on the other hand, from the consumption
by the gas stoves, there will be at least $250 to add
irmting should be reduced. Six hundred and ninety-
six dollars will be saved by insurance being paid last
year for three years. Salaries will be increased by about
„ . -^- — ..o. ^aw, Nurses'
Jixpenses aiul Washing- were all abnormal charges last
year, and should not be required to any great amount.
1 venture therefore to submit that, to carry on the Hos-
pital lor the present year on the same scale as last year
the sum of $37,500 to $38,000 will be sufficient, estimated
as loilows : —
Provisions, etc $16,000
Drugs, etc 3 .^qo
Bedding and Clothing i'oqo
]^^T« 1,000
J<°^^ 2,000
'^IS »7QQ
^ Water "" oqq
]^"'i^!»s- '.'''''''''. Joo
j?^P''^»'« 1.500
l^urniture qqq
Medical Salaries qqq
^l^''^'' ^o ."'.'.".".' 3,000
^^''"^'^'^ <^o 5,400
$36,000
Leaving for unenumerated $1,500 to $2,000
In this calculation, I assume the Medical Staff to be
as at present, consisting of House Surgeon, Assistant
House Surgeon, and Apothecary.
The Steward, Assistant Steward, Clerk, Messenger,
two Orderlies, Doorkeeper (day), Surgery-man, Cook
(man). Carpenter, and two Firemen for six months
st, $500,
i year of
Liraption
to add.
ninety-
aid last
)y about
trained
ould be
Nurses'
ges last
amount.
fie Hos-
st year,
timated
3G.000
12,000
to be
istant
niger,
Cook
onths
18
fount '"''"-"^ "^""""^° -- P--n all the year
t^O- THE FEMALE STAFF
fk„ ""-"^'"ff-womcn, one—making foitv in .>ll v^i
tho numbufnif of Word. .,,,,1 tT ,.'. ""' ''°^
fwenty.fiv,. NMr.„. ","■"''' ,*'"- division lof the
dizC.) ' "'"* W''^<l-''le=iiere, (see Appen-
This givoN Mfdical Stofi; three ■ Male <iMtr .i
Female Stall; forty. Total, Hfty fouf ' °™" '
your wiXr^^r f " *''•"'''■ "'''«''• fr»'»
J «.«uwitagO 01 this work, VOU will arlmif +^ u
very low rate Nr««, w "'^ , &ainit to be a
patients n.. 1 ^^ """ ^''''"'*' *^«t "^«tead of 140
patients per day we could get twenty mor.^ of „ \ n
average, I caleuktn iU.. i1-.- .^ ^^'^^- ^^ a daily
M^Ai ■ ^"*<'"^ate the additional cost of Food ani
Medicines, even at our rate in 1877 ih.i ,1
would not exccad US 9nnZ J' ^^'^ expenses
dav for ifln!! * 'f ^ "'°'*'' *"^ ^°^'<1 cost 64c per
duce ou n r^t ®"P^"^^' «" *^« «*l^er hand, we re-
AdministratTon Id Hon I • *''"^ department, the
one Nicrht NuTr « 7 ^^"' P'''°°«' ^^^ °^« I>ay and
clea„ert!:;4^^^^^^^^^^^^^ one l^ard-
and PatientT a' ful ^^'^'^' ^^«&«. &<^-. for Servants
per day for 120 c^l^^^ "^''"^^^ ^"^"^^ -«* ^^^ 79c.
JcsVsT'l;'*' ^°' i''' ^^ '^*^- P- ^-y ; 80c. gives
Insurance, and the abnormal Washing account To
14
more than make up the differenco of the $42,861 98
expended.
In this connection it rni^ht he as well to quote some
other hospitals :— '
The Pennsylvania Hospital in 1875. (s.o 125th An-
nual Report) : Total number treated, 1,974; total num-
ber of days, 59,053; total cost, $64,951.99; number of
out-door patients, 9,750; costing equal to one dollar
and ten cents per day. The Presbyterian Hospital in
1«76 cost one dollar and eleven cents per day.
The Leeds Hospital, in England, treated 3,192 pa-
i-ents in 1873, average daily 201, average time 23i
days, total number of days 73,365, at a cost of i;i5,18o
ov lour shillings and two pence sterling, equal to one
dollar and four cents per day. In examining this report.
