Struggle to Serve: A History of the Moncton Hospital, 1895 to 1953 9780773570856

Citation preview

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The Struggle to Serve

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mcgill-queen’s/associated medical services (hannah institute) studies in the history of medicine, health, and society Series Editors: S.O. Freedman and J.T.H. Connor Volumes in this series have financial support from Associated Medical Services, Inc., through the Hannah Institute for the History of Medicine Program. 1 Home Medicine John K. Crellin 2 A Long Way from Home The Tuberculosis Epidemic among the Inuit Pat Sandiford Grygier 3 Labrador Odyssey The Journal and Photographs of Eliot Curwen on the Second Voyage of Wilfred Grenfell, 1893 Ronald Rompkey 4 Architecture in the Family Way Doctors, Houses, and Women, 1870-1900 Annmarie Adams 5 Local Hospitals in Ancien Régime France Rationalization, Resistance, Renewal, 1530-1789 Daniel Hickey 6 Foisted upon the Government? State Responsibilities, Family Obligations, and the Care of the Dependant Aged in Nineteenth-Century Ontario Edgar-André Montigny 7 A Young Man’s Benefit The Independent Order of Odd Fellows and Sickness Insurance in the United States and Canada, 1860-1929 George Emery and J.C. Herbert Emery 8 The Weariness, the Fever, and the Fret The Campaign against Tuberculosis in Canada, 1900-1950 Katherine McCuaig

9 The War Diary of Clare Gass, 1915-1918 Edited by Susan Mann 10 Committed to the State Asylum Insanity and Society in NineteenthCentury Quebec and Ontario James E. Moran 11 Jessie Luther at the Grenfell Mission Edited by Ronald Rompkey 12 Negotiating Disease Power and Cancer Care, 1900-1950 Barbara Clow 13 For Patients of Moderate Means A Social History of the Voluntary Public General Hospital in Canada, 1890-1950 David Gagan and Rosemary Gagan 14 Into the House of Old A History of Residential Care in British Columbia Megan J. Davies 15 St Mary’s The History of a London Teaching Hospital E.A. Heaman 16 Women, Health, and Nation Canada and the United States since 1945 Edited by Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson 17 The Labrador Memoir of Dr Henry Paddon, 1912-1938 Edited by Ronald Rompkey 18 J.B. Collip and the Development of Medical Research in Canada Extracts and Enterprise Alison Li

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19 The Ontario Cancer Institute Successes and Reverses at Sherbourne Street E.A. McCulloch 20 Island Doctor John Mackieson and Medicine in Nineteenth-Century Prince Edward Island David A.E. Shepard

21 The Struggle to Serve A History of the Moncton Hospital, 1895 to 1953 W.G. Godfrey

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Almshouse

The first home of The Moncton Hospital from &'& to '! was in the top two floors of the Almshouse on Beausejour Street in Dieppe. The Almshouse was built in &&#.

King Street

In '!. The Moncton Hospital opened this building on the Michael Spurr Harris property on King Street in the east end of Moncton.

The Moncton Hospital

The Moncton Hospital is now situated on MacBeath Avenue on land donated by D. A. MacBeath in '"' Moncton Museum, File a-096, “100 The Moncton Hospital”

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The Struggle to Serve A History of the Moncton Hospital, 1895 to 1953 w. g . g o d f r e y

McGill-Queen’s University Press Montreal • Kingston • London • Ithaca

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© McGill-Queen’s University Press 2004 isbn 0-7735-2512-2 Legal deposit first quarter 2004 Bibliothèque nationale du Québec Printed in Canada on acid-free paper that is 100% ancient forest free (100% post-consumer recycled), processed chlorine free. This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada. Funding has also been received from the Marjorie Young Bell Faculty Fund at Mount Allison University. McGill-Queen’s University Press acknowledges the support of the Canada Council for the Arts for our publishing program. We also acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program (bpidp) for our publishing activities.

National Library of Canada Cataloguing in Publication Godfrey, William G., 1941– The struggle to serve: a history of the Moncton Hospital, 1895 to 1953/W.G. Godfrey. Includes bibliographical references and index. isbn 0-7735-2512-2 1. Moncton Hospital – History. I. Title. ra983.m58m65 2004 362.1′1′09715235 c2002-904897-4

This book was typeset by Dynagram Inc. in 10/12 Sabon.

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To my son K.K., Born at the Moncton Hospital

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Contents

Figures ix Acknowledgments

xi

Map xiii Illustrations 135 Introduction

3

1 “Into the Hands of the Ladies”

12

2 From the Almshouse to Respectability

31

3 Continuity with Significant Discontinuities 4 At the Crossroads

93

5 An End and a Beginning Conclusion 179 Appendices Notes

191

Bibliography Index

187

236

221

147

62

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Figures

1 Populations of Westmorland, Kent, and Albert counties and the City of Moncton, 1901–1951 43 2 Number of patients by residence, 1905–1953

44

3 Residence of private and semi-private patients, 1913–1953 96 4 Residence of public/ward patients, 1913–1953 5 Per diem patient cost, 1898–1953

97

96

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Acknowledgments

The Moncton Hospital was first incorporated in 1895 and this study originated as a centennial project of sorts. First suggested as a possible student project by two people closely linked with Moncton Hospital – Joan Allain, nursing educator, and Dr Victor McLaughlin, a long-time medical staff member who is now retired – it has grown into considerably more. Support and encouragement were received from many but a special few must be singled out. The hospital librarian, and archivist by default, Sue Libby, provided outstanding co-operation. The staff of the Provincial Archives of New Brunswick was, as usual, extremely helpful, particularly Twila Buttimer, who first guided me to the Moncton Municipal Records. At Mount Allison University, my greatest debt is to one of my honours thesis students, Colin Smith, who spent a summer labouring in the archival sources available at the Moncton Hospital. Colin produced a preliminary overview entitled “The History of the Moncton Hospital, 1895 to 1954,” as his honours thesis in 1996. This reconnaissance in strength convinced me that, if matched with other primary sources and systematically applied to the existing hospital literature, sufficient sources were available for a detailed and balanced academic history of the hospital. Colin will probably not recognize the direction I have taken this study, the quite different questions raised and sources consulted, but his work constituted an excellent starting point. Two other student research assistants, Tianna De Benedetti and Deanne Fowler, plowed through newspaper and government record sources on campus at Mount Allison, and I very much appreciate their diligent and thorough efforts. Aurèle Parisien and other members of the

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xiv

Acknowledgments

McGill-Queen’s University Press staff were consistently patient and helpful, while Lesley Barry’s editorial work was outstanding. My eversupportive wife, Rhianna Edwards, contributed her genealogical expertise and census knowledge to pull together names and occupations while also painfully and patiently reading the manuscript in order to help with the construction of the figures and the index. I am also indebted to Acadiensis for permission to publish material that first appeared in that journal [27 (autumn 1997) and 31 (autumn 2001)]. Pictures and illustrations appear with the permission of the Moncton Hospital, Moncton Museum, University of Toronto Press, Nimbus Publishing, and Patricia Winans-Orr.

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Thorburn, Politics in New Brunswick, 2

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The Struggle to Serve

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Introduction

The Harvard University medical school certificate of one of the Moncton Hospital’s first staff physicians, Dr James D. Ross, included among its signatories Oliver Wendell Holmes. The same Oliver Wendell Holmes once warned: “To write of ‘Medicine in Boston’ is not unlike writing of the tides in Boston Harbor. Boston is a fraction of the civilized world, as its harbor is part of the ocean.”1 The historian who quoted this daunting description demonstrated successfully that a study of Boston and its hospitals could provide an excellent window for comprehending the emergence of the modern hospital. But can examining a small hospital in a small New Brunswick community also prove rewarding and instructive? In order to answer this question, we must consider the historiographic context, the sources available, and the questions to be raised in such a study. Edward C. Atwater explains the significance of small hospitals, as opposed to teaching hospitals and large metropolitan institutions, in the United States. He contends that between 1875 and the Great Depression almost every town in the U.S. “established a small general hospital” and that the impetus for “the development of a hospital to serve all people came from smaller towns.”2 Since the overwhelming majority of hospitals both in the United States and Canada were not the better known medical centres based in large urban centres, Atwater’s point is well taken. Moreover, the focus on smaller institutions in smaller communities is given further stimulus by the strength of American hospital historiography in general. The work of Charles E. Rosenberg, Paul Starr, Rosemary Stevens, Morris Vogel, and David Rosner,3 for example, testifies to the insights

