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Last Resort: Hospital Care in Canada

Denis Goulet, Université de Sherbrooke

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Introduction:

Denis Goulet, Université de Sherbrooke, 2003

The modest hospitals of early New France served mainly as shelters and general care providers for the needy. The Hôtel-Dieu institutions in Quebec City and Montreal, respectively founded in 1639 and 1642, accepted patients of all nationalities and religions, refusing only those with contagious diseases, pregnant women and the insane.

Hospitals primarily dedicated to medical care date to the early 1800s, when physicians and philanthropists set up small private facilities to make treatment more widely available.

In Canada's large cities, new hospitals like the Montreal General (1819) and the Toronto General (1829) were built for the English-speaking Protestant population. Others such as the Hôpital des Fièvres (1830) and Hôpital de la Marine (1834), both in Quebec City, were opened for people with contagious diseases, immigrants and sailors in an attempt to limit the spread of epidemics.

The foundations of a Canadian hospital system were laid, but it was not until the latter half of the 19th century that the modern hospital was born.


I-34463.1
© McCord Museum
Photograph
Hospital, Toronto, ON, 1868
William Notman (1826-1891)
1868, 19th century
Silver salts on paper mounted on paper - Albumen process
10 x 8 cm
Purchase from Associated Screen News Ltd.
I-34463.1
© McCord Museum

Keys to History:

For Canadians today, hospitals are part of a way of life. While we find it perfectly normal to be born and to die there, this was not always the case.

In the 19th century, hospital births were very rare. Most deliveries took place at home, attended by a midwife or, for the wealthy, a doctor. The few existing maternity hospitals were reserved for exceptional cases. Similarly, dying patients were not taken to hospital. Most breathed their last breath in their own bed, surrounded by family.

Hospitals were seen as a last resort. People feared dying there and preferred home care. But not everyone had the means to pay for house calls.

What:

The Toronto General Hospital - a handsome example of 19th-century hospital architecture - was the city's principal care facility.

Where:

Originally located at the corner of Simcoe and King, the hospital was enlarged in 1856 to border Gerrard and Sumach streets. In 1913, it relocated to College Street.

When:

Toronto's General Hospital was founded in 1829 under the name York General Hospital.

Who:

Run by lay administrators, the hospital treated primarily poor patients.

VIEW-2548.1
© McCord Museum
Photograph
Montreal General Hospital, Dorchester Street, QC, about 1890
Wm. Notman & Son
About 1890, 19th century
Silver salts on paper mounted on paper - Albumen process
15 x 17 cm
Purchase from Associated Screen News Ltd.
VIEW-2548.1
© McCord Museum

Keys to History:

By the 1870s, all major Canadian cities had both Protestant and Catholic general care hospitals, whose chief function was to treat the needy sick. Stemming from the British tradition, the General hospitals were under lay administration, whereas the French-inspired Hôtel-Dieu hospitals were run by religious orders.

The nurses, matrons and ward maids were poorly paid but often fed and housed. In the French-language hospitals, nursing sisters worked without pay.

Doctors treated the poor for free but collected fees from wealthy patients. Hospital practice also added to their prestige.

To reduce food costs, hospitals sought cut rates from generous butchers, bakers, produce growers and dairy farmers. Some further economized by growing produce and keeping a few cows.

What:

The Montreal General Hospital was a lay institution offering medical care for the poor. Founded by physicians in 1819, it soon expanded its bed capacity with new buildings and developed close ties with the Faculty of Medicine at McGill University.

Where:

The original Montreal General Hospital building held only 24 beds and was located at the corner of Craig and St. Lawrence. Three years after opening, it moved to more spacious 72-bed quarters on Dorchester Street.

When:

The Montreal General Hospital opened its doors on May 1, 1819. It shares much of its history with McGill University's Faculty of Medicine, since the two institutions have long had close ties.

Who:

Getting the Montreal General Hospital off the ground caused quite an uproar. Some politicians wanted to expand the Hôtel-Dieu instead of building a new facility. In the press, sharp controversy broke out between one Mr. O'Sullivan and Dr. William Caldwell, who was directly involved in the project. This led to a pistol duel in which both were wounded.

VIEW-1424.1
© McCord Museum
Photograph
General hospital, Winnipeg, MB, 1884
William McFarlane Notman
1884, 19th century
Silver salts on paper mounted on paper - Albumen process
20 x 25 cm
Purchase from Associated Screen News Ltd.
VIEW-1424.1
© McCord Museum

Keys to History:

Up until the last third of the 19th century, the delivery of care in hospitals (which were still fairly small) was based more on domestic skills than on medical knowledge. Neither the lay nurses nor the nursing sisters had academic training, and some of them were limited to monitoring patients and keeping them clean.

The English-language hospitals recruited middleclass women for their home economics skills and to supervise the nursing staff. Maids did the cleaning and laundry. The cooks, often men, prepared meals that consisted mainly of eggs, beef and potatoes. In season, the patients might enjoy produce from the hospital garden.

Labourers took care of general hospital maintenance, and specialized workers were hired for occasional major repairs.

What:

This fine photo of the Winnipeg General Hospital shows the pavilion-style architecture that was popular at the time. A central corridor connected the different buildings, each of which usually had a particular function.

Where:

Medical progress and the population's growing needs soon saw large or medium-sized general hospitals in all major Canadian cities, including Winnipeg.

When:

In the 19th century, general hospitals such as the one seen here were not very large but met the needs of the day.

Who:

Most hospitals of this sort were founded by doctors with the support of philanthropic organizations.