I was struck with the enormous waste of linen there
reported. In the years, 1872-73, they used up 42
bolster cases, 42 counterpanes, 43 dustors, 1,127 pillovr
cases 1.272 sheets. 61 pairs of slipper.. 37 table cloths.
523 towels, and 34 toilets.
I will now call attention to the report of the sub-
committee appointed on the 24th day of September
and their proposals for reducing the expenses of the
Hospital, (see Appendix B;.
I have numbered the paragraphs for convenience of
referei.ce, and would say that with Nos. 1, 2. 3, 4. and
19, I entirely agree. No. 4, the words "simply enor-
mous seem very strong. The amount should have
been given so as to form an estimate. I may say that
tlV '""^'l^ ^^'^ thonsar^d dollars per annum.
5. While It may be possible to dispense with the night
door-k.eper-a messenger can hardly be dispensed
with. Nos. 6, 7, 8, are, I think, practically the same as
m Appendix, (see C).
No. 9. Is to my mind simply impossible unless to
15
i" a proper „.an„„r "„ oue ;"u b tn 7'"'' "' '"
myself. ^'" ''" '"*"'■'• pleased (han
i... »d 'h: "Tzt:"'- ""'z ""■"""""- »- i"<i«'god
admit in ™e;: cas r.M ""' tT""" '' '" ™P°-ible to
«0, or 83 bed, md ,h " °"'' "''"•<'■'' "'"" »» 28,
attached ft tl; m rts'T''" '°"-»-™«- »<! ™m„
four nurses con d do fl; k "'""'« '" "<''»" ">«'
to 7 7i „7s . . "*""'" """'''" «'y one nurse
amoult ™r":r d' ^P'^™"''— ■ "'hen . i:^:
amonnt of lypS ,et?'"^ " "'"'"'"''• "^ " '"^S"
iuformed tat ThifZ ':•■'" """""^ O'^^^-' ' »»
Hospital hardly comls'^i"'" u "'*"'■='"■ !>»* ""r
nu.es d , ward .U.n.^:.^Zs'Ztn' wIm!
21, 23, bemg on 2d flat with nothino- else nL th
20, 22, 24, withT bed * r;',» :-;"-« f OS
beds, which requirerurhirrr !Lf a]::''
1 assmg up-stairs to third floor, Nos 30 3 ' 34 1 '
ito^tVdTd^VeV" ?''■■■ ''• '^' -'«^-^c!
1 day assisCf .!, ti't':: Vwrf" rf '■^"'■''^"
"iffht, when no one is aboiU T In """""S ""«
tween, although this can h»rdl f '""' '" S" •>«•
For the privaie wards ^ J considered correct.
nursetok.de^ro:^t Sk^r/rr'' * "*="'''
Which itself requires 1 ,?,.• 1 i , ^^^ '^'"^ A^t.
35 beds i„ it ' "^"^ ^"^^ ^ ^'^'^^^tant' there bein.-
16
This makos the number of nurses 2.;. and of ward
cleaners 5, the kteer having, in addition to their e,ec
ttve wards to clean, all the halls, passages, etc., etc
Exception will no doubt be taken to this statement
140 average datly pat.ents, and as one i„ C is considered a
hberal allowance, 28 is all we should have. As ha2
been already stated, we have had 307 patients in Z
hlled^ We „u.s be prepared for the largest number.
mt r"?- T"" '■"^ ""-' !'""'» wards, and
twt 1 '" r"^'"^ •''='"? "'' near as possible I in G. lu
this connec ton rt...ould be as vvell to read the report
of the Medical Board, (see E in Appendix) for their
neetion. It seems to me that as soo.i as patients are
convalescent they should not be allowed to" on!