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4 The Struggle to Serve

and findings of a well-developed and sophisticated field of inquiry. By contrast, Canadian hospital historiography remains largely undeveloped, lacking synthetic hospital studies that provide an overview as well as systematic comparative studies of institutions both large and small. This is not to say that Canadian hospital histories are nonexistent. A good number of older studies are available and have been joined more recently by an outpouring of hospital histories, many of which were timed to coincide with hospital centenaries or other anniversaries.4 What many of them lack, however, is the research and analysis that American academics have applied in their studies. To be sure, there are some prominent exceptions. In their examinations of institutions in Owen Sound, Ontario, in Halifax, Nova Scotia, and in Hamilton, Ontario, David Gagan, Colin Howell, and Mark Cortuila have been sensitive to and willing to address and apply the issues raised in the broader hospital literature.5 Nevertheless, the field of Canadian hospital history “remains in a somewhat immature state as compared with the United States,” in the valid judgment of J.T.H. Connor.6 Some would go even further in chastising Canadian scholarly shortcomings. Assessing the broader field of Canadian medical historiography, Ronald Hamowy pulls no punches in describing its “long and undistinguished career” as producing only “tedious, often banal, works” that have usually been “authored by physicians who appear to have had little or no interest either in analysing or interpreting the events which they chronicled.”7 While there is a measure of truth in this harsh indictment that is all too applicable to many hospital histories, S.E.D. Shortt offers a more balanced evaluation and suggestion. His “Lament” about the “generally inadequate character” of studies of the nineteenth-century Canadian hospital urges the application of American and British insights that could create a better understanding of the twentieth-century Canadian institution as well. As he notes, however, too many Canadian hospital histories are handicapped by their “deliberately commemorative” nature and their assumption “that the direction of hospital development was both relentlessly progressive and ultimately inevitable.”8 This mention of progressiveness and inevitability underlines both differences and similarities between Canadian and American scholars. Both tend to allow the final outcome to influence the emphasis: in the American case, the emergence of hospitals as private money-makers shades various studies with a critical tone,9 while in Canada the eventual emergence of a substantial government presence through medicare and hospital insurance leads to a more positive, almost Whiggish, tone. While American studies question “why there is no national health insurance in the United States,”10 Canadian scholars focus on key decisions leading to Canadian health insurance, the medi-

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5 Introduction

cal profession’s reaction, or a present-minded and supportive presentation of an evolving state role.11 As the title of this study indicates, the creation and growth of the Moncton Hospital was marked by significant struggles that made its successful service far from inevitable. Indeed, throughout this history, both within and outside the hospital, struggle between various individuals or groups marked the institution’s evolution. Delays and setbacks at times matched the moments of triumph as patients, politicians, and the general public had to be educated and convinced of the hospital’s merits and potential contribution to the community. In many studies the minimalization or neglect of the problems faced by hospital advocates, trustees, and staff, as a growing demand for hospital services went unmatched by substantial public sector enthusiasm or support, leaves a rather rose-tinted picture of enlightened public and private acceptance and generosity. What is not captured, and what might only be captured in individual hospital histories sensitive to chronic hospital difficulties and struggles, particularly in the area of funding, is how small Canadian general hospitals emerged, survived, and grew in the first half of the twentieth century. It is a particularly timely question in an era of government cutbacks in health services and much talk of what would really be a return to the privatization of such services. Admittedly, the individual hospital perspective in the work of David Gagan12 reveals a great deal about the problems and funding of public general hospitals in Ontario. Likewise, in providing a synthetic personal overview, G. Harvey Agnew offered a then timely summary of the Canadian hospital system that benefitted from his direct involvement in questions such as standardization and hospital financing.13 But an updated and detailed synthesis of the tide of hospital histories that crested in the last quarter century is lacking. Such a synthesis would have to wrestle with the diversity within the Canadian system: hospitals launched with substantial endowments and connected with major medical schools, hospitals that could make a strong case for generous provincial government or municipal support from day one, or hospitals such as Moncton’s that were independent community ventures launched with broad-based private support and which quickly turned to relying upon paying patients because initial government support was token while private philanthropy was limited. In drawing upon other nations’ hospital or medical history, several scholars sound a quite legitimate note of caution. Connor makes clear that Canadian “hospital examples” should not “simply be grafted to an American framework.”14 Veronica Strong-Boag warns that nursing history advocates should remember “not to borrow blindly from American or British models of development and explanation.”15 Likewise R.D.

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6 The Struggle to Serve

Gidney and W.P.J. Millar emphasize that “the history of medical education in nineteenth-century Ontario, and especially in Toronto, is not that of the United States writ small.”16 Importing a hypothesis for testing remains valid, but transplanting evidence when Canadian evidence is lacking is a questionable exercise. In a field such as hospital history, however, borders frequently must be crossed if insights and themes are to be verified by the evidence available. Thus when John V. Pickstone defines as central to his study of the Manchester region’s hospitals “the complex interrelations between the hospitals and the communities they were built to serve,” Canadian variations of his “political ecology”17 immediately come to mind. Moncton Hospital, opened to serve both urban and rural as well as French- and English-speaking constituencies, could be usefully approached in this way, as a vehicle for examining how the citycountryside relationship shaped health services in Canada.18 When Brian Abel-Smith bluntly states in the introduction to his study of hospitals in England and Wales that “[l]ittle is said here … about methods of treatment,” and excludes Scotland’s hospitals because they differ so greatly, it is a reminder that hospital histories can be circumscribed yet still be extremely useful and legitimate.19 The best of medical and hospital history transcends national boundaries, providing methodology and conclusions that deserve consideration, and application if appropriate.20 If the literature on hospitals can be both brilliantly insightful and distressingly inadequate, the same can be said of the primary sources. Hospital records management has always been a problem and, in the case of the Moncton Hospital, it is a problem that persisted through the entire period under examination. Three different hospital sites and a 1956 fire that destroyed the hospital’s medical library create concerns about what valuable archival sources may have been lost through the years. What is described in this study as the Moncton Hospital Archives today remains a small room in the hospital library with its documentation largely unorganized and unprocessed. Unfortunately Barbara L. Craig’s observations about records and record-keeping, growing out of her comparative study of a number of hospitals in London, England, and Ontario, are all too applicable to the Moncton situation. “Explosive growth” in the number of records met with “generally poor systems in place for their planned control.” Systems of classification have not survived, resources allotted were inadequate, storage and indexing were problems, long-term records management policies were lacking, and, by the early 1950s, “an institutional policy that integrated record-keeping and planning had yet to emerge.”21 If the Moncton Hospital’s archival situation is any indication, like other hospitals it was unable to devote the resources and planning necessary to what historians would regard as a vital sector.

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7 Introduction

Yet despite the archive’s gaps and disorganization, the Moncton institution did have an almost complete run of annual reports, although, even here, format changes, different accounting methods, and changing categorizations of patients required a careful mining of the reports. Press coverage of the more public questions relating to the hospital, particularly during its first thirty years, was pressed into service and provided an excellent insight into the hospital’s relationship with the communities it served. Turnouts at annual meetings of the hospital board, open to all and where even a limited donation to the hospital gave the donor the right to vote, allowed an at times outraged citizenry to publicly voice its criticisms of hospital policies, or, at least, the board’s policies. Discussions by municipal and county councils, again fully reported in the press, concerning the need for hospital funding and of specific problems or advances within the hospital provided both a perspective and documentation often lacking in the regular archival sources. This is not meant to devalue the hospital’s archival materials, since the minutes of various committees, extensive correspondence, numerous reports commissioned by the board, brief histories of groups or departments vital to the hospital’s development, and scrapbooks, among other items, provided much that was essential to this history. Equally and at times even more valuable was the well-organized and substantial material concerning the Moncton Hospital available at the Provincial Archives of New Brunswick. Crucial to this study were the provincial Department of Health and Moncton Municipal records, as well as printed primary sources containing, for example, the province’s hospital legislation. Nevertheless, the quantity, quality, extent, and unevenness of documentation, as in the case of the secondary literature, required a selective approach and a hospital history with an emphasis upon certain questions or themes. Charles Rosenberg’s excellent examination of the emergence of the American hospital system is selective in its approach. As he explains, his work emphasizes the “role of the medical profession” and subordinates nursing, hospital administration, and changing methods of hospital financing, which he admits also played key roles “in shaping the modern hospital.”22 This study’s order of priorities differs from Rosenberg, although it accepts and examines all his major shaping forces. At the time of first researching and writing this history, Moncton’s hospital doctors had been chronicled in an undocumented manuscript by Dr Donald I. MacLellan, which I used. As a long-time staff physician MacLellan received access to the personnel records of the doctors employed by the hospital and was able to present a wealth of information and anecdotes. This same manuscript was published in 1998 as a 320page book,23 with roughly its first ninety pages devoted to the period

