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 I*. *^ 
 
 Thoughts on Hospital Sites. 
 
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 PREFATORY NOTE. 
 
 The following letters and editorial, first published in 
 the Montreal Gazette, have been reprinted by request of 
 friends of the union of the Montreal G-eneral and Royal 
 Victoria Hospitals, and are respectfully commended to 
 the favorable consideration of those interested in either 
 or both of those institutions, and in the great public 
 objects which they are intended to serve. 
 
 Copies have been placed in the hands of gentlemen 
 connected with both hospitals. 
 Sept., 1889. 
 
^ . 
 
 THOUGHTS ON HOSPITAL SITES. 
 
 {Prom Corretpondence and Editorialof Montreal Qatette, My and Avg., 1889.) 
 
 The Nbw Hospital SiTB. 
 
 To the Editor o/Thb Gazette : 
 
 Sir —Those who watch the diBcussion of public affairs from 
 the standpoint of the ordinary citi^-en, who, while deeply 
 interested, has no determining voice (except that of an occasional 
 vote at a civic election), have been sometimes amused, sometimes 
 grieved, in noticing the varied and discordant opinions of " ex- 
 perts " and " non-experts " on the above matter, so seriously 
 concerning the most vital interests of the community; 
 
 One thing that strikes the average citizen, if at all an observant 
 man is the familiar fact that in the St. Lawrence valley, and es- 
 pociilly in our cities, a very little elevation on any hillside secures 
 an appreciable improvement of atmosphere as compared with 
 that in the lower grounds, where the air is moist and warm in 
 summer and loaded with noxious effluvia. In the lower part of 
 the town one can scarcely open a window in the warm weather 
 without being disagreeably reminded that the atmosphere is flat 
 and destitute of ozone, besides being none of the purest. But if 
 I can Hpare an hour to ascend the slope »f Mount Royal, or to 
 stroll in the Mountain park, I find a fresh and invigorating 
 atmosph^-e-as much so as if I had gone a hundred miles into 
 the country. I return feeling myself for the time a new man. If 
 I were sick I would rather lie in a shanty on the mountain than 
 occupy a palace in the lower part of the town. Some day, wheu 
 
intelligence has advani'cd a little, there will be a sanitarium on 
 the top of the raountnin to which mothers may send their 
 children, and where frewh aii", pure water, and Huitable food 
 would remove their little summer ailments as effectually as a more 
 expensive ar troublesome journey to the country, and whence 
 they may return to their homes instead of being carted oif to the 
 cemetery, where we provide over their little graves the moun- 
 tain air and foliage that might, if administered in time, have 
 helped to keep them alive. In the meantime our wealthy citizens 
 appear to know this, and perch their handsome residences on the 
 mountain. I can fancy that some of them, after enjoying siich 
 pure air, must appreciate the difference when they go down to 
 the General Hospital to vote for keeping the poor man in his 
 sickness in the warmest and most crowded pait of Dorchester 
 street, and out of the reach of the fresh breezes that would double 
 his chances of recovery. 
 
 In view of all this, two liberal and large-hearted men have 
 been found who have purchased one of the finest sites on the 
 mountain — a much bettor site than either of them possi^sses for 
 his own house, and have broken ground for the erection of a noble 
 structure overlooking the city and away from its noxious exhala- 
 tions, where the poor man may be tended in his sickness, and in- 
 stead of pining amidst insalubrious surroundings may have all 
 the advantages which the rich can command. The distance is, 
 no doubt, a little greater, and the ascent somewhat steep, but the 
 beautiful house is at the top, with the pure air of heaven iuH^ead 
 of an atmosphere which no amount of carbolic or chlorine can 
 render wholesome. 
 