UuZTul'' "Vrr^- ^'*'> ™«?esti„nsVos
in M.. '1 "°."'^ '""■" ^'^'^ ""« satisfactory if
TJlTiril >f"T *""* """"' "'"»'<'• ""-i '» "-e
cWk should r ^ ^:f V'*"' ""' P™P<»*'» «'«""<•■'•
Clerk should board m the house, and reduce the salary
l::i:zr '-"^ ''"'■ °- ^"-"^ -^ «•"« •» -
Nos. 17 and 18. I„ this connection you cati refer to-
the op„„on of the Medical Board. For myself I mu t
most strongly dissent from No. 17. Mv recollection
Mta ML^r ''"™ "" '» y°" hands, is that
Miss Machin camr ,o us as a Matron or Lady Superin-
tendent, or whatever the Committee of Manaerment
choose to call her, with trained nurses to carrTrthe
work of the .Hospital at a stipulated salary of «640 ~r
crtabhshed her renumeratiou should be increased for
^7
^h^' additional wdiL- ..„ i i
ArmstioMff, on,. ,o, 1 , '7 '"'"^•^'"■y '" ""y that Mm
.1.0 ai:;r:;r;:';,;;",;; ';'"■•■'>• '- «■-'■'■'". -J till
byth,. |„o,,,«,,i ,.h,„„ „' ""' f '" »s I eun loam
"..<! the ward .-loan . t '^ "T" '•"' "■•^'''"'^ '" "'<>■
;van-e.s saved ^vill be sav $0, t, ^' '^" '^"^^""* «^'
be reduce,!, from the .„ , ihl' ' '''''"'' ^^"^ ^^"''^
various staffs of "0 00 "^'"""'"^ ^"^^ ^^^^ the
'h<'Munof.$7.l'20 ' ^ '^""' '" P^^^ .ent., say to
Sn^n!^' A^^st'.lif H^'^" T"'^^ ^^"^^^^^ ^'^ ^^'^ H«"«e
which they o,:^^C-:t^^ t]^;>avanta,es
reduced one-ha]]; *^^ Hospital, might bo
1 AKKistant $t;40
1 f 'lurk . . . ,' .'. 480
1 Mi'SMeDffor 240
2 Orderlifs.. 120
' IJ«y Duorkor'nVr '*<5S
1 Night d,. 180
1 Surgery Man . ^ 80
1 t!arpen ter 1 80
1 Fireman ..'*.'.'.'■'■ 180
^ ^ Men Servant, ..osting ." ^'
Tn Kitchen, , (cZ^T''\ '"^"-^"^vr.
In Launch-;, 4' ^^ "'*' -^^-^'^^'ot and Maid) .... ^.^
Houscn^HidV 2' .'.■■■■ *;^n
seam«tre«s,' ,; :;;:;::;:;;;;; ■■■'. til
— 120
2 1«
2 $'.'J2
18
NL'rtKi>i(i KKi'AnriiKNr.
I Matriiii ^
" NiKlit .1.. ''j"!
n AHsiKlmifs , f":
.-. Ward 8.1UM..TS .....'''..'■.■,■,';.'.';;,'; ',,„;,
This makes th. tolal staff 5o in iMimlMT. a.ul total
wago« SO.OGH. I rnay her. stat. that Ih. a.tnal w„t
paid under these separate stallk han bee,, (or ,ho half-
year endin- the 81h( October has been «4,837.0(i.
The report of the «t,b-Connnittee, as I u,.d.,rsta,ul it
means a redmt.on in the male stall' IV.u. Jl ,o !. vi/
the Night Doorkeeper and Messenger. ' '
The Housokeepino stall' is now arranged aecordinir
o report at ]0 pc-rnons, costin,. same an ha« U.-n al-
ready mentioned.
The Nursing D.-pariment is proj>osed to b,. reduced
from 31 persons to 21 ; and as , of then, are wa
deaners, and the trained nurses are not to be dinpensed
with the calculated saving would be $(mo. To nnm
up 8 Medical Staff; U .Stewards. &c.. ,0 honHekee™:
and .1 nurses, will give a total of 4ii per^onH ;~and
as 1 IS i)roposed that the Assistant Wteward or Clerk
shall board out, it will save the food of 14 persons
wfuch will amount to a further saving of $1 200 —'
thus making a total saving of $2,840, to be further in-
creased by such amount us they may agree on an the re-
duction by the proposed new Matron's Balary, In order
to accomplish these savings, we are to part with our
present I.ady Superintendent. I am ntrongly opposed
to this^ I do not oelieve that theno Havi«g« .an be
effected, having regard to the efficiency of the Hospital.