II-105877
© McCord Museum
Photograph
Nurses of the General Hospital, Montreal, QC, 1894
Wm. Notman & Son
1894, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-105877
© McCord Museum

Keys to History:

In the 19th century, like today, women played a predominant role in the hospital world. They served meals, changed dressings and administered medicine, but did not hold specialized positions. In some hospitals, they washed windows and did the dishes.

At the Montreal General Hospital, until the 1860s, women were mainly considered servants and were often recruited from among former patients. They worked long hours, from 5 a.m. to 9 p.m., and received only a meagre stipend. Many of them either quit or were fired.

In the later 1800s, working conditions improved. Hiring criteria were raised, and a portion of the female staff was assigned exclusively to patient care. In 1875, the hospital hired its first trained nurses. All of them were graduates of the earliest professional nursing school, founded in 1860 by Florence Nightingale at Saint Thomas' Hospital in London.

What:

This Notman & Son photo is typical of the staged portraits of the day. It was taken as part of a series of reports on different lines of work and illustrates a brand new medical profession.

Where:

The first graduate nurses hired in Canada worked at the Montreal General Hospital, while Canada's first nursing school was founded at the General Hospital in Toronto.

When:

An initial attempt to establish a nursing school was made in 1874, but differences between the doctors and the nurses (who were probably less submissive than expected) put an end to the project. Canada's first nursing schools opened at Toronto's General Hospital in 1881 and at Montreal's Women's Hospital in 1886. The Montreal General Hospital school began operating on April 1, 1890. That same year, the Grace Hospital Training School for Nurses opened in Toronto.

Who:

Nora Livingstone, a graduate of New York Hospital's school, founded the Montreal General Hospital Nursing School.

II-113321
© McCord Museum
Photograph
General Hospital nurses, Montreal, QC, 1895
Wm. Notman & Son
1895, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-113321
© McCord Museum

Keys to History:

The first professional nurses trained in Canada studied at hospital nursing schools in the 1890s. In some schools, they were subject to strict rules governing both their professional activities and their general behaviour, similar to military discipline.

At Notre-Dame Hospital, applicants for nursing positions were selected on the basis "of their disposition for dedication and their aptitude for submission and discretion." Moreover, in dealing with doctors, they were expected "to be prudent, discrete and reserved and to make no comment even the least bit critical of anything at all."

All were unmarried and (for the most part) lived at the hospital. They worked long hours under the twofold rule of the sisters and the doctors, and many had only a half day off each week.

What:

This group photo illustrates the mutton-chop sleeves in vogue at the time. White, as can be seen, was already de rigueur. The elegant caps and outfits were no doubt of comfort to patients.

Where:

Nurses now held specialized positions in hospitals. Assigned to different areas, they cared for the sick, assisted the physicians and, occasionally, administered anaesthesia.

When:

As care became more specialized in the early 20th century, most major Canadian hospitals opened their own nursing school.

Who:

Young women wishing to become nurses were chosen based on their physical health, their propensity for study and their aptitude for dedication.

MP-0000.1764.2
© McCord Museum
Photograph
Hotel Dieu Hospital, Montreal, QC, about 1865
Anonyme - Anonymous
about 1865, 19th century
Silver salts on paper mounted on card - Albumen process
8 x 5 cm
Gift of Mr. David Ross McCord
MP-0000.1764.2
© McCord Museum

Keys to History:

In French-language hospitals like the Hôtel-Dieu institutions in Montreal and Quebec City, nursing sisters were central in ministering to both body and soul. But they preferred the latter role, ensuring prayers, masses and other religious rites for the patients' health.

By the 1870s, these hospitals were focusing more on medical treatment and had their own doctors, who made diagnoses and prescribed care and medicine during their daily rounds. Still, the sisters were often responsible for administering the treatments and preparing the medications.

With medical advances, the task became more difficult, as seen in this 1892 note from the sister superior of Notre-Dame Hospital: "In order to save souls, we must resign ourselves to meeting the demands of science."

What:

Montreal's Hôtel-Dieu was the second hospital founded in Canada, shortly after the one in Quebec City. With the Montreal General, it played a major role in the development of medical care.

Where:

Originally built at Pointe à Callière, within the walls of the Ville-Marie fort, the Hôtel-Dieu moved to the corner of Saint-Joseph (now Saint-Sulpice) and Saint-Paul streets a few years later. In 1861, it relocated to its present home at the foot of Mount Royal.

When:

Founded in 1642, the same year as the Montreal settlement, the hospital opened its doors in 1644. It was rebuilt in 1645 outside the walls of the fort. With the move to new buildings in 1861, it was able to provide 150 beds for the city's sick.

Who:

French nurse Jeanne Mance founded the Hôtel-Dieu Hospital in Montreal. It was run by the Hospitallers of Saint Joseph nuns until the mid-18th century. The Sisters of Charity, or Grey Nuns, took over in 1747 and ran it until the mid-1900s.

VIEW-11536
© McCord Museum
Photograph
Ward, Hotel Dieu, Montreal, QC, 1911
Wm. Notman & Son
1911, 20th century
Silver salts on glass - Gelatin silver process
20 x 25 cm
Purchase from Associated Screen News Ltd.
VIEW-11536
© McCord Museum

Keys to History:

In addition to their religious mission, the Hospitaller nuns took on increasing medical and administrative duties. They were responsible for the hospital's internal operations, for discipline and for organizing the delivery of care.

The community's nursing sisters had no formal training but operated within a certain hierarchy. The most experienced became ward officers. Each ward was under the authority of a Hospitaller, seconded by an assistant who rubbed down and bandaged the patients and administered medication. In the late 19th century, assistants were helped by young lay nursing students.