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8 The Struggle to Serve

examined in this study. It does more than justice to the doctors but gives short shrift indeed to other players or even to the sort of questions raised in this study about the physicians of Moncton. Their changing educational training, the community’s perception of their contribution both in the hospital and beyond, and their role in and shaping of the hospital are examined here. At the same time, this study balances the doctors’ role, and the legitimate but perhaps excessive attention they have received, by looking in even more detail at the hospital’s financing, the role and importance of nurses and the nursing school, and the makeup and impact of hospital advocates, board members, and important support groups such as the Ladies’ Aid. To explain in more detail just one of these issues, hospital funding is a major concern of this study, since too many hospital histories revel in grand opening ceremonies and ribbon-cutting celebrations as new wings or buildings were added yet ignore the evolving funding patterns that made such space and service extensions possible. Funding was basic to hospital establishment and expansion, but it remains little examined or understood, particularly in Maritime hospital histories, which have largely neglected any precise delineation of the funding realities behind the evolution of these institutions.24 A comprehension of hospital financing can best be achieved by an intertwined overview of local, provincial, and federal policies, or non-policies. Employing at the same time the sometimes limited documentation within one hospital and within the communities it served provides a better understanding of how the changing demand for hospital services meshed with changing funding to achieve substantial growth in hospitals during the 1898 to 1953 period. During these years the journey from a largely privately funded hospital to an increasingly government-funded institution had been completed to a considerable extent by the Moncton Hospital. In the area of major capital expenditures, private donations had been supplanted by grants from various levels of government. Operating costs by 1953 were met by enhanced provincial contributions, a more substantial municipal and county role in hospital finances, and patient payments, whether direct or from a third party (government or private hospital insurance schemes). Focusing on changing patterns in hospital finances from the vantage point of one institution reveals a gradually growing governmental role, whether municipal, provincial, or federal, when “a long-standing governmental unwillingness to intrude in the delivery” of hospital care25 prevailed in both the U.S. and Canada for much of the period under examination. Yet, as Rosemary Stevens has demonstrated, in certain parts of the United States and at certain times, government funding support for hospitals deserves attention because it was present and signifi-

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9 Introduction

cant.26 With a gradual shift in capital cost from the private to the public sector, and a continuing heavy reliance on private patient payments to meet operating costs, the Moncton Hospital, born in 1898 in the Moncton Almshouse with fewer than twenty beds and $600 in renovation costs, grew to a $3-million, 225-bed facility in 1953. Three different sites and experimentation with different financial arrangements marked this transformation. The New Brunswick situation was further complicated by the division of hospital responsibility between provincial, county, and municipal authorities, with the gradual intrusion of a limited federal presence. This conflicting thicket of responsibility, or evasion of responsibility, was only cleared away by federal-provincial actions in the late 1950s and the Equal Opportunity program of the 1960s.27 The Moncton Hospital is an especially interesting case study because, although located in a relatively small community, from the outset it served not only its urban constituency but the surrounding counties – Westmorland, Kent, and Albert – as well as, initially, Frenchand English-speaking communities. If provincial, municipal, and county support was limited or static, paying patients from the constituencies served were vital to the survival of the institution. Consequently, funding realities were closely tied to patient usage figures, the shifting constituencies served, governmental policies or non-policies concerning hospital support, and the hospital’s own resourcefulness in adjusting its services to remain an attractive and worthwhile proposition that deserved the support of the communities it served. While the changing treatment and services available to patients enters this study, I must confess, like Abel-Smith, that only limited attention is paid to how and what patients were treated for, since the evidence is frequently inadequate or non-existent. Instead the increased patient usage of the hospital, occasioned by the steady expansion of services offered, is emphasized. Particularly important from the hospital’s vantage point was the recruitment of paying patients, which, as Vogel and Rosner have argued, was a vital feature of American hospital development and which, as Atwater notes, marked the small town hospital as well.28 Charting the rise and residence of private and semiprivate paying patients versus non-paying or low-paying public and ward patients provides an appreciation of the hospital’s success in quickly securing the paying clientele so vital to its continued operation. Payments for many of these patients would later take the form of voluntary hospital insurance but their importance in meeting the hospital’s operating costs persisted well into the 1950s. Attracting patients required a respected staff of physicians and surgeons, but a well-trained student and graduate nurse complement also was necessary. As the first hospital campaigners had advocated, early

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10

The Struggle to Serve

in the hospital’s history a nursing school was created and became an integral part of the hospital. Comparisons can be made with other hospitals’ staffing balance between graduate and student nurses, and the careful hand and policy of Alena MacMaster, who served as superintendent of both the hospital and of the nursing school from 1919 to 1947, deserves considerable credit. The importance of women can be seen in other aspects of the hospital’s history, as they were a driving force in the original movement to create the hospital and remained through to the 1920s the most active and successful of its fund-raisers. Women gained positions on the hospital board during World War I but no provision was made for them in the reconstituted 1947 board. Ironically, at the same time, the all-powerful position of Alena MacMaster was split into two separate positions and her successors as superintendents/administrators would all be male. Nevertheless, MacMaster had put her personal stamp on the hospital and her dominant role raises questions about the commonly accepted distribution of power within hospitals. Instead of a gradual shift in authority from trustees to physicians, and then to administrators by the 1930s and 1940s,29 the Moncton process was both more complicated and abrupt. Given the administrative/political/economic emphasis in the various themes of this hospital history, the institution’s internal medical dynamics frequently receive less attention than the more outwardly oriented forces at work in its growth. The efforts of hospital supporters and staff to gain political and economic approval and support from the surrounding communities are at the heart of this study because the story of hospital growth is as much a study of politics and community persuasion as it is of new surgical techniques. Thus, to return to the question asked at the outset, approaching the history of the Moncton Hospital by understanding both its evolution and the broader societal forces that shaped and redefined it can be a rewarding and instructive exercise. Emphasizing the hospital’s constant interaction with its immediate and surrounding communities reveals a relationship that was not always as progressive and harmonious as might be assumed. What emerges is a picture of a constant struggle to serve that was shared by hospital advocates, staff, administrators, and board members, who dealt with a public that often had to be educated and persuaded. The public response in using and supporting hospital facilities eventually brought pressure to bear on politicians at various levels of government to take a more active role in the delivery of medical care. Unfortunately, in tracing the acceptance and expansion of hospital services, the genre of Canadian hospital histories is uneven and, at times, tends to gloss over important aspects of institutional development or merely to quietly assume that the growth of hospital care was inevitable. Such

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11

Introduction

was certainly not the case in Moncton. Moreover, the Moncton Hospital’s journey from voluntary philanthropy to paying patient to government support and private hospitalization insurance schemes was a shift in dependency experienced elsewhere in the region, and throughout Canada, but rarely documented and analysed. Moncton is not Boston and the Petitcodiac River is not the Atlantic Ocean, but both locations offer a valid prism to view and understand some of the historic realities behind the emergence and growth of the modern hospital. I am of course responsible for overstatements, misstatements, or outright errors, but I trust that these are more than balanced by a history that was enjoyable to research and write and which should prove of interest to both a scholarly and a wider audience.

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1 “Into the Hands of the Ladies”

In 1984, a “Historiographic Lament” suggested that many hospital histories “imply that the direction of hospital development was both relentlessly progressive and ultimately inevitable.”1 Since then, however, a number of significant studies have appeared that eschew such assumptions,2 and socio-medical history in general has become increasingly sophisticated, providing new insights into the professions, institutions, individuals, and societal responses and pressures at work in the late nineteenth and early twentieth centuries.3 Yet in many cases the founding moments of hospitals are still presented casually as the result of a certain inevitable progressiveness. The movement leading to the creation of the Moncton Hospital in 1898 does not fit that categorization. Moreover, the community’s size and the timing of the hospital’s creation make placing this institution in its proper comparative context no easy chore; it was not situated in a large urban centre and it was not the product of mid-nineteenth century reform impulses. Within the Maritimes, Saint John and Halifax had gone through the hospital creation process at roughly mid-century, and their examples, while instructive, are not readily applicable.4 In addition, the field of hospital studies is not yet fully developed,5 despite its recent growth. Thus, comparable case studies are limited and at times uneven in research and analysis, although hospitals founded in Owen Sound and Fredericton in 1893 and 1888 respectively match neatly in terms of time and community size and are useful in measuring the parameters of such studies. Whether hospital histories deal with larger or smaller urban centres, in the mid or late Victorian periods, the sometimes complicated process