But even if they were possible, I cannot thmk that the
friends of the Hospital would consent for «tich an
amount, to relapse into the system of untrained Huper-
19
I would her«» coll +^
«no«,lo.s,a„d oubot/r 'T"'''™'"" ">- '■"-
Pected,that,„ecossarilv r " "■"' '" '"' •'«•
*>« carried on with n « enaoio the opcratioiiM to
I cannot, a. p:^:^ , i^Z^h " ''?"" "' ■•"""■""•
half-year endi,.. .^'^^^ Zntr''"" '"' '"•'
w«y, that our ordinarvincL, I ■'""'f"""-"'
♦I.OOO, and our exld Z" '"" '"";■"■"'' "'"'"
♦2,500-as compared ithL: v 'T'' ''^ ■"'"'"
«h«t this will be the Ir!t ^ ' """""" '" '"-
with the Ho»pi al h . ' tiirh ""t ."'^ ■■»•"-'■'".
of p.operco.pari.n.':hl.tlnX;;„:r '■'''"'-
rthi°rd?to:tr'»F-
always disclaimed LL-TrrthL:' t T' "■""■""
■nternal management of th,.wf , ''" "'"'' "'"
took care of th% r„me a, d" Z' h at f"'"" """ "' '
vouched for, before it .vis expe, ded i did Z7'T''
of the work. But on my return t,',* '"/I'""''"'"
many Governors p„n-„, u ""'" ' f""'"! "o
system of iZ dX--"'' '"^' >''™'"" """ "■ "'"
1 have to include theL ; T" ''"''"''""'' ""'1 '» 'hi,
withdraw their s„ltrfr''>""f "''■"'• ">ey woul,,
'hatX felt a ^eL;?;:: o^t^J ^/^^ H-Pital,
prevent such a resnlt t 4u T^ ^ "P°" "'e lo
imposed task,rd intended'";:'°"-"'f-'' ™ >»y -1-^
before —
you in a much less formal
mr/i\
8Ubj(
»fr, but fmdin^^
20
^o..u).i|y eri,i,.i„„, ,„ ,1,., p„hlio,„c». on the action
> "l'i»u>t(i 10 ijio < hau'res |>roi)os»'d in ihn,
"r"-";'" "-..,, I hav,. ,h„.,:h, !, hl.r ",1°
K„ ■ '^^'' ^' "HI '>»' proj)orly earned ouf anrl
«»;?'::",:'[;'""""■' "• ""■ •'"'""'''- ■»-""' ^
iM art, ,e„ Tl"' '7I"'^«' "'-'^"- in 'h" NurMnR
™ et, 'Tb'" """";■'"' '"" '""^ '"'■ ''■' """ »^'ke
...adeo ,,,■''''•'':•■'■";" "'" «»'■"■"•'■"'» already
lojh, Ilosp,,,,! „, ,„„,, ,h„„<,o,„,i„ ,he suving pro.
I am.
My Dear Sir.
Youvs veiy Jaifhl'ully,
ANDHEW KOBERTSON.
3Iontreiil. Nov. 2, 1877.
iction
well
most
I the
take
ly as
atter
nch-
aiul
bincT
ake,
ady
loss
pro-
t. ,1
22
"''IS'^oj^If •^"''•^ "' "=^''»"-'""™ - »'»"-
m
1877.
Provisions
Drugs, Medicines.
1876.
Instruments
jL^widing, Clothing...,.
3483 62
393 07
1687 03
Medical salaries 606 no
Steward, &c 1952 00
Servants' wages | V 237 48
Wines
Fuel, Gag, Water
Insurance
Printing, be
Ordinary Repairs
Furniture
General charges
$14944 98 j$13159 81
3253 98
273 13
1775 87
913 84
834 00
2054 70
5702 38
948 68
3698 73 3194 04
Total .
796 93
426 57
754 59
560 90
145 48
743 44
279 05
738 44
5079 17
4540 30
$42871 ')7
$38306 24
$12225 80
2629 69
664 75
1391 31
1712 00
1250 00
4107 70
807 15
3506 73
350 40
343 29
172 20
613 14
4299 19
$34073 35
1874,
$12874 4r
2616 95
616 03
1470 16
725 00
1395 00
3879 06
1085 41
2862 68
250 72
381 93
176 35
1203 10
4260 34
$33797 19
For fuller details see opposite page-the total result being the
same.
23
^^^S-T^'^"^^^ of Expenditure absorbing (leneral Charge,
under Iheir respective heads. "^
Total provisions
Drugs, Medicines
Instruments
Bedding and Clothing .
Wines, ic . .
Coal
Gas
Water '.......'..
Printing
Insurance ][
Repairs
Furniture . . .
Hardware ' '
Soap, Oil, &c ..... ..[[[
Salaries — Medical . .
'' —Men .'
" — Women
" — Workmen ....
