given them by law, and they will make use of such institutions for all possible charitable work, and public hospitals will be developed only to supply any gaps in the private hospital system or for the care of such cases as may not be suitably handled in a private hospital. The city of common sense will take advantage of a great principle, and that is, the love of man for his own particular kind and the honest pride that comes through witnessing the growth or development of a work to the support of which one is stimulated by the instincts of humanity plus the instructions of his religion.

A civic government composed of sensible men will make use of the principle demonstrated so signally and successfully in those two great institutions in New York-the Metropolitan Museum of Art and the Museum of Natural History, both under the control of boards of independent citizens who give their time for the management and bestow their means for development, and who in following this plan have placed at the disposal of the general public the two finest institutions of their kind in the world, which, while sufficiently under civic control, are after all under the direction of these private boards, and because they are removed from the influence of political parties and are sure to continue their purpose of collecting works of art and educating the public, are receiving at the present time increasing millions of private money, and additions to these splendid institutions can hardly be erected fast enough to provide the inrush of contributed wealth.

FINALLY.

It may be that there are cities in which the general idea suggested in the foregoing could not well be carried out. I know of none such. It is pretty certain, in a general way, that any community, if it has the disposition, can arrange so as to take advantage of the philanthropic efforts of the good men and women in the community, for in all these. private hospitals the wives and daughters of our foremost citizens are identified; they give personal service, advice and money, and the number of those who are willing to do this kind of work for humanity, both men and women, is continually on the increase. As for myself, I have not the

slightest doubt as to our own city that private hospitals will continue to multiply and so relieve the city of the necessity of maintaining a very much extended public plant for years to come, and these private hospitals will continue to do their noble work for the city poor, so long as the principles of religion and humanity control the hearts and actions of our best citizens.

DISCUSSION.

MR. ROBERTSON: I was very much obliged to Dr. Potter for the complimentary allusion he makes to Canadians and Torontonians. I would say that we have one municipal hospital in Toronto, that is the hospital for infectious diseases in connection with the City Government. That hospital handles scarlet fever, diphtheria and measles, and the per capita is about ninety cents per day. It is under the excellent management of Dr. Chas. Sheard, the Medical Health Officer. We consider that the city has made a wise investment. It was thought better to erect this hospital near the city. Then we have what is called "The Swiss Cottage Hospital," a mile or two from the city, for smallpox cases. The infectious hospital was erected because it was found impossible to carry on the work with infectious cases at the Toronto General or at the Children's or other large hospitals of Toronto. In the Hospital for Sick Children we have a ward where we take care of the infectious cases that originate in our building, but for the past two or three years the city has taken care of those cases, so that we have more space in our building for the ordinary cases. I merely mention the fact that we have a City Hospital for Infectious Diseases so that when this paper of Dr. Potter's goes into print those who read the paper may note the omission, and that in what I have to say they will note the correction.

303

HOSPITAL CONSTRUCTION.

JOHN N. E. BROWN, M. B.,

Superintendent, Toronto General Hospital, Toronto, Ont.

The imperfections of this paper will be shared by yourselves; for, like the friends of Tom Sawyer, you have helped me to whitewash the fence.

Realizing my limited knowledge on hospital construction and the little time I have had to study of such a big question (being yet only a novitiate), recourse was had to yourselves for information. You have carried the bricks up the ladder, I have tried merely to lay them in place.

I must thank those who replied very cordially. The submission of such a formidable list of questions was almost an impertinence. For publication purposes I herewith append it; for our purpose this morning I shall simply summarize the queries.

SUMMARY OF QUESTIONS.

The questions related to site, style of building, construction material, heating, ventilation, number of beds in wards, classification of patients—as to ability to pay and as to disease, convalescent patients, kitchen, operating room, call system, provision for domestics, laundry, pathological department; and last, and perhaps most important of all, one to which fewest answers were given, the request to know the faults and defects in your own hospitals and any special ideas you had in respect to hospital construction generally. This question was asked in pursuance of a recommendation from Professor Osler to "Find out the mistakes the other fellow makes and then don't make them." You no doubt deferred answering this question until after you had heard this paper; therefore, it will be now your duty and your

privilege to make your confession.