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13

“Into the Hands of the Ladies”

of educating the general public and winning support for the institution’s creation generally receives short shrift in favour of its triumphant opening, applauded by a generous and appreciative community. At times, this neglect is caused by a documentation problem, as David Gagan’s Owen Sound study acknowledges. One of the research difficulties Gagan faced was the lack of sources “to explain why Owen Sound’s physicians collectively took up the cause of a voluntary public general hospital or how they managed to enlist the aid, then the leadership, of some of the town’s wealthiest and most influential citizens in this enterprise.”6 Nonetheless, his study carefully knits the Owen Sound hospital’s emergence with local social and economic pressures and broader reform forces. As the quotation above makes clear, doctors, aligned with business leaders and municipal and county politicians, were instrumental in the process, but they were helped by the most “energetic” fund-raising group, the Ladies’ Aid. When the women were excluded from the more important decisions, however, “anger” at their treatment eventually caused their “dispirited” withdrawal from “all direct involvement in the management of the hospital.”7 In contrast to this collective effort, Arlee McGee’s treatment of the Victoria Public Hospital focuses on the one-woman show of Lady Alice Tilley, the lieutenant governor’s wife, who is portrayed as almost single-handedly conceiving and directing the creation of this institution. McGee explains the situation: “With one woman as the worker and God as the Master Builder, a remarkable gift was bestowed upon the Fredericton community that day” in 1888 when the Victoria Public Hospital opened.8 A more balanced and thorough dissection of hospital movements is needed, and detailed case studies of the “founding moments” in Moncton and other small communities could add another dimension to our understanding of the birth of the modern hospital. The progressive impulse behind health reform and hospital building may have been less overpowering and pervasive than previously assumed, the emergence and opening of the institution far more complex than previously believed, and the roles played by different genders, groups, and individuals more varied than hitherto recognized. The process, players, and support of hospitals by “progressive” communities needs to be examined through a wider variety of prisms, including that offered by Moncton. Incorporated as a city in 1890, Moncton elected as its first mayor Frederick W. Sumner. The boom and bust pattern of its earlier years – created as a town in 1855, forced to surrender its charter in 1862 only to regain it in 1875 – seemed over.9 In the decade from 1881 to 1891 the town’s population soared from 5,032 to 8,762 (a 74 per cent increase)10 and it witnessed significant industrial growth. A prosperous

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The Struggle to Serve

future appeared to be guaranteed by, among other industries, textile manufacturing, sugar refining, and foundry production, along with the Intercolonial Railway shops. Moncton’s geographic position as the urban centre of Westmorland county provided a further advantage. The city was rapidly eclipsing neighbouring communities such as Shediac, Dorchester, and Sackville, which had once had equal aspirations. Although a late starter as a New Brunswick community, compared to Saint John, for example, by 1890 Moncton had come of age. But it lagged in one area: it lacked a hospital, an institution that to some was the all-important sign of a truly progressive city. In general, Rosemary Stevens’ description of the American situation fits well the motivations behind Moncton’s hospital campaign: “Social, industrial and medical interests in the founding of hospitals interconnected; the establishment of a hospital became the goal of every civicminded community.”11 Still, the acceptance and realization of that goal did not come quickly or without questions and opposition in Moncton, despite the humanitarian concerns and needs expressed. A coalition of political, business, religious, and professional community leaders came together to champion the hospital cause, yet, as future Moncton mayor and county sheriff George B. Willett tactfully expressed it in June 1899, it was only “after many unsuccessful efforts” that “we have at last been able to establish this institution.”12 “Resurgo” seemed an appropriate motto for the hospital project in the 1890s: at times some proponents of the project declared themselves to be on the verge of losing hope, as a growing community commitment was constantly offset by disagreements about precisely how to achieve the goal. In late January 1895, one pessimistic observer commented: “First, give the whole matter back into the hands of the ladies who may possibly be able to do something tangible, which the men, judging from the tenor of the meeting in the Opera house on Friday evening, cannot do, except to interrupt each other, and try to force their opinions on some others.”13 Perhaps the writer was unduly pessimistic about masculine deficiencies, but the comments perceptively hinted at the substantial feminine contribution to the establishment and success of early hospital services in Moncton. Like other growing industrial communities, Moncton was not free from the social problems accompanying urban development. As a local historian later described, “[p]overty, alcoholism and prostitution – issues rarely discussed by polite society – now found their way on to the pages of local newspapers.”14 An almshouse opened in 1885 and, four years later, its broader use as a hospital was suggested. At the same time a group of energetic Moncton women advocated a “small municipal health facility” to meet the medical needs of “the poor, the diseased and

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depraved.” Neither suggestion gained the approval of the municipal authorities but, undaunted, various individuals and organizations continued the struggle. One group of women was particularly active in the 1890s. In January 1895 the fourth annual report of the “Watchful circle” of the King’s Daughters enumerated one year’s activities. Thirty-six meetings had been held, resulting in “aiding poor families with milk, groceries, clothing and medicine,” assisting in the payment of board, distributing Christmas dinners, and making payment for the education of a boy at the school for the blind in Halifax. In addition, a new major project was underway. “A number of meetings have been held to discuss the advisability and possibility of starting a small hospital in our city. As the need of one has been quite often felt by doctors and those who work among the sick, steps have been taken to bring the matter before the public.”15 One such step was a meeting, “largely attended” according to the press, held in the parlour of the ymca on Monday morning in late December 1894.16 It brought together “a number of ladies,” clergymen and doctors, all “interested in the establishment of a general hospital.” The meeting was chaired by James S. Benedict, the U.S. consul in Moncton, while local physician Dr Ambrose R. Myers served as secretary. There was unanimous agreement about the need for a hospital, and ways and means of achieving this goal were discussed. Eventually a committee was struck to look at the cost and possible fund-raising methods, with a requirement to report in seven days’ time. On the committee were two women, Mrs Carrie Benedict, wife of the consul, and Mrs Annie Purdy, wife of Dr Clinton T. Purdy. The clergy were well represented with Rev. W.W. Weeks from the First Baptist church, Rev. John Read from Central Methodist church, Rev. Edward B. Hooper from St George’s Anglican church, and Fr Henry A. Meahan from St Bernard’s Catholic church. Rounding out the committee was another local doctor, James D. Ross, and Murray Fleming, an Intercolonial Railway manager. The clergy promised “an active interest in the movement” and, most importantly, that they would bring the hospital issue before their congregations “at an early date.” This public lobbying was to be followed by “a public meeting of the citizens” at the Opera House. Buoyed up by such plans, participants emerged from the first meeting convinced that “there is no doubt that at an early date the city will be in line with other places of much less importance in having an institution” long needed by the community. The King’s Daughters were quick to report this hospital initiative in the city’s newspaper and underlined how “enthusiastic” both physicians and clergymen were. Indeed, they went so far as to express the view that perhaps the entire movement must be broadened and the

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torch of leadership passed. On the one hand, new supporters among the women of Moncton would be enlisted. “Our little circle will amalgamate with all those women in the town who feel an interest in the matter. We already know there are a great number of such; a ladies aid society will be formed which will work toward the support of the hospital.” At the same time, and with equal optimism, they hoped that the project could soon be spearheaded by incorporated leadership: “As soon as a public meeting can be called a body of corporators will be formed who will appoint a Board of Trustees in whose hands will rest the management of the hospital.”17 Within the week the fund-raising committee reported on its progress, the president of the King’s Daughters outlined the steps taken by her organization, and the stage was set for a public meeting, the arrangement of which was “left in the hands of the King’s Daughters.”18 It was soon scheduled for Saturday, 11 January 1895. Up to this point the women of Moncton involved in the hospital crusade had dealt largely with the already converted. Solid support could be mobilized throughout the major religious denominations by clergymen quite willing to sermonize on society’s medical and other social needs. Even more important to the movement’s success was the reality that Moncton was served by a group of well-educated and well-trained physicians, by the standards of that time, whose views and talents were respected by the community. By the mid-1890s the medical profession in New Brunswick had largely shed the image of charlatanism and quackery that hobbled its development in some parts of Canada.19 With the creation of a College of Physicians and Surgeons for New Brunswick in 188120 the assessment of educational credentials and the professionalization of doctors were well in hand. An emerging faith in medical science, on the part of both doctors and patients, was linked with the development of general hospitals, where medical practitioners and the general public could profit from the new skills and advances. There were even physicians who carried their new confidence in “scientific medicine” into social and sanitary reform, diagnosing “a diseased social order that could be nursed back to health with the proper advice and leadership of a scientifically-based medical profession,”21 although to ascribe such views to a majority of the members of the Moncton medical community might be going too far. A brief glimpse at some of the Moncton physicians practising in the mid-1890s who would form the core of the hospital’s future medical staff reveals their strong credentials and sensitivity to the needs of their community. On the newly formed committee was Dr James D. Ross, eventually acclaimed as one of the fathers of the hospital. Nova Scotianborn, he graduated from Harvard in 1862 and began a practice in