T^w
Nurse's Expenses .. .
Washing
Other Expenditure
1877.
Meat Poultry, Ac, $ c.52!) 80
Vegetables
Bread and Flour ....
Butter and Cheese .
Milk ■;;■
Groceries
Fruit
187«.
520 !)8
1829 83
1943 07
3787 78
21!)0 06
253 36
$ 6129 93
495 38
1800 14
1448 41
3107 32
1852 46
228 70
* 17054 88 $15062 34
1875.
'§ 5517 46
477 17
1901 02
1528 41
2801 72
1365 45
234 79
$13826 02
3483 62
393 07
1687 03
913 84
2870 26
521 28
211 85
754 59
696 93
1459 36
640 12
305 23
327 15
696 00
3204 00
5018 96
866 52
100 00
179 62
947 81
427 95
3253 98
273 13
1775 87
948 68
2443 23
452 52
211 85
560 90
3o5 51
1697 36
1103 70
326 80
276 97
834 00
2844 00
4056 12
852 96
61 06
564 22
1874.
$ 5006 29
407 22
19U 72
1"36 88
2197 21
1495 43
249 90
12304 65
'''"*"' $42861 97
241 04
$38206 24
2629 69
2715 97
664 75
341 75
1391 31
1082 04
807 15
983 61
3023 08
2068 83
380 97
376 8!)
212 80
200 10
343 29
303 43
350 40 250 72
1249 54 ]572 58
019 80 1.375 50
163 21 118 00
254 96 269 82
1712 00
725 00
2134 00
1982 00
3052 00
2429 00
371 70
408 28
686 68
4288 91
$34073 35 $33797 10
• $391«.75 Bhould be deducted from this item, being the balance of Iwt
^::Z:::T'' ""' ^^-^ '---^ *^^ --• expenditure^-^
2i
^V;
No. of NurscH,
ctv., required.
Brick Building
■omen's wards. Ncs.
:i6 and H6 are infectioifi wards """ "' '"'' "'°'"""'« «'
The wasos paid to Uw ab..v.. a
«nnum:- ''^"''' ^' P'''' October sheet, will cost per
7 diiy Nurses
" ni.ylit do
11 day AsHistiint.s..
T) ward cleaiiors
$1200
840
lO.JG
480
••'0 inaiI,eo8ti„,., per ,„„„„,.._
inis Mini will incn.as,. in ti, S'd:u6
26
<i ^
a
CI
o
At the regular meeting of th^ n ^^'^ September, 1877
^th day of SeptembSTnstent : Commhtr' ^^'"»*^««««t held on the
^e following gentlemen, viz MeZ?^i '''^*PP°'"'«^ composed of
•BiysonandClendinnena i«„i^' .^®?^"- Alexander, Brydees Piimoiii
"trying out tL rep'oTt' of TeTuV^*" ''^ t'^"^^
Hospital expenditure: which reS,rth;ST"'^ *^" *''« reduction of the
the Committee of Management on th!^,mK'' ^'^^'""^'y Mly adopted by
"ijet.ngofQoyernorsonttTsth '^^ 10th mstant, and by an a(yourned
^f^^^:ir^oz;::sj^jr^/'^r^^- -t this day, ^eth
when were present, Messrs Ail! f ^^ ^''^ Institution, at 9-3o am
Clendinneng'^ Afte^ TJZ ancUe^t"'^ ^'ft«' ^''™««". Bryson aSd
the report, also an interviW of 'nf ^i^^°?*? discussion of the object of
which howcyer in its rSuTts failed ^oS'f 1 '*'"«*'» ^'"^ Miss Mad in
Jie,olved,~That the adoption ofll, '^^ ""^ t'ommitloe, it was '
J^ent, by the meeting "rtraoVs ''f f '''. .1'^' Committee of Manage-
*y upon the Committee to\"ter at on '" ^"''""♦' ''^"^*^'-« '* «Sa-
xnp« J^*" request made to thrLadv «^ ' -^t 'T'' *^'''*'" ^'an^ruptcy