Only a few of the points I shall dwell on briefly.

SITE.

From the ninety-six replies received concerning sites, the expressions, "ideal," "perfect," "first-class," "very much," "unsurpassed," were applied to hospitals in suburban or residential districts, such as the Michigan Hospital for the Insane; The Memorial Hospital, Canton, Ohio; The Homeopathic Hospital, Rochester; The Eastern Maine Hospital; St. Joseph's Hospital, Glace Bay; The Brocton Hospital, Massachusetts, and a number of others.

Hospital sites referred to as "good," "satisfactory," or liked "O. K." and "well," are the Centenary, St. Louis; Mercy Hospital, Chicago (Central); Worcester, Massachusetts (Residential); Lebanon, New York (High Hill); Bell Memorial, Kansas City (Suburbs); Macon Hospital, Georgia (Central, on a hill); and many others, some central, some suburban.

The chief point in favor of the central location is that it is good for business,-convenient for accidents and emergencies. It is generally more convenient also for the medical staff and medical students. A teaching hospital should adjoin its medical college, a point to be considered in the choice of its site. The superintendent of a large hospital in Chicago confesses that he dislikes the central location of his hospital. Where a hospital, though central, adjoins a park, no strong objection is urged against its position. Placing the patients' welfare uppermost, I have no hesitation in saying that a hospital placed beyond the noise of the traffic of the city, and completely removed from the vicinity of its smoke and germ-laden atmosphere is the ideal spot. Sir Henry Burdett, one of the greatest British authorities, advocates that all sick people requiring hospital attention should be cared for in such a location, in what he terms the "Hospital City."

Let us for a moment consider the arguments which lead up to the conclusion that such a site is ideal.together with good nursing, have very largely taken their tific therapeutists. Fresh air, sunshine, rest, proper diet,

Drugs are every day becoming more distrusted by scien

place. We are already utilizing as much as possible such means as are at hand-balconies, roof gardens and our grounds.

Last month a prominent hospital superintendent published the following in relation to the treatment of a large class of diseases:

"One almost feels forced to the conclusion that the simple, common-sense remedies, such as nutritive diet, fresh air, sunlight, mental and moral suggestion, rest or exercise, as may be indicated, are as efficacious as anything that has been advocated," etc.

The value of light as a therapeutic and germicidal agent is unquestioned. An eminent specialist in light therapy whom I saw this summer informed me that one of his patients, a lady suffering from lupus, being obliged to go to the mountains for her holidays beyond the reach of Roentgen and Finsen rays, was directed by him to expose the ulcer to the direct rays of the sun for a certain portion of each day. The ulcer healed.

So, without doubt, the perfect site should afford air of the utmost purity, a maximum of sunshine and perfect quietude, three most desirable adjuvants in the cure of disease.

There is only one word to be said in respect to the size of the site, and that is that it should be as large as possible. The Beverley Hospital, Massachusetts, has ten acres; Evanston Hospital, Illinois, five acres; Worcester, Massachusetts, seven acres; the Municipal Hospital, Philadelphia, fifty-eight acre; St. Joseph's Hospital, Cape Breton, four acres, with a farm nearby; William Backus Hospital, Norwich, Connecticut, twenty acres; Wolfsboro Hospital, New Hampshire, twenty-five acres; Agnew Hospital, California, three hundred and twenty acres. I should like to have a farm adjoin my ideal hospital.

A large site outside of the city limits can be purchased, as everyone knows, infinitely cheaper than an urban site, and where the amount of money available for a new hospital is limited the amount saved by building in the suburbs can be applied to construction and equipment. The average length of patients' stay in such a hospital, I am told, is some days less than in a hospital in the city.