MONTREAL GENERAL HOSPITAL. MONTREAL GENERAL HOSPITAL, Montreal, 6th March, 1884. To the Governors of the Montreal General Hospital Gentlemen,— addressing yon in regard to the Hospital, and trust, in its interests, you will give this communication your careful consideration. For your information I take this mode of In the years 1811 and 1812 Mr. Peter Redpath was your Vice-President. Having gone to England in the latter year he resigned his position, but on his return in 1815, he was then elected your President, in place of the late Mr. Wm. Molson ; this position he continued to hold till 1882, when he again went to England. At the Annual Meeting of the Governors in 1812, when I was absent in England, you did me the honor of electing me a member of your Committee, the year thereafter as your Treasurer, in 1818 as your Vice-President, and when Mr. Peter Redpath retired in 1882, as President. In the annual report of 1812 it was stated that a sum of $lO,OOO was promised for a wing to commemorate the name of a valued vice-president, the late Mr. Thomas Morland, who had been a warm friend of the Hospital, and whose decease was greatly lamented. For this wing a building committee of three Governors was appointed, of which I was one. We entered upon our duties, entrusted the plans and building to an architect, who, no doubt, did his best with the facilities which were placed at his disposal, but I soon learned to regard 4 the erection of the Morland wing as a great blunder for the future interests of the Hospital, as on Mr, Redpath’s return, I found that before he went to, and while he was in England in 1873 and 1874, he had been studying the question of increased Hospital accommodation, and on his return to Montreal, when he explained to me his study of the subject and the information he had obtained, I then, and since, have ever regretted that before the Morland wing was built that we had not first decided upon some such comprehensive scheme and plan as Mr. Redpath had obtained from a leading architect in London. These plans at that time were submitted to Miss Night- ingale, Captain Douglas Gralton, Dr. Sutherland, and other high authorities, and such suggestions as they recom- mended were embodied in the plans. Mr. Redpath and the architect have kept the plans under revision with every known improvement that has taken place up to the present time. From the annual report of 1875 I quote the following extract; “ With the view of providing accommodation for the “ yearly increasing number of sick persons seeking admis- “ sion, it has been deemed advisable to acquire additional “ property adjoining that on which this building stands, “ for the purpose of erecting thereon buildings on the most “ improved principles of Hospital construction ; it is pro- “ posed to undertake the erection of one pavilion, which “ will form part of a general plan that can be carried out “ gradually as circumstances require. “ An effort is being made to procure the necessary plans, “ and it is hoped the result will be an institution con- “ taining all the best features of the most approved modern “ Hospitals, but it will take years to complete the design “ now contemplated. “ When we reflect that the body of the present Hospital “ was erected 54 years ago, and the Eichardson wing 43 5 “ years ago, and that it has been chiefly since the Crimean “ war that very much attention has been paid to the “ scientific principles upon which Hospitals should be “ constructed, it will be at once evident that the citizens “ of this large city are bound by the highest considerations, “ the value of human life, the sanctity of human suffering, “ to provide for the sick an hospital as free from defects as “ can be constructed.” Before that meeting was held, and after due considera- tion, I agreed with Mr. Redpath to do all in my power to carry out his views, and offered, if spared, to devote ten years of my life to assist him in carrying out this most important work. During all that time, and which has now expired, we have worked together in the most cordial manner, and the knowledge he has obtained is so very valuable that I exceedingly regret that he is absent from the city at the present time. Nothing could be done with these plans, or in fact with any comprehensive scheme, till the Scott property was obtained; to secure which, or a portion thereof, efforts were then made, but failed. Owing to the decease of Miss Scott, the properties of the estate have lately been brought to sale, and for the Corporation I was enabled last February to buy the whole of the property fronting upon Lagauchetiere and St. Dominique streets, so that we are now for the first time in a period of ten years, in a position to consider plans and the propriety of building. In this connection it is fortunate that Mr. Gfeorge Stephen last year so generously donated to the trustees viz., John Turnbull, Andrew Robertson and Thomas Davidson, fifty thousand dollars of Pacific land grant bonds to build a pavilion to commemorate the name of the late Dr. Gr. W. Campbell. The late David J. G-reenshields by his will left forty thousand dollars, which is to be used when required for 6 erection of another pavilion, and in the mean time the interest is to accumulate and to be placed to the perma- nent fund. As already stated, I regret extremely that Mr. Redpath should be away from Montreal at present, especially that we have now reached a point so momentous in the history of the hospital, as his knowledge and the careful consider- ation he has given to the subject, his opinion would be of immense value to us, and while we have regularly corresponded together on the subject, and had several interviews when I was in England last year, his absence at present and his return to Montreal being so very uncertain, is one of the reasons for thus troubling you with my views, first, as to the present state of the fin- ances, and second, the future requirements that will be involved