 Let any one who doubts walk up University street to the site 
 where the foundation is now being dug, and as he stands there 
 let him note how his chest expands and he draws full and 
 gratifying inspirations of pure air free from dust, disease germs, 
 and the exhalations from yards and refuse heaps. Let him 
 imagine a palace for the sick erected there — roomy, clean and 
 airy, with fine surrounding grounds, provided with all that 
 modern science can secure in the way of both sanitary and 
 sanatory conditions, he will return thankful and content, and will 
 be prepared to attach as much value to the learned prognostica- 
 
tioHH of evil which have haunted the Boyal Victoria Hospital as 
 to the CAW of the crow which flieu acrosH his path. 
 
 Thi» is a part of one side of the question, but the venerable and 
 honored General Hospital has something to suy for itself and its 
 site which should also be listened to. 
 
 The Old Hospital Site. 
 
 To the Editor of The Gazette : 
 
 Sib, — In a previous communication something was said as to 
 the advantages of the site of the Royal Victoria Hospital. Let 
 us now turn to the old site, as it may be supposed to appear to 
 the oi-dinary citizen. 
 
 The venerable and justly loved and respected General Hospital 
 has, beyond the remembrance of the present generation of men, 
 been an institution of which our city ha« good reason to be proud, 
 and which has confeiTed inestimable benefits not only on our 
 own citizens but also upon strangers. It has been emphatically 
 the English hospital, managed on the principles which commend 
 themselves to the practical good sense and sagacity of the Eng- 
 lish-speaking porHon of our people, attracting to itself the best 
 medical talent of Canada, and cared for and supported by the ilite 
 of our citizens, while it has extended its benefits to patients of 
 eveiy origin and creed. It has also been an essential helper to 
 the great medical school which has given Montreal celebrity as 
 a centre of professional education, as well as to the rivals which 
 have recently endeavored to share its laurels. It has now the 
 prestige of great reputation and enduring usefulness. Its present 
 governors revere it as an object of solicitude to good men who 
 have passed away, and generations of our citizens have looked to 
 it as their resource in accident or sickness. 
 
 Such an institution necessarily commends itself to the good 
 will of all men, and it has accordingly from time to time received 
 many generous gifts, and few of our more wealthy citizens de- 
 part this life without remembering it in their •.<ill8, while there 
 is no charity to which they are more willing to contribute. Any 
 attempt to weaken or injure it would be sure to meet with publiQ 
 reprobation. 
 
The site of tho General hospital woh Holected at a timo when 
 the city of Montreal y/an almost liniiled to tliu ridgo ocoupie<l hy 
 St. JamoH and Notre Damo streets, when Craig street was in great 
 part a swamp where a botanist might still collect marsh plants 
 and where possibly an early sportsman might chance to have a 
 a shot at a snipe. Dorchester street was then nearly as far afield 
 as the mountain park is now ; and if the records of the time were 
 caref\illy searched, it would no doubt be found that there were 
 conservative people then who deprecated a location so distant 
 from the heai-t of the city, and contrasted it with that of the 
 older hospitals then near the river side. Medical doctors at that 
 time considered the central part of St. James Street sufficiently 
 remote from their patients, and probably regaixled a drive to 
 Dorchester street as something of the nature of a country visit. 
 Since that time all the lai'ge populations occupying the western 
 and upper parts of the city have grown up, and the General 
 hospital is nearer to the river than to the rear of the city, while the 
 part of the town surrounding it is becoming more and more occu- 
 pied with shops, warehouses and factories, and it is being more 
 and more enveloped in the increasing smoke of a manufacturing 
 town. 
 
 The nuns in the meantime have wisely removed their great 
 hospital to the upper part of the city, where it has ample space for 
 extension, and for surrounding grounds, and where the existence 
 of the park on its western side, that of the prevailing wind, ensures 
 to it for all time the inestimable blessing of fresh air for its 
 patients. In these ways it possesses inducements which com- 
 mend themselves to the people, and which tend to counterbalance 
 the great advantages in other respects offered by the General 
 hospital. The latter also falls short of the accommodation neces. 
 sary to meet the present demand. It is said that many patients 
 have to be refused admission, and that the space both for patients 
 and attendants is altogether inadequate. Donations and bequests 
 in aid of extension, it is true, have been received, and plans for 
 improved buildings have been prepared, but the more prudent 
 and sagacious of the governors unquestionably are impressed with 
 the feeling that it would be improvi lent to expend large sums of 
 money on a site at present insufficient for the requirements of a 
 good modern hospital, and which must yearly become, with the 
 
