VOL. XXXVII

AUGUST 1905.

No. 12

EDITORIAL.

THE PROPOSED NEW PROVINCIAL HOSPITAL IN TORONTO.

No doubt our readers are well aware of the main facts in connection with the New Provincial Hospital movement.

The Ontario Legislature voted $300,000 towards bettering the hispital facilities in Toronto for clinical teaching. This money to go into the present General Hospital, or a new Provincial Hospital provided such should be erected.

The bill also provided that the City of Toronto might give $200,ooo towards the purchase of a new site, should such be decided upon, as the General Hospital trustees came to the conclusion that it would not be expedient to build on the present site.

The proposed site in the centre of the city will exceed in value the present General Hospital site by perhaps $300,000. This would mean

a loss to the city in taxes of about $6,000; or, at 4 per cent., the equivalent of $150,000 in capital.

Then, again, the present income of the General Hospital is $25,000 a year from lands given it about 60 years ago by the Government of the Province of Upper Canada. This represents a capital of at least $650,000.

These various sums make the total of $950,000 from the Province, and $350,000 from the city, or a grand total of $1,300,000.

It was felt by many members of the profession, and this view was shared in by many citizens that, if so much money of the people was put into the scheme, the new hospital should be open to any medical practitioner in good standing to attend his own patients, provided they paid for themselves.

A meeting of the medical profession was called on July 6th to discuss the matter. At this meeting, Dr. Charles Sheard, Medical Health Officer, moved the following resolutions:

I. The material of the public wards shall be available exclusively for the Faculty of Medicine of the Toronto University, but all other accommodation in the hospital shall be equally available to all other practitioners of good standing in the city.

2.

A public ward patient shall be defined as one who is unable to pay for his medical attendance.

The municipality of the City of Toronto to be represented upon the board of hospital trustees, numerically equal with those appointed by the Ontario Government.

4. In the new hospital accommodation is to be afforded as far as possible to patients sent in upon the city's order.

Dr. R. A. Reeve, Dean of the University Medical Faculty, seconded the above resolutions, which were carried, and it was felt that the matter was in a fairly satisfactory form, as Dr. Sheard had said in answer to a question, that he would recommend special public wards for the general profession, in order to avoid confusion in the matter of clinics.

The subject came up before the City Council on 10th July. Those representing the hospital scheme asked for the $200,000 without conditions, and the by-law received its first and second readings to give the money unconditionally. The third reading was set down for 17th July. During the week a good deal of opposition was developed against the Council giving such a large sum without conditions.

At this meeting of the Council, Controller John Shaw moved, seconded by Alderman Dr. Harrison, as follows. "But the proceeds, or any portion of the money so raised, shall not be paid over by the City Treasurer until the new hospital trust is formed with city representation thereon, consisting of at least two appointed by the City Council, and then only when the new board so formed shall undertake to allow or permit all patients paying their way in the new hospital the right of employing their own surgeon or physician, and shall undertake that accommodation shall be afforded in the new institution, as far as possible, to patients sent in on the city's order."

After a good deal of discussion this was carried by 14 to 8 on the following division: For-Controllers Shaw and Ward and Aldermen Fleming, Harrison, Chisholm, Lynd, McBride, Coatsworth, Stewart, Vaughan, Noble, Dunn, Graham and McGhie; Against-Mayor Urquhart, Controllers Hubbard and Spence, and Aldermen Hay, Geary Church, Keeler and Jones.

Alderman Geary moved that the words, "Subject to the regulations of the hospital board," be added to the clause permitting patients paying their way to employ their own doctor. This was agreed to.

Legal opinion has been secured to the effect that, regardless of the ward or the hospital charges therefor, all patients who pay their own way will enjoy the privilege of selecting their own medical attendants, whether on the staff of the hospital or not. It makes no difference whether the charges made by the hospital board be adequate to de

fray all the costs of maintenance, provided the patients pay what is demanded from them, they possess the right of choice as to doctor.

The above are the simple facts, so far as we have been able to gather them by watching the progress of events during the past two months.

THE INCREASE OF INSANITY.

There appears to be good grounds for the general belief that insanity is on the increase. So far as Canada is concerned, Dr. Burgess, in his address at the American Medico-Psychological Association, made this quite clear. The report of the Inspector of Asylums for Ontario also emphasizes this same fact. In 1884, there were 8 insane to every 5,000 of the population; but in 1904, there were 14 to every 5,000. The average daily number in the asylums in 1884 was 2,867, and in 1904 it had increased to 5,500.

The report condemns the custom of confinement of the insane in jails. It suggests that some small, but separate building be erected for these

cases.