by the much needed extension of the hospital. I find that the ordinary revenue of the hospital during the last decade has averaged $84,900, the lowest sum in any one year having been $30,200, and the highest $38,500. The ordinary expenditure has been an average of $36,300, the smallest being $33,100, and the highest $42,700. You will at once see that during the past decade our income has fallen short of our expenditure about 1,400 dollars per annum, or $14,000 in all, which had to come out of our permanent fund. Let me take last year as an example: the average num- ber of patients in hospital was 136, multiplied by 365 days amounted to 49,640, and the expenditure to $39,114 or 80 cents per day for each patient. Suppose we build a new wing to accommodate say 10 beds; this will at 80 cents a day increase our yearly expenditure by $20,440; but suppose we assume only one half of this number by reducing a similar number in the present buildings, which are over-crowded, the cost will still be over SIO,OOO, so that under the most favorable circumstances $50,000 will be yearly required to meet the expenses. It will be comparatively easy in consequence of Mr. Stephen’s gift and Mr. G-reenshields’ bequest to add build- ings, but the question is, when they are built how are they to be kept up ? It is with no wish to delay building that I raise this question, because I am of the opinion that at least one pavilion is absolutely necessary, but after my experience in extending accommodation, I do not wish to let the governors take that responsibility without making them fully acquainted with the state of the case. It must be understood that our permanent fund is only about $lOO,OOO, which yields a revenue of say $5,000 ; the balance has to be met by voluntary subscriptions from the citizens, except that the local government has hitherto been giving us $4,000, which has been reduced this year, and from the straightened circumstances of the Province with other grants of a similar kind, will, I think, no doubt be ultimately withdrawn, so that if this takes place, so much more will be required to be voluntarily subscribed. At the last annual meeting I said that when I was in England I would visit some of the modern Hospitals, and which I had the pleasure of doing. In this connection let me say that St. Bartholomew’s, in London, has a yearly income from land and investment of somewhere between ,£BO,OOO and £90,000 stg., say $400,000 to $450,000. They, therefore, do not require to depend on, nor do they ask for voluntary subscriptions. Next let me quote from the last meeting of the Edin- burgh Royal Infirmary, the cost of building which is stated to be £350,000 stg., or say $1,150,000. They had legacies left them for their permanent fund of £131,000 stg., or $685,000 last year alone. 8 I only mention these two, to give yon some idea of what is being given, and to show how these institutions are supported in London and Edinburgh, so as to urge upon all who are giving donations or legacies to the Montreal Greneral Hospital, that in view of these facts large additions to the permanent fund are urgently required to support not only what has been already built, but the additions wThich are proposed to be made at an early day. The questions which I have, therefore, to put before you, are as follows: First—Should the plans referred to and so carefully supervised by Mr. Redpath, be adopted, or if not, what steps should be taken in the premises ? Second—The desirability of building’ one or more pavilions at once, or when ? Third—Should it be deemed advisable to build, the question of increased income which will be necessary should be considered, and how it is to be obtained ? To the first question I may mention that the plans re- ferred to are so arranged to involve the greatest economy, in adapting them as required to the land now in our possession, and will cost per pavilion from $50,000 to $*70,000, according to size and construction. The present main building and the Mori and wing may remain un- touched for years to come, or so long as necessary, or may be considered desirable. The plans in their entirety are designed for the accom- modation of about 300 beds, and the building will probably cost about $400,000 when finally completed. In my opinion one pavilion at least should be built without delay, and a second also, provided the means can be found to sustain them. These additions would, I think, fill the requirements for twenty years to come, except for infectious diseases, which might require ad- ditional accommodation. 9 TW subject will come up for discussion at the next quarterly meeting the second Wednesday in May, and as I feel it of so much importance I have written this, so that before the meeting you might have the facts before you for intelligent discussion. And I am, Gentlemen, Yours very truly, Andrew Eorertson. P. S.—I wrote the foregoing on 6th March, and forwarded it to Mr. Eedpath for his perusal and comment. Evidently Mr. Eedpath’s mind was running in the same direction, as on the Ith he wrote me on the subject, and also on the 21th and 28th, extracts from which I have appended hereto, as also copies of notes from George Stephen, Esq., and E, B. Greenshields, Esq. A. E. Montreal, April 14th, 1884. The Manor House, Chislehurst, March 1, 1884. My Dear Eobertson,— I congratulate you and the Hospital on the acquisition of the Scott property. The Hospital is now independent of the proprietors in the other corner for many years to come. Now with regard to the plans I do not know that I can say more than what I have already said. The G-overnors will doubtless decide to build something, and that some- thing ought to be part of a general plan to cover the whole ground. The plans you have were designed by one of the first Hospital Architects in England, and were subjected to the careful scrutiny of Miss Nightingale, Capt. Douglas Gallon, and I think Dr. Sutherland and 10 other Hospital authorities, some