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 oytension of the city and the occuymlion of iIm central part for 
 bu8ineHM pur|K)HeH, more and more unuuitable. The governors of 
 the hospital should, in the public interest, regard not the present 
 merely, but the future, and note the upward and westward ex- 
 tension of trade, population, and our churches and public insti- 
 tutions. They should also bear In mind that within not many 
 years the churches and public institutions, which are now moving 
 up to western Dorchester and St. Catherine streets, will be as 
 much "down town" as they were in St. Jaraos and Craig streets, 
 and the time is coming when the Mountain park will be in. the 
 middle of the city. They should be prepared not to tie them- 
 selves to a piece of ground, however hallowed by old association, 
 but should bo ready to act with the same wise forethought which 
 animated the original founders of the hospital, at a time when 
 the present extension of Montreal would have been regarded as 
 an impossibility. 
 
 In the circumstances, the foundation of the Koyal Victoria 
 hospital on a site further removed from the lower and less salu- 
 brious portion of the city, should be regarded by thosp interested 
 in the General hospital as a welcome deliverance from a great 
 and increasing difficulty ; and if any armngenient can be secured 
 whereby the two hospitals can work together and be mutually 
 helpful, a great advantage to the ])ublic will be secured. Besides 
 this, economy is :m important object. 80 long as our Fi'ench- 
 Canadian fellow-citizens prefer the e^'clesiastieally managed hos- 
 pitals, which are now being so severely repressed by their bre- 
 thren beyond the sea, it is evident that the support and manage- 
 ment of properly equipped general hospitals ».. '."t devolve on the 
 comparatively small English element, and this should not be 
 burdened with a duplication of work and expense. It follows 
 that amalgamation of some kind must commend itself to all pru- 
 dent men, animated by a sincere regard for the public welfare ; 
 and the question really is how this may best be effected. To this 
 end some concessions may be required in matters non-essential, 
 while securing the permanence of a thoioughly efficient manag- 
 ing board representing all interests, and the retention of all that 
 is desirable in the capabilities of both sites and of the buildings 
 erected upon them. 
 
 Fortunately, while there is some natural hesitation and indis- 
 
position to any precipitate action on the part of the governors of 
 the General honpital, the majority of them are dinposed fairlj'^ to 
 weigh in the public interest any propoii^als laid before them ; and 
 thu board of the Victoria hospital, on its part, has made advances 
 and offered largo concessions in aid of union. This, it is under- 
 stood, is with the full concurrence of the generous founders of 
 the new hospisal; who by the pui'chase of enlarged space on the 
 mountain side, at a great additional cost, have shown themselves 
 disposed to consult in every way, even the prejudices of some of the 
 citizens, while at the same time advancing much beyond our old 
 ideas of the requirements of a great and growing city, of whose 
 extension and prosperity in the future they have, from their own 
 successful work in this direction, some leason to feel confident. 
 When the agitation for the impiovement of the parish schools of 
 Scotland was in progress some years ago, an attempt was made 
 to raise a popular cry to the ettect, that this was derogatory to 
 the memory of Knox, the great founder of these schools. The 
 reply was : " If Knox had been of j^our mind, theie would have 
 been neither reformation noi* parifih schools." Let nn not allow 
 unreasonable prepossessions with reference to the past to stand 
 in the way of enlightened provision for the future. This, how- 
 ever, raises the question, how best the rival sites may be combined 
 and used for the public benefit ; and this may afford material for 
 another communication. 
 
 Mkrits and Uses of the Two Sites. 
 