The key position, however, was that of the pharmacist, who reported to the Head Hospitaller. Besides preparing medicines, she frequently visited patients and made ward rounds with the doctors. She was also responsible for making sure that the operating room was kept spotless and the instruments were properly laid out.

What:

This is probably the Sainte-Marie ward. Wards of this type were common at the time, with each bed having curtains that could be pulled for patient privacy.

Where:

Montreal's Hôtel-Dieu Hospital has been located at the foot of Mount Royal since 1861. At the time this photo was taken, it had more than 270 beds.

When:

Taken in 1911, this photo provides a good view of how the wards were arranged at the Hôtel-Dieu. Few changes had been made since the 1890s.

Who:

Women were admitted to hospital for many different complaints in those days, but rarely for childbirth.

II-105911
© McCord Museum
Photograph
Women's ward, Royal Victoria Hospital, Montreal, QC, about 1894
Wm. Notman & Son
1930-1950, 20th century
Silver salts on film (safety) - Gelatin silver process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-105911
© McCord Museum

Keys to History:

Hospitals usually accepted people of all circumstances and all nationalities. But not everyone shared the same status. Poor patients, who were most numerous, received free care and medicine.

Men and women were housed separately in large wards, each accommodating up to 50 patients. These were vast, high-ceilinged rooms with a row of iron beds aligned along either side of a centre aisle. Until the 1900s, the uncomfortable mattresses were often stuffed with kelp, straw or horsehair. The beds were sometimes separated by a nightstand and a chair.

There were also wealthy patients, who paid for their hospitalization but enjoyed preferential treatment. Housed in comfortable private rooms, they had their own doctor, were tended by a nurse and could receive visitors at any time. These cases were rare, however.

What:

This photo shows the women's ward of the recently opened Royal Victoria Hospital in Montreal. At the time, it was one of Canada's most modern hospitals.

Where:

The Royal Victoria Hospital, named in honour of Queen Victoria's Golden Jubilee, was built on Pine Avenue West, on the land it still occupies.

When:

The Royal Victoria Hospital was founded in 1887 and admitted its first patients on January 1, 1894.

Who:

In the 19th century, many hospitals were built with the support of wealthy philanthropists. The Royal Victoria Hospital received large monetary contributions from Sir Donald Smith and Sir George Stephen, and the land was donated by the City of Montreal.

II-103637
© McCord Museum
Photograph
Ward, Royal Victoria Hospital, Montreal, QC, 1894
Wm. Notman & Son
1894, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-103637
© McCord Museum

Keys to History:

Life in some hospitals was relatively unregimented until the 1880s. Patients were not restricted to eating at mealtimes, and the alcoholic beverages used as stimulants were not always rationed. Even the nurses occasionally over-imbibed in the wine. One nurse at the Montreal General was fired for drunkenness.

Visits were permitted freely, and people prayed aloud in the wards and corridors. In Hospitaller-run institutions, the rules were strict but not strictly observed.

In the late 19th century, the medicalization of care led to more rigorous patient regimes. Alcohol was rationed, diets were imposed, snacks were eliminated and visits were limited. As for the nightshift staff, tea replaced beer. Silence, courtesy and compliance with the prescribed treatments became mandatory, with misconduct punishable by firing.

What:

The hospitalization conditions for ward patients are well illustrated in this photo. The iron beds were arranged two by two between the large windows that afforded good lighting.

Where:

The traditional rocking chairs sat along the centre aisle, near the hot water radiators.

When:

Shortly after it opened, the Royal Victoria Hospital began adopting specialized medicine. In 1904, it added a neurology department, which was followed in 1905 by the dermatology and pediatrics departments.

Who:

The medical board played an important role in managing patient care at the Royal Victoria Hospital. Composed of physicians for the most part, the board controlled equipment purchases and medical staff hiring.

II-181192
© McCord Museum
Photograph
Ward M, Montreal General Hospital, Montreal, QC, 1910
Wm. Notman & Son
1910, 20th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-181192
© McCord Museum

Keys to History:

Canadian hospitals in large urban centres were already facing excess demand. This was particularly true in Montreal, where hospital capacity was not keeping pace with population growth. The Montreal General Hospital, for example, was plagued with overflow problems between 1860 and 1900, with patients sometimes obliged to sleep on the floor.

There were many drawbacks to being hospitalized in a public ward, including lack of privacy, odours, constant noise and moans from neighbouring beds evoking treatments received or yet to come. Injured patients were often brought to wards during the night.

Some doctors upped the doses of sedatives to ensure peace and quiet. Minor medical and surgical procedures were sometimes performed in the wards, further undermining patient morale. Those who found these conditions unbearable fled to their homes.

What:

The far wall of the men's ward at the Montreal General Hospital was curved, providing better light. There were no rockers here, just straight-backed chairs for patients and their visitors.

Where:

All injured or ill men unable to pay hospital costs were admitted to this large ward.

When:

By the early 20th century, general care had improved and patients were receiving more thorough medical treatment.

Who:

Nurses, doctors, residents and medical students were now a regular feature in wards. Medical attention had become a matter of course in hospitals.

II-132158
© McCord Museum
Photograph
Christmas in Ward H, Montreal General Hospital, Montreal, QC, 1900
Wm. Notman & Son
1900, 20th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-132158
© McCord Museum

Keys to History:

In the absence of fast, effective therapy, the average hospital stay was measured in months. For men and women used to working long hours and little inclined to reading, the days before radio and television were filled with boredom. This led to the tradition of providing moral support.