means of economy having fail J „ft ^«"y ^"Permtendent to suggest anV
any response which promises anymlt^ ^" ' '"i"'"^''''^ ^'"^ >>«••, tf p oduce
pursuance of the respons bility now r f- '■«^"'^t'«"- The Committee [n
the whole question in the mannr^^" V"f "''^^ *^^'» m"«t S wit
judgment. The cost of conSictfni The H ^^f .''^"""ends itself to treir
That tl ^T '^' '""'^^ ayaflable^ ^^ "°'P'*^' "°^ ^^^^^eds by at lea^t
«ome ti„^: be'slcTin^Teilt^'STir ^*^"""* '^^'^^ "^^ '^'^^ f-
Sr ^~ -- -^- -'^;tin^-;i:,-'-ons>:;
imperious
thepreseiU ^n^-^^'artir' ^"^^ P-^^i- "oH
necessity. "^ '^''"''*^'^ ^^ery economy a matter of
J'^'TVtiizrzi'r^ ''■ "' -- p"* ^" ^-e .-
Wards be advanced to'fif,??eStf;erdi;r "^'^'""'^ ^"'^" "«' '" ^"-te
f 7sS::^:;ti^^s?-^eirr^' -^-^^ ^« -^« ^-o their
^^r r^Th' ''"""^ enforced. '' *^'" *° ^« «°. ^^^e charge of 50 cents
admission tru"fS^;i^ \otV? *'" '^^^'^^' ^^-d on the subject of
With the object Of pu^^^l^rany Ifte ?f T ^^^^^ n.les l^cSr ced
and the poi^sibiliiv of its usHnhL ^ *''^ rfsourscs of the Hosnital
m.crfcred with in-fut„,;" ""'"'"^«''' ^'""^ ««"* "f funds, being ferSly
-rio^^ly ^s£r"'^S:S"r onln^""''"' ^^-■t-'^-- relief be yerv
branch of the Ho.spi.al is gSiy '4, ^ "'"" "* *''". Committee tha S
'".^ T]«t ti,„ li,, s.rvrtV™,';,i """, '1'™""!!'" te di.peo.d »ltl,
«.W. te r,,l„.„l .„ ,C '""'"'^'' '» '"« "■■'» foom and I, H„,„o.
'til. Hint the five Scivnnf
'^"*^-;!/"-lfbly after a td^.TtS'"^'^^ ''" "" ^^^""^'•V ^^^ -''"ced to
otU. 1 lint Mk. niivil ,. ,. . '-'"^>-
it b
le cor sidered if tliMt
yth. Tliat the nurn
tl.cnumlerof Cook.sbe
■ ......mi lu III,
niiuibcr may not be reduced
ni!:'!l':^'"'>^^'^^^^terirM
exceeding twenty. " - ''" reduced from^ imnty-:
■five to not
26
buUdingf t * ™l,e%r''H "*'^ "'" ''"^" "^''^° Permanently in tho
coiftro of kn th M *'"'" ^'''^ '*J^e'-«>^'«*« i« not exceded ; who 8 hall haw
the itl!.t '"" "•""•"'I'" »"»»«1 one j„„l„, Cierk to .Ml.t him .UK
vams^Je'f thrj 1?'^"* ^■*"°"*' !!f "'"P^'^y^^ *" »"> tho Regular Ser-
bolS'inJ'I'c^X*""'' ■" "'° '""""' """ '"""" "' *— "-'■■ -'«■
h/fcilre'""'"'' """""S,-"- hi. d«,e?S he'lellS^'i'S
must therefore wthre^rpf.! ^-^f ^ bupenntendent, and the Committee
19^%.?;'^'^'^''"'^ "P°" ""* •"-* P-P-- and liberal basis *'
niSl ^*-!." ^■°"f'"-«»^-« ^ith the Medical Board, the whoroucstion of
ttn?p:rr:»r;LS""*'' ""* ^"'^ ''- ''''^'^'' ^^ "- ^'^^^^'^ ^•*
toSfh?fo'^"'''•™T'"r^'■^^°™'"•'"^*'''• Committee of Mauaffemen*
to paj,s the foregoing Resolutions as calculated to save tho HosDitfS
f CHAS. ALEXANDER,
I C. J. BRYDGES,
(Signed) J JOHN PLIMSOLL,
I T. 51 BRYSON,
[ WILLIAM CLENDINNBN*
John Plimsoll, Knq ,
27
iSt'pti mlier lOtli, 187';
Seiretury ComfnlHoc of Miinagement.