 To the Editor of the Gazette: 
 
 Sir, — Tf the facts and inferences stated in my previous letters 
 have commended themselves to the good sense of those inter- 
 ested in the matter, the next question will be how, in view of 
 these facts, we may best use the two sites now available in the 
 interest of the public. The alternatives are : (1.) There may 
 be two distinct hospitals, duplicating each other's work, and 
 rivals for public support. (2.) The two hospitals may remain 
 distinct, but with some alliance of a more or less intimate char- 
 acter, providing for common action in certain matters. (3.) 
 There may be a complete amalgamation under a united board of 
 
11 
 
 management, and with a single purse. The first of the^e is obvi- 
 ously likely to lead to much inconvenience and waHte, while it 
 will emphasize that disunion of which our groups of churches 
 on Beaver Hall, St. Catherine street, and around the Windsor 
 Hotel, are at present outward manifestations in the religious 
 world, but which, happily, has as yet had nmall effect on our 
 charitable and educational institutions. The second mode would 
 be cumbrous and uncertain in its working, and, therefore, pro- 
 bably inefficient, while it might not be free from the rivalries 
 and jealousies incident to separate managements. If the hospi- 
 tals were purely business corporations, like banks or insurance 
 companies, wo might hope that in either of the above modes 
 some healthy competition would arise beneficial to the public, 
 but, unfortunately, this law of competition does not hold in ben- 
 evolent enterprises in the same way as in those that are merely 
 commercial. The third mode, that of amalgamation, therefore, 
 remains as the most desirable if it can be attained. 
 
 To secure a united board, two concessions, one on the part of 
 the Victoria HospiVal and one on that of the General, seem neces- 
 sary. The former must consent to enlarge its board of manage- 
 ment so as to admit of an adequate representation of the latter, 
 and must modify somewhat its conditions for the admission of 
 life associates. The latter must come under the management of 
 a united board on which its numerous governors will act not 
 directly but through representatives. There would seerji to be 
 little difference of opinion as to the expediency of these conces- 
 sions, the principal question raised being as to the : mount of 
 representation of each hospital in the first instance. It has 
 been proposed to adjust this on the basis of a representation in 
 pi'oportion to tjie amount of property and income possessed by 
 each hospital, which seems a not unfair arrangement. It is to 
 be observed, however, that any difficulty on this point applies 
 merely to the board as at first constituted, while the hospitals 
 are yet separate. When once united, as their constituencies, or 
 the great majority of them, consist of the same persons, no ques- 
 tion can arise as to the one hospital as distinct from the other. 
 The whole will then be one establishment, with two places for 
 carrying on its business. 
 
 But then arises the question as to the business to be carried on 
 
12 
 
 in each place. This must finally be a question for the united 
 board, and any attempt to tie up its hands for all time would 
 certainly be injurious. But some arrangement should be made 
 for the initial distribution in a way that might remain undis- 
 turbed, so long as the present condition of the city and its 
 hospital requirements continues. 
 
 Here common sense would dictate that, as the higher site is the 
 more salubrious, and has the advantage of a change of air to a 
 higher atmospheric stratum, it is best suited to continued and 
 chronic cases and to convalescents, whether recovering from 
 disease or from surgical operations. On the other hand, the 
 lower site is more accessible to out-door patients from all the 
 central and eastern parts of the city, and is more convenient for 
 cases of accident and emergency. These considerations might 
 easily form a basis for a primary division of work. The ordinary 
 cases may be removed from the General to the Victoria, so soon 
 as it can be ready, and the dispensary rooms, the arrangements 
 for cases of accident and the accommodation for patients ot that 
 kind in the General may be improved and enlarged, so soon as it 
 can be freed from the burden of the ordinary patients. In this 
 way nothing of consequence would be duplicated, there would be 
 an intelligible division of work, and the public would have a 
 vastly better provision I'or its needs than at piesent. The 
 question of contagious disease^!, which practically should have a 
 distinct provision amounting to a third hospital building, might 
 be left for tinal decision to the united board, though the higher, 
 more distant and more salubrious site should be secured for it if 
 means will permit. 
 