At Montreal's Notre-Dame Hospital, women volunteers organized musical activities, gave the patients pious books "apt to give them courage" and decorated the wards with fresh flowers.

On major holidays, there was a "patient banquet," featuring turkey, beef and fish. The remark by a Balzac character to the effect that the sick were unwilling to go to hospital because they believed people starved to death there certainly did not apply to all institutions.

What:

This Notman & Son photo illustrates the hospital authorities' efforts to cheer up the patients at Christmastime.

Where:

Christmas festoons brighten an austere ward at the Montreal General Hospital.

When:

Most hospitals provided for Christmas and Easter celebrations. Volunteers, generally women, decorated the wards and organized the festivities.

Who:

All patients profited to some extent during holidays. Visiting hours were extended and the menus were adapted to the event: turkey at Christmas and ham at Easter.

II-73328
© McCord Museum
Photograph
Anatomy study, McGill medical students, Montreal, QC, 1884
Wm. Notman & Son
1884, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-73328
© McCord Museum

Keys to History:

The advent of the modern hospital was closely linked to the establishment of medical schools. As of the mid-19th century, all medical students were required to complete clinical training in a hospital. This led the faculties to either make arrangements with existing institutions or to create their own.

Public ward patients had to submit to examination by doctors surrounded by their students. This was the price of admittance, an exchange of sorts that financed the hospital. It worked this way: wealthy donors helped to provide free hospital care for the poor, who, in turn, lent themselves to the scrutiny of students, who thus received better medical training, which benefited the donors.

What:

The students seen here are performing a mock autopsy on one of their classmates. Morbid scenes like this were staged quite often, since no real autopsy could be photographed.

Where:

This photo was taken in an anatomy classroom at the McGill University Faculty of Medicine.

When:

As of the mid-1800s, all Canadian medical students were required to take courses in human anatomy. In addition to studying wax figures and anatomical drawings, they learned to recognize every part of the human body by practicing on cadavers.

Who:

The cadavers needed for anatomical study were not always easy to find. As a general rule, the medical schools procured unclaimed bodies from the hospitals. But some students took a risky route to satisfy their curiosity and dug up the deceased in cemeteries.

MP-0000.3141
© McCord Museum
Photograph
Montreal General Hospital, Montreal, QC, about 1875
James George Parks
about 1875, 19th century
Silver salts on paper mounted on card - Albumen process
8 x 17 cm
MP-0000.3141
© McCord Museum

Keys to History:

In the 19th century, general hospitals were rarely financed by the Canadian government. Income from hospitalization fees was negligible, since, although they paid room and board, private patients were few and far between.

As a result, Canadian hospitals turned to wealthy donors and religious communities to fund their charity work. Bequests of money, buildings, land, shares and annuities were all crucial to hospital operations and expansion.

Social and cultural benefit events were another way to meet the hospitals' financial and material needs. Considerable amounts were raised by means of fairs, bazaars, plays, concerts, sales and special outings. The businesses and tradesmen involved in these activities willingly reduced their prices to generate support. Lotteries and races were shunned, however, as being bad for a hospital's reputation.

What:

As seen here, the Montreal General Hospital was fairly typical of 19th-century hospital architecture.

Where:

The Montreal General was located in the heart of the city. This made it handy not only for patients but also for medical students and their teachers.

When:

In the 19th century, the large Canadian hospitals did not have architectural master plans. And despite attempts at harmonization, many were disfigured by the addition of new wings or pavilions.

Who:

The founders of the Montreal General Hospital incorporated the institution on January 30, 1823, under a French name: Hôpital général de Montréal. Its English name did not become official until 1910, by amendment to its charter.

VIEW-13712
© McCord Museum
Photograph
Ward "O", General Hospital, Montreal, QC, 1914
Wm. Notman & Son
1914, 20th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
VIEW-13712
© McCord Museum

Keys to History:

In the last third of the 19th century, the medical monitoring of ward patients became systematic and structured. Nurses were required to see all cases, enquire about their condition and record any change in their symptoms.

Diagnosis was in the hands of the doctors, who took the patients' medical, social and family history and asked about lifestyle and diet. Depending on the case, they examined the tongue, eyes or ears. They checked the pulse for abnormalities - shallow, rapid, weak, bounding - took the temperature, percussed the chest or areas of the back, probed the abdomen and palpated specific spots. They might also order routine urine or swab tests.

This approach, similar to what we undergo in a doctor's office today, made the diagnoses more reliable. Unfortunately, the same was not true of the therapies, which more often relieved than cured.

What:

This photo illustrates everyday medical practice in a ward. The nurses are going about their work and a doctor, at left, is observing a patient in bed.

Where:

This ward was at the Montreal General Hospital. Adjustable beds like the one in the right foreground made patients more comfortable.

When:

By the early 1900s, general care was more continual and better organized. As well, patients were subject to stricter rules.

Who:

The hospital staff surrounding patients grew considerably in the early decades of the 20th century. Cleaning women, maintenance men, orderlies and graduate nurses came and went regularly in the public wards.

II-181471
© McCord Museum
Photograph
Ward L, Montreal General Hospital, Montreal, QC, 1910
Wm. Notman & Son
1910, 20th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-181471
© McCord Museum

Keys to History:

Medical schools and hospitals began developing close alliances in the 19th century. In addition to their courses at the faculty, students had to take clinical lessons at the hospital.

At bedside, the professors demonstrated the new diagnostic methods that consisted of sounding and palpating the patients. Some used newly developed instruments such as stethoscopes and ophthalmoscopes. Others relied more on their senses.