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Moncton two years later.22 An outspoken early supporter of the Moncton Hospital, he was blunt about the increased medical efficiency that could be achieved and the suffering such an institution might ameliorate. He pointed out that the city gave a physician treating the poor both inside and outside the almshouse roughly twenty-seven cents per day. With an average of ten to fifteen visits per day, this meant an expenditure of roughly one or two cents for each patient. Surely the poor deserved better treatment. Moreover, the pauper in society must contend not only with inadequate attention to his sickness but with “filth saturated” housing that was “cold in the winter and closed in the summer,” the poorest quality food, and constant anxiety. “Here,” he argued, “surely, we have suffering that to be understood must be felt.”23 Clearly, from his vantage point, a hospital would be a godsend in terms of delivering adequate medical care, as well as providing a far more efficient allocation of a physician’s precious time. Dr Oscar J. McCully was even better known in medical circles than Dr Ross, because of his published papers. Born in Sussex, New Brunswick, he received an M.A. from the University of New Brunswick in 1875 and graduated in medicine from McGill University in 1879. He became a Master of the Royal College of Surgeons in England in 1885.24 Other than a few years in Saint John, most of his medical career was spent in Moncton. When he died in 1911 the Moncton Daily Times described him as “[e]minent in the practice of his profession, active in any movement which elicited his co-operation for the good of the city, genial and affable in his relations with all, and courteous and self-sacrificing.”25 As a “great student of human nature” and a “remarkably well read” individual, he gained a reputation as a “lecturer of more than local repute” who presented public orations as well as papers to medical societies. The practice of medicine, he believed, had benefitted immensely from the scientific achievements of great men like Louis Pasteur and Joseph Lister. Pasteur was “the father of the germ theory, and if we measure men by the good accomplished by their work, he stands as the greatest man of the century, if not of all time. Then came Lister,” he continued, “who introduced antiseptic surgery, which has gradually developed into aseptic so that now the surgeon can invade any cavity of the body, and all that is asked of him is to be surgically clean.”26 On occasions McCully’s radical views placed him in the ranks of Maritime doctors who believed in the “need for social regeneration through reform.” He called for a “purely scientific and rational approach to crime in which the morally infirm criminal [should] be treated in the same spirit as we treat the physically infirm.” Since doctors aimed often at prevention rather than cures, so society should aim

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at prevention of crime rather than its punishment. Hence, criminal rehabilitation, if it was possible, called for careful diet, cleanliness, exercise, education, and the teaching of a trade.27 Crucial to this moral rehabilitation was a proper environment. In the area of medical care, McCully also underlined “the gospel of fresh air, of healthful environment, of plain food, and of the simple life to the exclusion of humbug, for has it not been fresh air and a simple and generous diet, which has at last conquered the most deadly of foes to the human race – the White Plague [tuberculosis].”28 This controlled and health-restoring environment, one assumes, would be perceived by Dr McCully and the Moncton medical profession as lacking in the mid-1890s so long as the community was without a hospital. Another booster of the hospital was Dr Fred J. White. His obituary recalled: “The city hospital and kindred institutions had no stronger supporter than the late Dr. White. He gave generously of his time and his talents to promoting the interests of the hospital and that institution owes much of its success to his efforts and unselfish service.” The Newfoundland-born White graduated from Mount Allison in Sackville before attending McGill University, earning his medical degree in 1886.29 He received a Licentiate of the Royal College of Physicians of London in 1888. Prior to practicing in Shediac and then launching his long Moncton career, he briefly served in Wilfred Grenfell’s Labrador and northern Newfoundland medical mission. This noble experiment, for which Grenfell was eventually knighted, provided the migratory fishers, permanent settlers, and indigenous peoples of the area with medical care that had been totally lacking.30 Service to his community, whether in Newfoundland or in Moncton, became a feature of White’s medical and non-medical activities. A stretcher-bearer in the Riel uprising, he was later a surgeon major in the New Brunswick militia and he served as mayor of Moncton in 1907. In mourning his passing, the press noted the duality of his service: “He was widely known as one of the most skilful physicians and surgeons in eastern New Brunswick and was one of the leading citizens of Moncton, being popular with all classes and highly esteemed by all. He took a deep interest in civic affairs and was full of optimism as to the future of the city of his adoption and the Dominion at large.”31 Doctors such as White, McCully, and Ross, religious leaders like Meahan and Hooper, and the King’s Daughters together represented a formidable alliance. But all recognized that private support alone could not secure the necessary hospital. Approval and funding at the municipal level, from the mayor, council, and ratepayers, must be achieved, and in other similar-sized communities, such as Galt, Ontario, this had been a struggle as reluctant taxpayers hesitated to take on additional

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burdens.32 In Moncton on the Saturday evening of 11 January 1895, a meeting of citizens to gain public endorsement for the hospital cause got underway, “largely attended” according to reports, “by ladies as well as gentlemen interested in the project.” About twenty ladies, six clergymen, six doctors, one of the county’s mpp s, the mayor, a number of aldermen, and many of the city’s prominent citizens were present. Mayor Sumner presided, with a dentist, Dr Charles A. Murray, as secretary. Sumner immediately turned to Mrs Annie Purdy for a report and she seized the moment. Outlining the campaign of the King’s Daughters, she spoke at length about the numerous committees that had been at work canvassing physicians, clergymen, and business leaders about the project and gathering information concerning “the cost of building and maintaining” a hospital. Valuable aid had been promised, commitments had been made, sermons would be delivered along with special collections, and lectures as well as concerts were planned in support of the hospital fund. The advice of “the practical business men of the town,” however, had been heeded and “the almost universal opinion is that although such an institution is much needed in our midst yet we are in no position to make any great outlay at the start and the plan which commends itself most to our judgment is the renting of some suitable dwelling which can be furnished in a comfortable but simple manner.” In terms of staff, she recommended hiring “a thoroughly competent graduate nurse with hospital experience” to act as matron and to train other nurses. Moreover, looking to the future staffing needs, Mrs Purdy continued, it was “conceded by all in the hospital world that by far the cheapest and best method of caring for the patients is by means of a training school for nurses.” Annie Purdy was quite open about the cheap labour, and resultant lower costs, student nurses would provide, and she also willingly addressed the important issue of whom the hospital would actually serve. Among hospital advocates there had been much emphasis on the needs of the poor, who did not have access to the personal physicians, home care, and, when really necessary, distant private care institutions that were enjoyed by the better-off in society. Purdy’s hospital was intended to serve the destitute patient as well as the paying patient. As she put it, “Though we know many of our patients will be charity ones yet there are those in our city who are away from home, and who, in case of sickness, will gladly avail themselves of the opportunity which the private wards will afford of giving them board and excellent nursing for very little more than they would pay for board alone.” Private wards for those who could pay were thus acknowledged as necessary, along with the privilege, for “paying patients” only, “of choosing their own physician.” The class rules and realities, the differing levels of service,

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and the dependence on attracting a paying clientele, which certainly would not be restricted to those stricken while temporarily visiting the community, were delineated at this early moment in the planning stages of the proposed institution. These were the realities faced by other general hospitals, and the Moncton institution’s backers, well aware of such models, had recognized that a strictly charity-oriented venture would not succeed. Continuing with this practical approach, Purdy then widened her discussion to consider possible sources of funds and methods of fundraising. Along with the revenues raised from paying patients, the provincial government would be approached for a grant (York county and Saint John already received such grants), memorial gifts from individuals and societies would be sought for the endowment of beds or furnishings, and “hospital Sundays” with church collections earmarked for the institution were yet another possible continuing source of revenue. “The rest of the funds,” she asserted optimistically, “can be raised by entertainments and by the subscriptions of generously disposed citizens.” Mrs Purdy shrewdly did not once mention a municipal contribution or permanent grant, the items probably very much on the minds of Mayor Sumner and his aldermen. In concluding her presentation Mrs Purdy returned to the point made earlier by the King’s Daughters that the required next step was incorporation. “In order that the government grant may be obtained and the hospital name [gain?] a legal standing, it will be necessary to secure incorporation. A number of citizens have signified their readiness,” she reported, “to act in the capacity of corporators.” There was an urgency about this since incorporation by the provincial legislature required thirty days notice before passage of the bill, so “it was necessary” to move on this “at once.” Annie Purdy’s performance was convincing. The substantial effort already invested in the project was driven home by her remarks, while the detailed proposal demonstrated careful thought and preparation. The initial modest scale of the hospital was clarified, the future direction it might take with the nurses’ training school was suggested, and she articulated a diplomatic deference to the advice of representatives of the business community. The response from the audience was almost completely positive. A letter from Dr Ross “strongly in favor of the project” was read out, while Dr McCully expressed himself as “heartily in sympathy with the movement.” Furthermore, he emphatically stated, “The lack of hospital accommodation of any kind was a disgrace to the city.” Religious representatives such as Rev. Weeks and Fr Meahan emphasized the “great need” and “absolute necessity” of a hospital for “sick and injured persons,” particularly the “sick poor.” Rev. W.W. Brewer added that the suffering of the latter group made