 It may be objected that by this arrangement the function of 
 the General hospital will bo too much diminished. This, however, 
 is a short-sighted view. The uccommodation tor dispensary ser- 
 vice needs great enlargement and improvement, and is in an3ca8e 
 a large, important and increasing department. The increase of 
 the city and the growth of its factories and its shipping will 
 unhappily rapi lly augment the number of accidents, and im- 
 proved provit^ jn for the immediate and effectual treatment of 
 these would tend to determine them more and more to the hos- 
 pital. It is not improbable that the provision of fifty beds, which 
 has been estimated for this service, might, in a few years, have 
 
t9 
 
 to be increased by the united board to an hundred, while the beds 
 in the Victoria hospital may be fully occupied. Another and 
 most important consideration is that in both hospitals there 
 would be an absence of that overcrowding and insufficiency of 
 room and appliance which affects the General hospital at present. 
 With ample space and improved means, the physicians, surgeons, 
 nuraes. and patients, would all be in more favorable conditions, 
 and better results in every respect might be anticipated. In a 
 growing city like Monti>eal all public institutions are more or less 
 afflicted with a chronic insufficiency of means to meet the 
 demands made upon them, and it is much to be desired that this 
 should once for all be effectually cured in the case of our 
 hospitals. 
 
 The writer of these letters makes no pretension to gifts of pro- 
 phecy ; but he can infer as to the future from what he has seen 
 in the past. If the present opportunity is lost, it may pass away 
 for ever, and those who, from the best intentions, obstruct a 
 wholesome union, may live to i-egret their present action. The 
 old hospital, with all its past prestige and popularity, will neces- 
 sarily suffer most from a failure to unite. It is the law of our 
 time that the new must increase, the old decrease. The Genera! 
 hospital may decay and fall into inferior hands, while the Vic- 
 toria may find itself hampered and overburdened. It is to bi-^ 
 hoped, however, that this failuie will not occur, and that as a 
 United General Victoria hospital, or parhaps in honor of the 
 Queen it should be "Victoria General," the combined institutions 
 will enter on a new and magnificent career of usefulness. In any 
 case let us not incur the risk of being blamed by those who suc- 
 
 ( ceed us for throwing away, even in part, the benefits of one of 
 
 I the noblest benefactions of our time. 
 
 I ON-LOOKER. 
 
 ] Juiy27, 1889. 
 
14 
 
 Editorial Comments. 
 
 The attention of our readers has, doahtless, been directed to 
 the letters of our correspondent on " Hospital Sites," w hich ap- 
 pea]*ed in our issues of the 16th, 24th and 31st ult. The writer 
 of those letters has pleaded with such conviction and convincing- 
 ness for the consolidation of the General and the Victoria 
 hospitals into one strong, serviceable institution, with its build- 
 ings on a site where the blessing of pure air might be had con- 
 stantly and in abundance, that all reasonable people must 
 acknowledge the force of his argument. Touching the union of 
 the two institutions he puts the alternative succinctly and clearly 
 before the public — " two distinct hospitals, duplicating each 
 other's work, and rivals for public support." And of this alter- 
 native he says that it " is obviously likely to lead to much in- 
 convenience and waste." Granting, then, that on the ground of 
 correct business principles and common sense, the preference 
 must be given to the plan of united action, on what terms should 
 the two institutions agree to co-operate? " Onlooker " suggeHts 
 two methods as possi ble. By one of these the two hospitals may 
 remain distinct, but with some alliance of a more or less intimate 
 character, providing for common action in certain matters. The 
 alternative to this ari'angement is " complete amalgamation under 
 a united board ol management and with a single purse " The 
 formei' of these two schemes of union our correspondent char- 
 acterizes as " cumbrous and uncertain in its workings, and, there- 
 fore, probably inefficient, while it might not be free from the 
 rivalries and jealousies incident to separate managements." In 
 fact, for the purposes of unted action it would be found inade- 
 quate, and in practice would be disappointing. There remains 
 the plan of complete amalgamation, and the first question to be 
 answered is whether it can be effected. Our correspondent thinks 
 that it can — the concessions necessary to that end being, on the 
 part of the Victoiia Hospital, an enlargement of its board and a 
 modification of its terms of admitting life associates ; and, on the 
 part of the General Hospital, the consent of its Governors to a 
 representative, instead of a direct control in the united board. 
 The representation, it was suggested, should be adjusted on the 
 