This was true of Dr. Emmanuel-Persillier Lachapelle, who, in 1878, drilled into his students that "touching and seeing" were what made a good doctor. Moreover, he added, some physicians had such a keen sense of smell that they had "diagnosed many illnesses by odour alone."

What:

The austerity of the public wards is evident in this photo. The lamps hanging by their wires, the bare walls and the wooden floors conjure up a bygone era.

Where:

Ward patients came from diverse socio-economic backgrounds. Not all of them were jobless. Some workers and labourers simply did not have the money to pay for hospitalization.

When:

For many people, hospitalization was a last recourse. In fact, people with serious fractures often waited weeks after the accident before going to hospital.

Who:

Not all ward patients were cooperative. Some smoked whenever they felt like it, others insulted the nurses or refused to follow the prescribed treatments. Orderlies like the one standing in the centre of the aisle kept things under control.

M19494.1-39
© McCord Museum
Microscope
About 1860, 19th century
9.5 x 34.1 cm
M19494.1-39
© McCord Museum

Keys to History:

Throughout the 19th century, technical advances and new medical instruments made diagnoses increasingly easier.

Today, everyone is familiar with the stethoscope (1819), used to listen to heartbeats and other bodily sounds. It was followed by the clinical thermometer, the ophthalmoscope (1851), the laryngoscope (1857), the spirometer (1861) (which measures lung capacity) and the sphygmomanometer (1881) (for measuring arterial blood pressure). All of these instruments were introduced in Canada shortly after they were invented.

With the discovery of germs, the microscope became an essential tool in hospital laboratories. In the early 1880s, many physicians recommended microscopic blood examinations to check the condition of the red cells. Others used urine analysis to measure sugar levels and to monitor the effect of medicines on the body. Some promoted microscopic analysis of the skin to diagnose skin diseases. Laboratory medicine was off to a fine start!

What:

This handsome copper microscope enlarges objects by means of the lenses inside the tube and attached to the stem. Prior to the development of bacteriology, it was used to analyze blood and urine.

Where:

This microscope was made in London by the Dolland firm.

When:

Sir William Dawson (1820-1899) probably bought this instrument in the fall of 1840, while he was at the University of Edinburgh studying geology and taxidermy and learning to prepare slivers of animal fossils for microscopic examination.

Who:

Doctors in 19th-century hospitals had little use for microscopes until the discovery of bacteria, after which most large facilities quickly acquired these devices for detecting the minute threats.

VIEW-11534
© McCord Museum
Photograph
Pharmacy, Hotel Dieu, Montreal, QC, 1911
Wm. Notman & Son
1911, 20th century
Silver salts on glass - Gelatin silver process
20 x 25 cm
Purchase from Associated Screen News Ltd.
VIEW-11534
© McCord Museum

Keys to History:

Hospitals were usually equipped with a pharmacy that stocked a wide variety of vegetable, mineral, animal and chemical products used to concoct syrups, pomades, unguents, medicinal wines, etc. They frequently maintained a small medicinal herb garden as well.

There were two types of pharmaceutical preparations: ready-made remedies, prepared in advance according to standard formulas and kept available, and custom-made medications dosed according to doctor prescription. The hospital pharmacist's job required extensive knowledge of the pharmacopoeia.

In the 1880s, doctors freely prescribed opium, morphine, cocaine, potassium bromide, chloroform, strychnine, peroxide, laudanum and nitroglycerin, though this did not preclude the use of leeches, snake powder or croton oil. Tradition and modernity went hand in hand for quite some time.

What:

This immaculately clean hospital pharmacy is fully equipped with the tools and ingredients needed to prepare prescription medicines. All of the hospital's orders were filled there.

Where:

This pharmacy was at Montreal's Hôtel-Dieu Hospital. Products from around the globe were used there, but to economize, the nuns grew medicinal herbs themselves.

When:

In the early days of the Colony, the Hospitaller sisters prepared remedies for their patients as best they could. The head pharmacist played a crucial role in hospitals.

Who:

In the English-language hospitals, pharmacy duties were carried our by trained professionals. At Hôtel-Dieu, the Sisters of Charity were in charge.

MP-0000.1842
© McCord Museum
Photograph
First floor display, Peter Redpath Museum, McGill University, Montreal, QC, 1925
Sydney Jack Hayward
1925, 20th century
Silver salts on paper - Gelatin silver process
19 x 24 cm
MP-0000.1842
© McCord Museum

Keys to History:

Hospitals were becoming essential to teaching medicine. Anatomy rooms like the one seen here allowed the professor to teach his art in front of a large class.

By the 1870s, most large hospitals had a dissection room to which unclaimed bodies were sent.

Dissection serves to observe abnormalities in the organs and to determine the causes of illness and death. If the liver is reddish-brown and fibrous, for example, the patient probably died of cirrhosis (from the Greek kirros, meaning red). Students spent time in dissection rooms to perfect their knowledge of anatomy.

What:

In the late 19th century, all medical schools had anatomy rooms of this sort. The many windows, a skylight and the semi-circular form of the tiered wooden seating allowed the students to follow the professor's dissection of the cadaver down front.

Where:

McGill University's anatomy room was modest by comparison with those of the old European medical schools. Some, like the ones in Bologna and Padua, are still famous for their lavishness.

When:

Anatomy rooms have existed for centuries, but some have known moments of glory. In the 16th century, Andrea Valsaius, the father of modern anatomy, taught in the one at the University of Padua, where Galileo was teaching as well.