Dear Sin,— I lu'^ to iMUnowItdKo tlic rocoipt of your letter ot the 17th
September, encIo«liiK Mi)iy i,f n resolution of tlie (Jomniittec of Manage-
ment referring tlw r.!|)oit of the Huli-Coramittecon the Hospital expendi-
ture tothe M.diciil lioitril for their conHideration ; this Board consequently
heldaKpecial meetii.g oil llio 18th instant, and adjourned until this dav,
when the following icdojiiUonK were passed ;
l8t. That with re»(|wt to the item of increased expenditure for food,
milk, &c , this IJoard itn- of opinion that as far as the item of milk is con-
cerned, it can reiulily bi' mwjf\mU'.(i for, by the increased prevalence of
typhoid fever anil Um ^mti consumption of milk in that disease, also
owing to the opening ol tli« (Jhlldren's Ward which did not exist in 1870,
further that it into hn rnnarki^d that while the item of milk is much
greater per patient now tlmn In 1H70, the charge per patient for stimulants
IS considerably leu* tlmn at that time, the former having largely sup-
planted the latter. With ntgard to other articles of food we are not in a
position to offer any tfxplftiwilon.
2nd. That with ntfciciMii to the suggestion of the Sub-Committee that
considerable reduction ih l\w number of Servants might be made, this
Board would do.-ire U) Psprni4H its decided opinion (founded mainly upon
the statements of the pn-ncnt attending Physicians) that the staff of
fvctual Nurses, i.e., Uu)m lit Immediate attendance upon the patients, is by
no means in excuHW of what is really required to insure a degree of
thoroughness and caro In tfilN all important work. On enquiry the Board
are informed that tU« nuniliitr of Nurses employed at the present time, is
as follows :—Heml Pny Niimm, (i ; Assistants, 9; Night Nurses, 6.
Making 15 Nurses fictimlly on duty in the daytime, or an average of
about 9| i)atjen«,s to oimjIi Nnrso. In addition to the Nurses 7 women are
employed in the Witrdu for the purpose of keeping them clean, and in
other ways assisting tho Nlirm s, and were not such assistance given, we
are of opinion that thuwo Jfi NnrsHs would not be sufficient, for the proper
nursing of the patientu,
3rd. In explanation of iho following expression in the report of the
Committee, " Your tJonjnilltcd also consider it advisable to remind the
attending Physician* thftt tho Hospittil is not a Convalescent Home,"
the Medical Board would ting to refer to Schedule B. appended to said
report, where it will lu. Nimn that the average number of days of each
patient in 1870=2807 ; In IH77*2(;.92, besides which must be taken into
account, the greater j)r«Vrtloiico of typhoid fever in later years. The
attention of the M.-dlciU Hoard has more than ever been directed to this
point during the lust twtilva months.
4th. The Sub-comniitt«fo recommend the appointment of a Matron to
replace the present Uuiy Hiipcrintendent. The Medical Board desires
respectfully to dinsent from that view. In the treatment of all diseases
good nursing is of th-i utmost importance, and without this medical advice
would be pow'irloSM f..r good, In oider to have nursing properly per-
formed, it is highly advlitttblB that the Nurses should be under the control
of a lady capable of Inxtnatlng them in their duties, and consequently
commanding their ro»\mi, The Board, therefore, would strongly depre-
cate any action which would have the effect of substituting a non-trained
Matron for a skilled r,«dy Hiipcdntendent.
6th. The Medical Boiird heaitily concurs with the Committee of Man-
agement in the great nBUfHnHy thst exists for reducing the expenditure of
the Hospital, and pl«dgB« lUtdf to co-operat« with them in their effort* to
<*<> «>. I remain, Dear Sir,
Your obedient servant;
<1F0, H088, M.D., Secretary to Medical B<mt4.
28
PETER REDPATH, Esq.,
President
Montreal Genkrai, Hospital.
T w" ^"'■-S;>"=e I addressed you ou the 2,id inst
LmT/T""'' "•" ^'""-'™™* ft' the quarter end nt
31st Oetober, 1877. I am thereby enabled to rive you
a statement of the income and expenditure (ordinarv
k hert r- '"^- '''O'" "■« statement whieh
noomelTr'ffr ^'°" "'" '"'-n. that the ordinarv
ZT ri ! '"'"^•'"''"' <'"^"= Sist October, 1877 has
ncreased by $910.57, and the extraordinary meome h^
diurcT." T'^'l- "" '*■'''■ TheordLryTxpe"
dure,., the working; and maintenance of the Hos-
r288 M T:^ •'^^ ^''■"'' ^'"^ "-» decreasedby
by m58 eT TK- ""T'""'^ expenditure decreased
fv^l; *"' ■■*'"" ™»'"' I "™ ""■«. be as grati.