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“his heart ache and he was very glad the King’s Daughters had taken the initiative in this matter.” Only Peter McSweeney, a prominent merchant and politician, dared to ask “the possible cost of the institution.” When Ella Hannington, the wife of lawyer Henry C. Hannington, responded that $2,200 a year would provide a six-bed institution, “including matron, nurses, servants, rent and provisions,” McSweeney agreed that “the amount needed” could be “raised by the city.” Amasa E. Killam, one of Westmorland’s representatives in the New Brunswick legislature, made a commitment that “he would do all that he possibly could to induce the local [i.e. provincial] government to grant a subsidy.” Only the mayor put a brake on the proceedings, with reminders that “ways and means” were under discussion and that this gathering was “simply to discuss plans and lay the results before a general meeting of citizens.” This could not stem the flood of motions passed: “[t]he hospital scheme was unanimously approved,” the mayor was authorized and requested to call a public meeting in the Opera House “for the further consideration of the matter in all its bearings,” and finally it was agreed, again unanimously, that “the society which has taken the primary steps in the movement be a committee, with power to add, to formulate plans for the public meeting.”33 The public movement had been well launched and the Moncton Daily Times seemed determined to push the cause forward. In an editorial it pointed out that a hospital had been much discussed “for several years” but it had “remained at last for the Ladies to take the initiative,” and they should “feel gratified with the result.” But, the editorial concluded, the hospital enterprise should now pass “largely out of the hands” of its initiators: “it now rests with the citizens at large to take up the work.”34 The citizens, or at least prominent citizens who chose to speak, were given their opportunity at a mass meeting held in the Opera House on Friday evening, 25 January 1895. With “nearly 300 of the leading residents” in attendance, including the inevitable “large number of ladies,” the first reservations about the funding of the project were openly voiced. George B. Willett was now functioning as secretary of the hospital committee and he brought before the gathering two different plans. One was an “endowment or voluntary subscription plan” under which approximate expenses of $3,200 would be raised by church collections, voluntary subscriptions, events such as bazaars and concerts, and revenue from paying patients. It was plan two, however, the “municipal plan,” that would generate both the most support and the most opposition. In this scenario the approximate “cost of maintenance” was estimated at $2,200, which “was to be raised by assessment on the taxpayers.” Discussion opened after it was moved “that this meeting express its deep sense of the need

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of a hospital for Moncton and pledges its support to any approved plan to consummate that end.” Mayor Sumner was first to speak and essentially made two basic points. Obviously apprehensive about the city’s major role under the proposed municipal plan, he questioned whether it was advisable “to open up another civic department to be managed by the board of aldermen” and preferred that the municipality give a specified amount “and have the hospital run independent of the city.” Then he turned to the aldermen present and asked for their views. Aldermen Alfred C. Chapman and James Flannagan both indicated their support for the hospital project but agreed with Sumner that city council was burdened already with enough responsibilities. Likewise Alderman James Doyle expressed “hearty sympathy with the movement” but along with the mayor he suggested the city provide “a local grant if a suitable building” could be secured. Murray Fleming, the Intercolonial Railway manager, counterattacked with a query as to whether the meeting had been called to ask “the city council for an opinion or the electors.” Clergymen intervened to quiet the now turbulent waters and the meeting proceeded to approve unanimously the need of a hospital and then turned to what plan should be followed. The motion “that plan No. 2, that it be a municipal institution, be adopted” focused the discussion considerably, but also sharpened the lines of division. After several speakers in support of the motion had expressed some ambivalence about the precise amount of municipal support it might be reasonable to expect, Sumner re-entered the fray with the pronouncement that he “did not think the tax payers would vote the money required to run the hospital.” In addition, he was confused about the extent of municipal control and who would make the decision as to which patients would pay and which patients would not. In response, George Willett emphasized that “it was not proposed to build this hospital on the charity plan.” There would be revenue once it was started and the actual running of it would lead to no great additional burden on city council. If it was decided a hospital was needed, he argued, then “they should each and every one of them bear their proportion of running it.”35 Frederick Sumner’s opposition at this point was intriguing in view of the major role in the hospital both he and members of his family would eventually play. When the Ladies’ Aid formalized its existence in June 1898, Sumner’s wife, Margaret, was a vice-president and active fundraiser, while Sumner himself proved one of the most generous donors to the hospital. In 1903 he joined the board of trustees and he served as hospital president from 1908 to 1915.36 This later support makes clear that he did not oppose the need for a hospital but, in 1895, he sincerely and quite validly believed that the municipal role was unclear and po-

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litically dangerous. As well, given the cumbersome system whereby city council expenditures were scrutinized, and usually criticized, by taxpayers in an annual meeting, a system that would change only in the early 1900s, he had reason to be leery of any expenditures that might constantly escalate and be difficult to justify. Finally, the fact that city incorporation was a fairly recent achievement, and city finances were still quite restricted, led Sumner and probably other Moncton citizens to the viewpoint that council’s role and the city services provided should be as limited as possible. Nevertheless, while Sumner’s views should be placed in the most tolerant of contexts, the debate and his position revealed the inevitable confrontation between fiscal conservatism and social responsibility, where an overly cautious city council’s evasion of responsibility would likely triumph. For the moment, however, only a temporary stumbling block was thrown in the path of hospital boosters. After hearing from a good number of further speakers, an amended motion was passed, approving the “municipalization of the scheme” without defining the extent of the municipal role, and calling for yet another committee “to work up the scheme and report at a future meeting.”37 It was a somewhat inconclusive outcome and the friends of the hospital who had expected immediate action must have been disappointed. The emerging pattern of one step backward balanced by one step forward also marked the next round of proceedings. At the municipal level, a special meeting of the electorate to consider the hospital project was called for the evening of 6 February 1895. Because of “the small number of electors present” a motion was quickly introduced and passed, by fifteen votes to seven, to adjourn the meeting for six months. There was a suggestion that “the matter will be brought up again at the annual meeting,”38 but when the annual meeting of electors was held on 12 February there was no mention of the hospital.39 The project dropped from sight, at least municipally. At the provincial level, however, the New Brunswick legislature passed “An Act To Incorporate the Moncton Hospital” on 5 March 1895.40 This legislation resolved a good number of the issues debated at the public meetings. But above all, with this action, as the King’s Daughters had hoped and suggested, the Moncton Hospital was born as a legal entity with a board of trustees to provide the leadership required. The act of incorporation named twelve men as trustees and made provision for two further trustees, one to be appointed by the Moncton city council and another to be appointed by “the medical staff of the said hospital” from among the ranks of Moncton’s physicians. The trustees named in the legislation included the three members of the committee appointed at the conclusion of the 25 January public meeting:

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Alfred E. Chapman, Henry A. Whitney, and Henry C. Hannington. Several of the other trustees appointed had been particularly active in the meetings: Murray Fleming, Peter McSweeney, and Charles W. Bradley. The remainder were Israel L. Miller, Andrew H. Jones, John L. Harris, Hugh Hamilton, Frederick W. Givan, and Frederick P. Reid, several of whom would give long years of voluntary service to the hospital in the years ahead. The legislation made clear that the trustees had full “management and control” and that the corporation was an independent body. It would be the corporation that would decide upon appropriate bylaws, rules, and regulations, and bear responsibility for property, debts, liabilities, and other matters. The hospital was not a municipal responsibility like the almshouse, but provision was made for possible municipal support. “It shall be lawful for the electors of the City of Moncton, at their annual meeting, from time to time, to vote such an amount in aid of the said hospital as may be thought advisable, and the City Council shall grant to the said hospital from time to time such aid as may be voted by the electors at such annual meetings.” In this way both the hopes of George Willett and the apprehensions of Frederick Sumner had been accommodated. The King’s Daughters, and Annie Purdy specifically, likewise would be pleased to see that “[t]he object of the corporation shall be” not only “the equipment, maintenance, managing and operating a hospital in the City of Moncton” but also “a training school for nurses in connection therewith.” With incorporation the way seemed clear for the creation of the hospital. Instead, the new leadership developed legal reservations. At a late March meeting of the Moncton Hospital corporation, held in the law offices of Henry Hannington, “the corporators” decided that “in view of the Act of Incorporation, as passed limiting the membership of the corporation to fourteen persons, and also constituting such persons the permanent trustees, that it would be impossible to successfully promote and operate the hospital under the act as it now stands.” Whether all the appointed trustees supported this position is unclear, and whether the objection was to a possible permanent trustee’s responsibility, when resignation was open to them, is uncertain. Whether they felt a more substantial municipal role was required for the success of the venture is equally unknown. With this enigmatic explanation, the designated trustees in attendance at the meeting “on motion resolved not to proceed at present.” Yet at the same time they indicated their continuing support for the hospital and pointed to the group who should provide community leadership. “In order that the hospital project may be kept before the people and the interest in it maintained,” reported the Daily Times, “a motion was passed requesting [that] the ladies of Moncton” should continue their fund-raising endeavours “for Hospital purposes