Who:

Until the 19th century, most of the courses given in this room were taught by anatomists. But gradually pathologists came to lecture there, showing students the organ lesions caused by disease.

II-128417
© McCord Museum
Photograph
Surgical staff, Royal Victoria Hospital, Montreal, QC, 1899
Wm. Notman & Son
1899, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-128417
© McCord Museum

Keys to History:

Surgical care in the mid-19th century was still in its youth, and the clear distinction we make today between medicine and surgery did not exist. But although all doctors could operate, not all had the same skill.

Surgical procedures were rare because of the high risk of infection. Anaesthesiology was just emerging. There were no specialized operating rooms and, for lack of electricity, surgery was performed in daylight, near a window. A table, a few instruments and a handful of bandages were all that was needed to perform amputations, tie off blood vessels, extract kidney stones or remove tumours. Fear of infection precluded any surgery in the abdomen or chest.

Post-surgery was grueling for patients, who could be in recovery for weeks with vomiting, nausea and fever.

What:

By the late 1800s, surgical operations had become more complex and required a larger and better-trained staff. Chief surgeons were assisted by a colleague, an anaesthesiologist, a sterilization nurse and operating room nurses.

Where:

The newly opened Royal Victoria Hospital boasted the latest surgical equipment as it moved into modern surgery.

When:

The birth of modern surgery dates to the late 19th century, when anaesthetic and, especially, sterilization techniques allowed surgeons to open the abdomen and chest.

Who:

Traditionally, a surgeon's reputation was based on how fast he could perform painful operations. By the late 19th century, things had changed. Operations lasted longer, and the surgeon's skill was measured in terms of how fast the patient recovered.

VIEW-2733
© McCord Museum
Photograph
Operating room, Royal Victoria Hospital, Montreal, QC, about 1894
Wm. Notman & Son
About 1894, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
VIEW-2733
© McCord Museum

Keys to History:

Basic techniques for preventing post-surgical infection were first adopted in Canada in the early 1870s. At the time, doctors wore neither gloves nor masks, and instruments were not disinfected but given a cursory washing, at best.

This was because the infection-causing role of microorganisms was not yet known. Some surgeons attributed patient deaths to internal biological factors not their responsibility. Others blamed the noxious city air and preferred to operate in the country.

Convinced that contamination was the culprit, British surgeon Joseph Lister developed a device that surrounded the patient in a cloud of powerful disinfectant. During the operation, it delivered a continuous spray of phenol onto the surgical area, the surgeon's hands and the instruments. Dr. Malloch of Hamilton was the first to use an apparatus of this sort in Canada, in 1869.

What:

In the late 19th century, surgery rooms had become the place of choice for teaching operating techniques. The presence of students without masks raised the risk of infection, of course, but this was not yet known.

Where:

The Royal Victoria Hospital lecture hall was fairly traditional and was used to teach surgery. Minor procedures were likely performed there.

When:

This room is typical of those in hospitals affiliated with medical schools in the late 1800s. Previously, when student bodies were smaller, the students had to crowd around the operating table to watch the teaching surgeon at work.

Who:

Surgery rooms were generally reserved for faculty surgeons. This one was used to teach surgical techniques to McGill University medical students.

VIEW-2735
© McCord Museum
Photograph
Operating room, Royal Victoria Hospital, Montreal, QC, about 1894
Wm. Notman & Son
About 1894, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
VIEW-2735
© McCord Museum

Keys to History:

New advances in surgery demanded substantial changes to operating rooms. The advent of chloroform and ether anaesthesia, improvements to surgical instruments and the introduction of basic disinfection measures made it possible to perform longer, more risky operations. This was called major surgery, as opposed to minor procedures requiring only rudimentary installations.

Before long, semi-circular operating rooms with large windows became the norm, providing better light for the surgeon's task. Patients were placed on an adjustable table at the centre, and students observed the operations from a half-circle of tiered seats. These installations were known as surgery rooms, and only non-paying patients were operated on there.

Unfortunately, the operating rooms in some hospitals were located near the autopsy room, which greatly increased the risk of infection. Students and doctors sometimes went from one room to the other without disinfecting their hands.

What:

The surgery room at the Royal Victoria Hospital was well equipped to make the transition to modern surgical practice. It was a far cry from today's operating rooms, but the adjustable operating table was already a sign of things to come.

Where:

At the Royal Victoria, as in all large Canadian hospitals, the operating room was semi-circular and had many windows. The stone floor facilitated cleaning.

When:

Surgery was performed from dawn to dusk. But surgeons were known to cancel their procedures in favour of a day off in the country.

Who:

The Royal Victoria Hospital surgery room could seat quite a crowd. Most were medical students, but nursing students and distinguished guests occasionally attended at well.

II-180990.0
© McCord Museum
Photograph
Operating room, Montreal General Hospital, copied for Mrs. Oliver, 1910
Anonyme - Anonymous
1910, 20th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-180990.0
© McCord Museum

Keys to History:

In the early 1890s, there was a growing understanding of the need to avoid contaminating the wounds of surgery patients through contact with unclean instruments, hands or other objects. Canada, like other countries, was in a period of transition, with physical sterilization, or asepsis, gradually replacing chemical disinfection methods.

It was around this time that pressurized devices called autoclaves came into use. Designed to work at extremely high temperatures, they made it possible to sterilize surgical instruments, bandages and anything else that might come into direct contact with the patient under the knife. Operating tables made of glass were preferred as they were easier to clean than the old wooden ones.

Procedures of this sort considerably enhanced the patients' chances for survival and paved the way for new operations. Doctors could now open a person's abdomen without provoking certain death, and the first appendectomies were soon performed. Modern surgery was emerging.