decre" e but r" 'u'T ' "«eipated a considerable
been.;. •^^.T'''' S^'^'ifyi-S. "'asmuch aL it ha.s
pa ents m the Hospital, there having been dnrmg- the
im IrT' '"■''' '""'' "=»"'-'^' 23,771 day's t
fo! r^" ."'"■" ™' *'' ■'"'"^^ I expressed i,, my
t would be found when we wer„ fairly in settled order
Th ner'd?'™'? '™"''' ""' ™''-'l™bly decreased!
hope, d.em rnte you will note shows a much laroer
fceebe.ng 96 cents in 1870, as against 71.0 eel
the present hall-year; this arises from the laro-er
number being treated, an,l at the small
or p-i
xpense
lllSt.,
29
am not yot able togivo particular.s of where the savings
have been effected, if able before this goes to press, I will
add it to th(> statement, if otherwise I hope to be able to
give it at the next quarterly meeting of the Governors.
In the meantim(\
I am,
My dear Sir.
Yours very faithfully,
ANDKEW TiOBERTSON.
MoNTnEAL, 9th Nvvcmhcr. 1877.
COMPARATIVE STATEMENT lo.- (ho half-yoars, i.uoino and cxpen-
diture m the Hospital, cudiiis lil.st October, 187t; find 1877
tively ; —
respof.
1876-77.
1877-78.
Increase.
Increase.
Ordinary Intonie
Extraordinary Iiiconio.
10.,577 8G
640 00
11,488 43
r-i.UO 00
910 ,'57
4,800 00
Totals
811,217 86
i 6,928 43
Increase.
5,710 57
Ordinary Expenditure .
Extraordinary do
22,219 .S3
2,476 66
18,936 19
622 07
Decrease.
Decrease.
3,283 14
1,853 69
Totals
$24,695 99
19,569 16
Decrease.
5,126 83
Average Nos. of days of patients in 1876, 23,771, cost 96c per diem.
Do
do
do
in 1877, 26,432, cost 71 6-lOc per diem.
80
Number and Salaries of the various Staffs iu the
Hospital, as they existed during, the investigation of
the Sub-Committee :—
No. of Persons.
;.t
MEDICAL BTAPK.
■ Medical Stiiff.
Wages.
STEWAIiD A.ND MEn'S STAFF.
I Steward j Q^^^
' AKsi.stnnt ,g,)
' Office Clerk 240
/, Messenger [[[][[ jgo
- Orderlies ^gg
' I>ay Doorkeeper jgo
Night Doorkeeper j so
; Stirgeryman jgo
' < 'arpenter j g^
' - Firemen, day and night, six
months — e(iiialling one
(ill the year roimd jijo
i' la all,
STAFF.
HOfSKHOLU
^ Kitchen $456
; Laundry ggf,
_ Seamstress 2 20
"•' Housemaids 2I6
II
11
In all.
NUKSINO DEPARTMENT.
• Lady Superintendent $ G40
. Day Nur-scK 1 200
Night Nurses g52
Assistant Nurses ... 1104
Ward Scrubbers 480
•^' In all
Total Staff, r,0; total (.'ost.
Totals.
$ 600
$2860
$1452
$4276
$9178
81
The Sub-Committee propose the following Stalf by
tbeir report (Appendix D) :—
No. of Persons.
3
USDIOAL 8TAFP.
.Medical Staff
Wngt.H.
STEWARD AND MENS HTATr.
^ Steward r,QQ
^ Assistant ' . ^qq
^ CKrk Conunitteedf Maiiage-
::' Orderlies 4^8
l><i.v Doorkeeper j «(,
SiJrgeryman jpy
Carpenter j yy
2 Firemen, day and niglit, six
months— equalling one
all the year round i;i2
9 In all
HOI'SEnOLD STAFl.-.
3 Kitelien
'' Laundry
^ Se.tmstresK
^ Housemaids
45B
540
120
210
10.
In all.
^ Assistant
21 In all
Total Stall; 43 ; total Cost
NUriSI.NO STAFP.
Matron ^^q
D.iy Nur.<es 1 200
Night Nurses §52
C24
Total K.
$600
2,740
1.332
3,076
f7748