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and [should] organize a Ladies Hospital Aid Association or take such steps as they might consider best in the hospital’s interest.”41 It was in the ladies’ hands once again. Fortunately the momentum of the movement had captured public attention and not only the ladies but other hospital supporters were loath to abandon what they considered to be a pressing need in their community. Unfortunately the next several years of agitation again brought what appeared to be imminent victory quickly followed by divisive discussions and eventual disappointment. An excellent vehicle for the possible creation of a hospital, especially from the perspective of the King’s Daughters, was Queen Victoria’s expressed wish that the celebration of her approaching Diamond Jubilee in 1897 might emphasize improving “the lives of the sick and poor.”42 What better memorial to Victoria, and what better way to serve the sick indigent, could there be than the opening of a hospital? Again the advocates mobilized. Plans were formulated for the construction of a $7,000 hospital, funded, it was optimistically assumed, by the city, which would also pay a portion of the annual operating cost. Money would be raised in the community as well and a building site was offered. As usual, a public debate ensued, with the predictable concerns once again raised about the real operating costs of such a project and whether Moncton taxpayers could afford such a burden. Alternative proposals about better ways of honouring the Queen – a city square, a library, or a school, perhaps – further complicated matters. The outcome was the inevitable meeting of Moncton’s all-powerful and ever cautious ratepayers who, in May 1897, honoured Queen Victoria’s Diamond Jubilee by rejecting every proposal. There would be no commemoration. Perhaps only divine intervention could convince Monctonians of their hospital needs. Constant newspaper headlines reporting diphtheria and smallpox epidemics helped in this regard. Such forceful reminders of the vulnerable state of public health were reinforced by sermons concerning the health needs of the city and by the two-week suspension of all public gatherings, including the brief closure of schools and churches during the diptheria outbreak. Meanwhile the hospital advocates were refining their proposal and retreating to a more modest suggestion, first made almost a decade earlier. The Moncton almshouse, actually situated just outside Moncton at Léger Corner (present day Dieppe), had been underused since its opening, partly because of the humiliation associated with confinement there and partly because of the strength of the local economy. Here was space that could be shared and possibly converted to meet the needs of the sick. The issue could be raised on 14 February 1898, when the annual meeting of Moncton electors, ratepayers, and non-ratepayers was scheduled.

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This “Annual Fiasco,” as one newspaper called it, was an opportunity for the citizenry to review the proposed expenditures of city council and also, on rare occasions, actually to suggest additional expenditures. This particular session would prove to be as delightful and spirited a circus as past gatherings. It began with a proposal, strongly supported by city council members, which, in effect, would do away with the need for such town meetings in the future. This was vehemently opposed by various speakers and rejected, along with a number of other council proposals. Salaries for the mayor and aldermen were of course thrown out. Item after item was hotly contested, with accusations of drunkenness exchanged, and order was only for brief periods restored to the deliberations. Gradually the estimates were approved one by one: city government, police department, firefighting arrangements, schools, water and light, street paving, and on and on. It was at the end of this entertaining but tedious evening that the ever committed George Willett “brought up the question of the city making some provision for taking care of the sick poor.” He proposed that $300 be appropriated “to fix up rooms in the almshouse” for this purpose. Rather than a separate new expenditure item, it was decided that this proposal could only be made under the almshouse appropriation. Supporters of the motion quickly moved reconsideration of the almshouse grant and then upped the ante. The crowd might have thinned but still present were Dr Ambrose Myers, who suggested at least $500 was needed for renovations, and Israel Miller who moved it up to $600, “for the benefit of the sick poor.” The press reported: “This was carried almost unanimously. The meeting then adjourned sine die.”43 The $600 renovation commitment meant the legal existence of the Moncton Hospital was finally matched by funds and space for its physical existence. Quite literally, however, it entered and would be entered by the sidedoor of the almshouse. A flurry of activity now followed as the hospital backers were determined to have their institution operative by April 1898, a date later revised to June. The evening after their appropriations triumph, George Willett and Dr Myers appeared before city council, seeking its support for a petition requesting a grant from the provincial legislature. As justification for funding, the petition argued that the hospital would serve Moncton and the entire province, and that the city of Moncton as its contribution “has given the use of a city building suitably located for such purposes and granted financial aid to the extent of $600.” It further explained that the plan was to have twenty beds ready for use by the first of April “under the superintendence of a graduated trained nurse.” What was requested from the province was an unspecified “liberal grant” to “the said institution,” which

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“shall be known as the Moncton General Hospital.” The petition received “the hearty endorsation of the City Council.”44 The long-sought support of the city council was more than matched by that of the community volunteers, many of them long-time participants in the hospital movement, who now sprang into action. At a meeting of “representative citizens” it was decided that a ten-person committee, including two doctors, should oversee hospital preparations. This group would evolve gradually into the new board of trustees with authorization to function under the act of incorporation. By late February, the committee had chosen George Willett as its chair, Hugh Hamilton as secretary, and Andrew H. Jones as treasurer. Both Hamilton and Jones were among the original trustees appointed at incorporation. The medical society selected doctors James Ross and Oscar McCully as representatives. The mayor, Clifford W. Robinson, was also on the committee. Various subcommittees were formed from the larger committee to deal with bylaws, securing nurses, and finance.45 Doctors McCully and Ross gave exceptional service at this time, with McCully on the bylaws and finance committees and Ross on the securing nurses and finance committees. Approval of the bylaws occurred in late April, confirming and legitimizing the evolving structure of the board along with establishing the hospital rules. The board of trustees was to have a president, vicepresident, secretary, treasurer, and two auditors, all selected by the board itself. Among other responsibilities, the board would select the “legally qualified physicians and surgeons” each year who were required on the hospital roster and would also appoint other medical staff such as the matron and nurses. The act of incorporation had given both the hospital’s medical doctors and city council the right to appoint each year a trustee for a one-year term. The bylaws arranged that, among the other trustees, three would have terms that expired each year, and their replacements or re-appointments would be voted on by the other trustees and by any persons who donated at least $5 to the hospital in the previous year. The bylaws went on at some length, spelling out how medical staff were to be selected, as well as their responsibilities, the matron’s duties, the distinction between paying and nonpaying patients, and elaborate rules for patients and even visitors.46 Donations of all sorts of items and cash continued to arrive and be acknowledged by what was now described as the “Hospital Board,” and fund-raising benefits were staged. In mid-May the unanimous appointment of Miss Margaret C. Grant as hospital matron was announced. She was to “assume her duties as soon as the furniture – such as beds – for the wards arrived.” Finishing touches to the renovation work and the furnishing of the rooms were reported in early June, and

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on 9 June 1898 came the announcement that “[t]he Moncton Hospital is now ready for the reception of patients.” A grand opening was planned for Saturday, 11 June, and, on the evening before that event, word arrived that a $300 grant had been received from the provincial government. To encourage the citizenry to attend the opening, “[c]onveyances will be provided for those who are unable to procure them. The livery stable men have kindly placed teams at the disposal of the hospital board in order that this idea may be carried out.”47 The opening on Saturday and another openhouse on Sunday attracted 437 registered visitors, of whom 250 were women (57.2 per cent) and 187 were men (42.8 per cent).48 The somewhat inconvenient Léger Corner location had not discouraged Monctonians from attending, and on the triumphant opening day even the location was interpreted as quite appropriate, since it aided the healing process facilitated by the hospital. “The large number of ladies and gentlemen visiting the building were delighted with the institution,” it was reported, since “a pleasing feature in connection with it” was “the situation which is one of the best that can be found anywheres. The building being located on a hill, the rooms are pervaded by the purest air and besides there is the cool refreshing breeze from the river, in close proximity.” Most of the renovation work had been done on the second and third floors, with the first still to be used as an almshouse. The visitors that day found the main hospital entrance “on the ground floor at the west end of the building.” Three private wards and the matron’s room were on the second floor. Patients’ rooms were furnished “with the latest style of cots in use in the Victoria Hospital, Montreal, and leading American hospitals.” Also on this level were a reception room, bathroom, and the operating room; the latter was equipped with a “steel operating table” and a “very nice … physician’s upright medicine chest.” This important area was “lighted by three windows which makes it specially adapted” for operations. Proceeding to the third floor, the female ward, “capable of accommodating 8 beds” with four windows to provide “a beautiful view of the Petitcodiac river and Albert county,” was on one side while another large ward for male patients, “with capacity for six beds” and a four-windowed “excellent view of the city of Moncton, Lewisville and Sunny Brae,” was across the hall.49 It was a day of celebration and congratulation. For the people of Moncton, according to the press, “[i]t is perhaps safe to say that when the appropriation for hospital purposes was made a few months ago, very few of the hundreds of citizens who visited the institution Saturday and Sunday ever dreamed that the city would so soon be the owner of premises affording such comforts and accommodations for the sick.” In opening the hospital the mayor of Moncton, Edward C. Cole,