However, surgical masks were still a thing of the future.

What:

This is a partial view of an operating room readied for one Mrs. Oliver. The patient is pictured with the surgeon and his assistant, a rarity in photos at the time.

Where:

There is nothing to indicate where this surgery room was located, but it was obviously affiliated with a medical school.

When:

Several things suggest that this photo was taken in the early 20th century. The surgeon is wearing gloves, and a sterilizer can be seen behind the patient.

Who:

Evidently, Mrs. Oliver had agreed to an operation with medical students looking on. If she did so by choice, then she was wealthy. If not, it was because she was poor.

MP-0000.25.255
© McCord Museum
Photograph, glass lantern slide
Bacteriological Lab, Medical building, McGill University, Montreal, QC, about 1895
Anonyme - Anonymous
About 1895, 19th century
Silver salts on glass - Gelatin dry plate process
8 x 8 cm
Gift of Mr. Stanley G. Triggs
MP-0000.25.255
© McCord Museum

Keys to History:

The advent of medical bacteriology in Canada in the 1880s drastically improved procedures for preventing the spread of infectious disease.

Laboratory research conducted by French scientists, including the famous Louis Pasteur, and later in Germany had partially elucidated the mysteries of infection and contagion, and it was now possible to identify the infection-causing microbes and determine their means of transmission: air, water, saliva, food, etc.

Gradually, laboratories for detecting pathogenic germs were opened in all hospitals, which also helped to improve diagnostic procedures and develop more efficient disinfection methods. Their role was vitally important, since hospital infections were rampant at the time.

Medical hygienists were waging a sanitation campaign, using the fear of germs as a weapon of prevention.

What:

The development of medical bacteriology required the creation of new research and diagnostic facilities. This was an important step in detecting and preventing infectious diseases.

Where:

The earliest bacteriology courses were given in Canadian medical schools in the 1890s. McGill University was one of the first to have this type of laboratory.

When:

Hospitals in large Canadian cities began setting up bacteriology laboratories in the late 19th century. Headed by the resident bacteriologist/physician, these labs served to identify patient infections.

Who:

The introduction of bacteriological techniques in Canada was primarily the work of Canadian medical school graduates having had further training in Europe. French Canadians trained in France, and English Canadians, in Germany.

II-115171
© McCord Museum
Photograph
Electric equipment for Dr. Brown, Montreal, QC, 1896
Wm. Notman & Son
1896, 19th century
Silver salts on glass - Gelatin dry plate process
25 x 20 cm
Purchase from Associated Screen News Ltd.
II-115171
© McCord Museum

Keys to History:

The late 19th century saw the emergence of new medical techniques that were thought to hold great promise for patient care. At the urging of doctors, hospitals brought in electrotherapy appliances, which were generally used to treat muscular pain and nervous illnesses. In the 1880s, they opened "medical electricity" departments.

Some doctors sought other applications for electricity. At the Montreal General Hospital, a device producing an electromagnetic current was used to reanimate patients on the operating table. Other physicians made vain attempts to cure tuberculosis and cancer.

More serious research was conducted on the therapeutic value of electrical stimulation, and it eventually resulted in the development of the physiotherapy appliances that have become standard hospital equipment.

What:

This is a crude electrotherapy appliance. Such devices prefigured the advent of physiotherapy.

Where:

Pictured here in the private office of a Montreal doctor, this device was normally used in large Canadian hospitals.

When:

The photo dates from 1896 and was clearly meant to introduce an innovation. Electrotherapy was just beginning to take hold in Canada at the time. Several hospitals were offering "medical electricity" treatments.

Who:

Photographed by the Notman & Son studio, the appliance belonged to Dr. Brown of Montreal.

II-105912.1
© McCord Museum
Photograph
Men's ward, Royal Victoria Hospital, Montreal, QC, 1894
Wm. Notman & Son
1894, 19th century
Silver salts on paper mounted on paper - Albumen process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-105912.1
© McCord Museum

Keys to History:

In addition to their charitable functions, hospitals were playing an increasingly important social and economic role. Accelerated urbanization and industrialization demanded prompt medical attention and the speedy rehabilitation of ill or injured workers.

Many hospitals focused their efforts on emergency care. Work-related accidents were frequent, and far more men than women were treated. Fractures and wounds were daily fare, and the ophthalmology departments were kept busy extracting foreign objects from eyes.

Many destitute hospital patients were labourers, longshoremen and other manual workers who were out of work because of illness. The dual goal was to cure them and get them back on the job.

What:

This Notman & Sons photo is not very cheerful. Although the patients enjoyed all the comforts of a newly opened facility, the ward is similar in many respects to those of other hospitals.

Where:

In the early 20th century, the public wards in most large Canadian hospitals were much the same as those of the previous decades. But differences between institutions were beginning to emerge. The well-funded Royal Victoria Hospital was finding it easier to keep up with medical advances.

When:

Large city hospitals were growing fast in the early 1900s. However, new equipment was expensive, and the care provided in Montreal and Toronto was far more advanced than in Trois-Rivières or Hamilton.

Who:

Even in the large cities, hospital care was still mainly for the poor. The wealthy had lost some of their reluctance and the new technologies were appealing, but general public acceptance was yet to come.

MP-0000.587.14
© McCord Museum
Photograph
"Chalmers" Ambulance, Montreal, QC, about 1920
Anonyme - Anonymous
About 1920, 20th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Mr. Fritz Arnold
MP-0000.587.14
© McCord Museum

Keys to History:

Contrary to what this photo may suggest, the first ambulances to appear in late 19th-century Canadian cities were horse-drawn. Alerted by phone, doctors and drivers raced to care for the injured and transport them to hospital. Ambulances were also used to move wealthy patients between home and hospital.