The revenue for 1904 was $106,167, and twenty years ago it was $48,135. Since Confederation Ontario has expended upon these institutions $16,000,000.

Housekeepers head the list of occupations, 296 patients having succumbed to the monotony of the daily round. Laborers come next, with 124, and farmers close up with 122; domestic servants are next, with 46, clerks 14 and carpenters 13.

Of mental causes of insanity, worry comes first, with 70 cases, domestic troubles 43, adverse circumstances 39, fright and shock 22, love affairs 15, religious excitement 7. Intemperance in drink heads the list of physical causes, with 50. overwork being next, 37. The married admitted during the year were 462; the unmarried 496.

THE CANADIAN MEDICAL ASSOCIATION.

We wish to call attention to the meeting of the National Association this year at Halifax, on August 22nd, 23rd, 24th and 25th. It is just twenty-four years since the Association met in Halifax. The President, Dr. John Stewart, in behalf of the profession of Halifax and the east, invites all to attend and partake of the pleasures of a trip to the Maritime Provinces, and the hospitality of the people down by the We hope to see this the largest meeting in the history of the Association.

sea.

THE TREATMENT OF MENTAL DISEASES IN HOSPITALS.

This subject is again taken up by Dr. Campbell Myers. He strongly advocates the treatment in general hospitals of early cases of nervous and mental diseases. He contends that many of these patients would recover and thus escape the stigma of having been in an asylum. He points out that in some countries this is now becoming a common practice. It is stated that the results, so far, have been very satisfactory. It would enable nurses and students to become more familiar with this class of patients. Those whose minds become unbalanced could be admitted at once without certificate, and placed under observation. Many suicides would also be prevented. It would be valuable from an economic point of view also.

CHANGE THE NAME "ASYLUM."

As the name originally comes to us through the usages of good writers, there should be no objection to it; but in practice there has grown up a strong feeling in the mind of the public against sending persons to an asylum. It is thought to be a stigma on those who are committed and upon their friends. The name could, therefore, be changed to one less objectionable, such as "Hospital for Nervous Diseases." This would remove, also, one of the grave difficulties in the minds of those who require commitment as they often say, “don't send me to the asylum."

A COMMISSION IN LUNACY.

In all our asylums the principle which should govern appointments is the one of fitness for the positions to which these persons are appointed. At the present moment there are in Canada 18 asylums for the insane, and 12 of these are under political control..

In New York, the superintendent is chosen by the board of management, and must have had at least five years experience in the care of the insane and asylum work. He, in turn, selects his assistants. In this way a more efficient service is secured than when the medical staff of an asylum owes its appointment to political influences.

This would introduce into the asylums of the country the principle of promotion as the reward of faithful and efficient service. It would also tend to introduce a more scientific spirit. If appointment in the first

place and promotion afterwards came to a person because he had done good work along the lines of mental and nervous diseases, or had shown his special fitness for the management of such cases, there would be better hope for the advancement of knowledge on the many phases of insanity.

What the taxpayer, the patients and the profession is entitled to is the best result for the cost of maintaining these institutions. That this could be secured by the creation of a Lunacy Commission as compared with the present system, there can be no doubt. Such a commission would take over the care of the insane, would appoint the medical superintendents, and, along with him, the assistants. Appointments would be made on merit, and retention in the service would depend on the quality of work done. Under such a system our asylums would be heard from as true centres of research and scientific progress.

THE SCIENCE OF PROLONGING LIFE.

The highest duty of the state is to protect its people, and there is no form of protection so important as the protection against disease.

In the case of consumption there are at least 8,000 deaths annually in Canada from this disease in its ordinary form, not considering the many forms of tuberculosis of various organs. And yet this disease is a preventable one. Why not prevent it then? It comes in the duty of the state. These cases should be reported and placed under proper instruction and safeguards thrown around those who are affected.

At the recent meeting of the Ontario Medical Association, Dr. Charles J. Hastings, of Toronto, read a very able paper on the enormous waste of life among children. Though he said nothing new, it was most timely to have such a careful presentation of all the facts. There is absolutely no need for such a high infant mortality. It can be reduced, it ought to be reduced, it must be reduced. The question comes in 66 How can it be reduced?" We think along the lines suggested by Dr. Hastings. There should be a medical inspector of public schools. He would travel the province over, and would inspect the schools from the sanitary point of view and the children from their health standard. Much information would be gathered as to cases of neglect and proper steps could be taken to remedy these. Proper literature could be prepared and distributed throughout the schools.

Some steps have recently been taken looking towards the early and more efficient care of the insane. This should appeal to all. There are many instances where it would be well to have a short probation period before formal commitment to asylum takes place. The care of