years ago; the plans you have embodied the suggestions of Miss Nightingale, confirmed by the others ; they have had the advantage of the Architect’s experience since; they will admit of being built as the requirements of the Hospital become developed. If the governors insist upon competition for the design, you will, of course, not exhibit them until the others are in, but if the governors will refer them to a committee, with instructions to report if they approve, you will submit them to the committee, on which, of course, there must be no architect. The Committee of Management, with perhaps three or four others, would probably satisfy the governors. Then as to means. It would be idle to shut our eyes to the fact that the annual expenditure will be increased. How this is to be met I cannot exactly see. A considerable amount may perhaps be subscribed as an endowment. Pro- pose your scheme to the public. Here are certain buildings which we think essential to the progress of the Hospital and the interest of the sick poor—we have money to erect this one and that one; we want so much to erect this, and so much as an endowment. You might offer the inducement to those who would contribute a certain sum by calling wards after them. You have your Campbell or Grreenshields building, but in those buildings you may have wards named after the large donor, and in those wards you may have beds named after the smaller donors; SI,OOO might name a bed, and SIO,OOO a ward. I have a strong desire to go out and help you, but it is impossible for me to go this year. Besides, I might be suspected of meddling where I had ceased to have any right. If you can start the thing you might then leave it very much in the hands of a few individuals of the committee. You cannot do any more until May, unless you call a special meeting for the purpose. A special meeting might con- firm the purchase, and appoint a committee to report to the meeting in May. I suppose the report would be pre- 11 sented to the governors’ meeting. I shall be anxious to hear of your further proceedings. Believe me, Yours very truly, Andrew Robertson, Esq., Peter Redpath. Montreal. The Manor House, Chiselhurst, March 21, 1884. My Dear Robertson,— only reached me on the afternoon of the 22nd. I have been so driven for the last few days that I cannot make time to write as carefully as I would like to-day. Your letters and papers of the 6th inst., I have written to Mr. Lome Campbell to ascertain Dr, Roddick’s address, if he knows it. Meantime I asked the architect to increase the operating theatre so as to accom- modate 150 students or more. The chapel I think may remain as it is, but that we will farther discuss. Your proposed letter to the Grovernors gave a very clear historical view of the question. It will do as it stands, unless you could add a few words to the effect that you are assured of my cordial co-operation in carrying out the designs ivhich you report, should they be adopted, otherwise I wish my name had been less prominent. The architect will have a pencil sketch of the enlarged operating room ready to send by next mail. Yours very truly, Andrew Robertson, Esq., Peter Redpath. Montreal. 12 The Manor House, Chiselhurst, March 28, 1884. My Dear Robertson,— I wrote to you hurriedly by the Canadian Mail of yesterday. I have since learned that Mr. Lome Campbell cannot find Dr. Roddick’s address for me, but I think I said to you that I had told the architect to pro- vide room in the operating theatre for 150 students. I doubt if a larger number than that could witness an operation so as to derive much benefit from it, but I will ascertain this from a good authority. I think you need not send tracings unless the plans be adopted, in which case I would like to go over them again in the light of the most recent information on the subject. Suppose that other plans are obtained, who is there among the Grovernors or in Canada to discuss their respective merits ? One of the highest authorities in the United States is Dr. J. S. Billings, of Washington, who once told me that he would be glad to look at any plans for a Montreal Hospital that I would show him. He felt at one time some interest in our schemes. The question is one that requires a special study. A Committee of Grovernors would very likely decide on the exterior that pleased them best. I care nothing about the exterior so long as it is sufficiently plain. If competition is demanded, you should insist that the competing designs should be submitted to a competent authority or authorities. You will be better able to decide which of the buildings are to be erected when you ascertain the opinion of the Grovernors generally as to the whole scheme. Yours very truly. Peter Redpath. Andrew Robertson, Esq., Montreal. 13 140, Drummond Street. 3rd April, 1884. My Dear Robertson,— Thanks for the perusal of your interesting letter on the Hospital matters, which I return herewith. If I were to offer an opinion, I should say that it is in- cumbent on those on whom the responsibility of deciding rests, to see a reasonable certainty of being able to provide for the maintenance and efficiency of the Hospital, before committing themselves to any extension. What is done should be well done. “ Overhousing,” so to speak, ought to be avoided, and rather than fall into that weakness, it would be better to devote attention to securing a capital fund for “ running expenses,” and only extend slowly as circumstances permit. Always yours, Andrew Robertson, Esq. G-eorge Stephen. 14 Montreal, 1 May, 1884. Dear Mr. Robertson, I am much obliged to you for shewing me the letters about the Hospital, which are full of interest. It is evident that some plan must be arrived at to pro- vide for an increase in the Annual Revenue, and I think this should be done before building new wings, that the Hospital may be maintained in a proper state of effi- ciency. Yours very truly, E. B. Gtßeenshields. Andrew Robertson, Esq.