This new service was not always well understood by the populace. Drunks occasionally called for an ambulance to take them to another tavern. And many calls were received concerning "domestic disputes, frightened women and insignificant falls." Hospital authorities grumbled about these too-frequent "useless trips," but overall the service was welcomed.

When a patient died during transport, a hearse was provided free of charge for the trip to the cemetery.

What:

Motorized ambulances soon replaced the horse-drawn versions. This elegant vehicle is a private ambulance.

Where:

The Montreal General Hospital introduced the first horse-drawn ambulance service in 1883. The Notre-Dame Hospital followed suit two years later. The City of Montreal provided each institution with a $500 grant to finance this new service.

When:

Montreal's Royal Victoria, General and Notre-Dame hospitals acquired their first motorized ambulances in 1909, 1912 and 1917, respectively. The Royal Victoria, however, continued to use horse-drawn vehicles during the winter until World War I.

Who:

The earliest ambulance services were run by the hospitals, but they were gradually taken over by entrepreneurs that provided both ambulances for the sick and hearses for the dead. In 1895, the Canadian chapter of the St. John's Ambulance Association was founded in Toronto. Small firms later put together the first fleets of private ambulances.

II-105910
© McCord Museum
Photograph
Children's ward, Royal Victoria Hospital, Montreal, QC, 1894
Wm. Notman & Son
1894, 19th century
Silver salts on glass - Gelatin dry plate process
20 x 25 cm
Purchase from Associated Screen News Ltd.
II-105910
© McCord Museum

Keys to History:

The earliest period of medical specialization dates to the late 19th century. In addition to the clinics already operating in the 1860s, hospitals established ophthalmology, ear-nose-throat, obstetrics, gynecology, pediatrics and "medical electricity" departments.

When people went to make appointments or to seek outpatient care, they saw an array of new and often strange instruments not found in their doctor's private office. This equipment helped to change the negative perception of hospitals. Some departments were not always able to meet the demand, but it took a while for the pediatrics clinics to overcome parents' reluctance to take their children to hospital.

This was not the case everywhere. The pediatrics department at the Royal Victoria Hospital, which opened in 1905, was very popular.

What:

From the outset, the Royal Victoria Hospital reserved a small ward for sick children. Pediatrics medicine was just beginning then. Rocking chairs and little game tables provided entertainment for the children.

Where:

After some years of operating this small ward, the Royal Victoria Hospital opened a pediatrics department in 1905.

When:

Hospital care for children began in the 1870s with the inauguration of the Morland Pavilion at the Montreal General Hospital. Subsequently, most large Canadian hospitals opened a pediatrics department.

Who:

Children received little specialized care before the end of the 19th century, in part because parents were reluctant to see them hospitalized. Like adults, children were segregated, those from poor families in wards and those from rich families in private rooms.

Conclusion:

By the early 20th century, Canadian hospitals were firmly established and providing better care. Clinical medicine had made immense strides, physicians were more competent and medical technology was opening new therapeutic avenues.

Medical bacteriology significantly improved diagnoses and the prevention of infectious diseases. It also facilitated the introduction of major abdominal and chest surgery. Some surgeons were so eagerly enthusiastic that they took to performing preventive appendectomies. Over-medicalization was already on the horizon.

Specialized care required the hiring of better-trained nursing staff. The establishment of numerous hospital-based nursing schools met these needs in large part.

The demand for care often outstripped the available resources, and some hospitals were forced to turn patients away for lack of beds. Outpatient clinics were overrun as well. But despite the problems, modern hospitals were a source of pride for their administrators. They had become the core vehicle in the delivery of medical care.


Bibliography



Yolande Cohen, Profession infirmière (Montreal: Presses de l'Université de Montréal, 2000).

James Thomas Hamilton Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000).

David Gagan, For Patients of Moderate Means: a Social History of the Voluntary Public General Hospital in Canada, 1890-1950 (Montreal: McGill-Queen's University Press, 2002).

Denis Goulet and André Paradis, Trois siècles d'histoire médicale au Québec. Chronologie des institutions et des pratiques médicales 1639-1939 (Montreal: Éditions VLB, "Études québécoises" series, 1992).

D. Goulet, F. Guérard, R. Lessard and A. Paradis, L'Institution médicale, in the series Atlas historique du Québec, N. Séguin, ed. (Ste-Foy: Presses de l'Université Laval, 1998).

Denis Goulet, François Hudon and Othmar Keel, Histoire de l'Hôpital Notre-Dame de Montréal 1880-1980 (Montreal: Éditions VLB, "Études québécoises" series, 1993).

Denis Goulet, Histoire de la faculté de médecine de l'Université de Montréal 1843-1993, (Montreal: Éditions VLB, "Études québécoises" series, 1993).

H. Ernest MacDermot, A History of the Montreal General Hospital (Montreal: [n.p.], 1950).

Terry Neville, The Royal Vic: The Story of Montreal's Royal Victoria Hospital, 1894-1994 (Montreal: McGill-Queen's University Press, 1994).

François Rousseau, La croix et le scalpel : Histoire des Augustines et de l'Hôtel-Dieu de Québec (1639-1892), vol. 1 (Sillery: Septentrion, 1989).

David Sclater Lewis, Royal Victoria Hospital 1887-1947 (Montreal: McGill University Press, 1969).


© Musée McCord Museum