 
w 
 
 
 basis of each hospital's property and income ; but as the result of 
 the meetings of the committees, it is believed the Governors of 
 the Victoria have consented that all the present Governors of the 
 General shall be continued as associate Governors of the new 
 institution, and that the qualifications for future Governors shall 
 be lowered. Should these propositions be accepted we shall 
 have one great hospital with two centres for ccnducting its 
 operations. 
 
 How, then, should the work be didided between the old city 
 and the new suburban or extramural establishment. Our cor- 
 respondent devotes two of his letters to a consideration of the 
 respective merits of the Dorchester street and the mountain site. 
 Those who have read his comments must admit that his contrast 
 between the air of the lower and that of the upper portion of the 
 city is not a whit too emphatic. Solvitur ambulando, as our cor- 
 i-espondent, with his twofold experience, suggests. To expend 
 money on rebuilding on a site because it was chosen some seventy 
 years ago by men whom all must revere, would be imitation in 
 letter but not in spirit. Look at a picture of the General Hospital 
 in its early yeara ! It is in the fields. Between it and Craig 
 street are men harvesting their grain. There is not a house in 
 the neighborhood of it save its own outbuildings. Beyond, to- 
 wards Sherbrooke street, are villas, surrounded by orchards and 
 groves. It is a rural scene throughout. The grounds had been 
 known as Marshall's Nui'sery before they were purchased by the 
 Hon. Messrs. Richardson and McGillivray aid Mr. Samuel Ger- 
 rard. Every word that " Onlooker " has written on the choice 
 of a site for a new hospital bears the impress of yound sense and 
 merits the sanction of the hygienic expert. Wherever just such 
 warnings as he utters have been disregarded, the consequence has 
 been disastrous. On this point one of the greatest of modern 
 authorities thus expresses himself : — " Fresh and pure air being 
 a prime necessity, as well as a considerable amount of space of 
 actual area in proportion to population, it would certainly appear 
 to be better to place hospitals as much in the outskirts as is con- 
 sistent with considerations of usefulness and convenience. In 
 short, the best site would be in the fields ; but, if that be im- 
 practicable, a large space — a sanitaiy zone — should be kept per- 
 manently free between the hospital and the surrounding build- 
 
I« 
 
 ingB." The same writer nays that, in most cases, it would be 
 advantageous to dispose of the present buildings and sites of city 
 hospitals and to retain only a receiving house in their stead. 
 
 Now this is jnst the view taken by our correspondent. He 
 would keep the lower sile (the General Hospital) for out-door 
 patients and cases of accident and emergency as well as 
 (with needed improveinentn) for a dispensary. The hospital 
 occupying the higher and more salubrious ground would then be 
 set apart for chronic cases and convalescents. As to the sufferers 
 Irom contagious diseases, who would require isolation and the 
 purest air available — the question of providing for them might 
 be left to the consideration of the united board. 
 
 Such, in the brief outline, is our correspondent's plan for the 
 solution of a problem of the highest interest to our city. That 
 there may be objections to it, he is aware. Of these, the most 
 weighty is that which touches the prestige, integrity and inde- 
 pendence of that time-honored institution — the General Hospital. 
 There is really, however, no conllict of interests. Those who 
 are concerucd for the welfare of the old are alike concerned for 
 the future of the new hospital. Both have been created for the 
 same benevolent objects — for the relief of the same classes of 
 sufferers and in the service of the same community. It is essential, 
 therefore, for the highest efficiency, contemplated by the 
 founders of each of them, that they work together and not apart, 
 without, however, any sacrifice of the name and fame of the older 
 nstitution.