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“Into the Hands of the Ladies”

“referred to the agitation for a hospital from time to time, and warmly congratulated the promoters of the institution, the Board of Trustees and Officers and all who in any way had anything to do with the movement, upon the magnificent success which had crowned their labours.” After all, he continued, a hospital was “one of the institutions required in every well regulated city,” and this successful opening was yet another sign of “the progressiveness of the people of Moncton.” He hoped that the large number of visitors was an indication of encouragement, interest, and a public “determination to co-operate with the Board of Trustees in lending assistance, financial and otherwise.”50 The mayor’s expansive rhetoric about his “well regulated city” and its “progressiveness” glossed over the reluctant and tardy endorsement of the project by the community and council. Moncton’s willingness to allow hospital co-habitation with the almshouse, and $600 for renovations, paled when compared with Owen Sound town council grants to its hospital of $600, plus another $1,000 from a charitable bequest it controlled, along with the necessary parcel of land on which the building was to be erected. In addition, Owen Sound’s neighbours on Grey county council contributed $1,000.51 Fredericton figures are far less precise, although a grant of land for one dollar per year and an annual grant of $600 from unspecified levels of government were arranged, while a York county council hospital grant also emerged.52 Moncton’s later characterization as an “exception” among Canadian cities for its lukewarm support for urban reforms such as municipal ownership in 191053 was already being borne out in its limited and grudging 1898 support of the Moncton Hospital. Singled out for special honours this day was Dr James D. Ross, who “was heartily congratulated by a large number of the visitors to the opening who have known of his zeal for the cause.” The Daily Times representative felt a special interview was necessary since it was Dr Ross “who may be regarded as the father of the Hospital movement in Moncton.” It was Dr Ross “who has been agitating for a hospital here, more for the sake of the sick poor than anything else, for the last twenty years, and it was to be expected that he should feel highly elated over the definite shape his efforts to arouse popular feeling in favour of such an institution had at last taken.” In response, the good doctor expressed himself as “greatly pleased” and “justly proud” of “the beginning that has been made.” He was gratified at the “deep interest” of the people and was confident that in the future there “will be no difficulty in running the institution quite successfully,” and that “the trustees will experience no trouble in a financial way.” People had given liberally once they had been “made to see the necessity of providing comfortable quarters for the unwell and those who may not be able to

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afford very many of the luxuries of life.” And “they will maintain such an institution,” he predicted.54 It was an occasion to offer optimistic predictions and to forget past problems. Over a decade later Dr Ross was more realistic in recalling some of the struggles faced by the hospital movement. A considerable campaign had been required in “the early days,” he reflected, since its supporters had first “to educate the public as to the need” of a hospital, and “after that arose the question as to how they were going to get it.”55 His remarks captured the at times frustrating moments experienced by those involved with the hospital movement, and underlined the importance of public education and planning in the process, areas in which some hospital backers had been especially skillful and active. The executive members of the board also earned plaudits for their significant contributions, with the president, George Willett, praised for being “indefatigable in promoting the work in connection with the hospital.”56 Amidst all the congratulations there was only a brief mention that the trustees and the matron were “assisted by some of the ladies.” Where were the fulsome tributes to the ladies on this day? The hospital had many fathers: James Ross, George Willett, Ambrose Myers, and Oscar McCully, among others. But it would not have detracted from their contributions to mention that at many critical moments in the hospital campaign it had been the women of Moncton who had nurtured the movement. At the hospital’s birth, they were forgotten. Annie Purdy symbolized the unrecognized contribution of the anonymous and overlooked mothers of the Moncton Hospital who shared and shaped its early history.

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2 From the Almshouse to Respectability

In September 1909 George Willett, as mayor of Moncton, presided over the first graduation ceremonies of the Moncton Hospital’s nursing school. Quite validly he could speak of “the small beginning made, the steady advancement and growth of the hospital and the excellent results achieved.”1 In its first decade the Moncton Hospital moved successfully out of the shadow of the almshouse and attracted the broader clientele that was crucial to its acceptance and growth. Its “eminent success” and respectability were marked by removal to a new site, increases in municipal government support, the opening of a training school for nurses, an accomplished if at times divided medical staff, and a huge increase in patients from a community much broader than Moncton itself. But trustees and staff, along with a now openly acknowledged and praised Ladies’ Aid, strained at times to generate the support needed to meet the constant challenges and problems. Middle-class representatives of both genders spearheaded the hospital movement. At times they campaigned in the face of indifference or outright opposition on the part of other members of the community and of the majority of the ratepayers – or at least the majority of the latter who turned out for meetings of the city’s electorate. Part of the problem in the early years, which was addressed by several hospital advocates but especially by supportive clergy, was the unfair image of the hospital as serving only charity cases or the poverty-stricken within society. No doubt this perception, which was faced in other communities as well, of a hospital as “fundamentally a charity for the custodial care of the sick poor,”2 was reinforced by the hospital’s

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initial location in the almshouse. Would treatment there bear the taint of lower-class status and thus frighten off paying customers? A change of site, accomplished in 1903, was one way of overcoming this problem, but the willingness of the city’s socio-economic leaders to serve on the hospital’s board of trustees was also of considerable importance. The presence of the prominent verified the institution’s serviceability to them as well as to others at lower levels of society, and also opened doors to further financial support at both the private and public levels. The elected membership of the board in the period from 1898 to 1909 reveals a strong commitment from the better-off and well-placed, and their presence helped create the aura of respectability so vitally required. Board members were willing to accept re-election again and again, and often their names were a list of prominent and successful male Monctonians. Women would not receive a position on the board until during World War I. Long-time hospital advocates, such as George Willett (real estate agent), Hugh F. Hamilton (railway clerk), and Andrew H. Jones (real estate/insurance/investor), were soon joined by those who had previously been lukewarm or hesitant, such as the cautious former mayor Frederick Sumner (merchant/industrialist), and John H. Harris (merchant/industrialist), whose well-established family had been active in the city square proposal offered as a Diamond Jubilee alternative project. Jones, Sumner, and Harris brought support from the second generation of Moncton’s wealthiest families. Continuity of membership along with recruitment and involvement by prominent political and business leaders characterized the board leadership. At the hospital’s opening in 1898 the board of trustees included Willett as president, Dr McCully as vice-president, Hamilton as secretary, and Jones as treasurer. The other trustees were Israel L. Miller (sewing machine agent), Peter McSweeney (merchant), Dr James D. Ross (physician), Clifford W. Robinson (lawyer), Dr Ambrose R. Myers (physician), James M. Ross (clothing merchant), Joseph H. Wran (Intercolonial coppersmith), James S. Marnie (merchant), Edouard Girouard (lawyer), and Benjamin H. Toombs (flour and feed merchant). Over the next decade many of these individuals served repeated terms. Continuity was particularly apparent at the executive level. Willett served as president until June 1901, when he was replaced by James M. Ross, but he returned as president in June 1903. John S. Rayworth (customs officer) took the office in 1905 for three years, to be followed by Frederick Sumner in 1908, who would continue as president until 1915. Sumner first joined the board in 1903 and, completely converted to the cause, gave long years of active and influential service. Hamilton would serve as secretary for over fifteen years, while Jones was treasurer until 1908, when, after he made several requests to be re-

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placed, John H. Harris took over the finances.3 Each year as three trustees’ positions came vacant, tried and true supporters were reelected or prominent figures were added. Structurally, legal changes to the composition of the board occurred in 1901, 1902, and 1903. Legislative amendments incorporated the bylaw provision for rotation of three trustees whose terms ended each year; as well, two representatives for Westmorland county and single representatives for other surrounding counties were added to the board. As of 1902, Kent and Albert counties were each to have a board representative as soon as they contributed “the sum of five hundred dollars [each] to the said Trustees towards the Building Fund for a new Hospital.”4 Analysing the hospital board’s membership in the early years, employing Stephan Thernstrom’s occupational categorization of Boston’s male labour force, confirms domination, not surprisingly, by the upper levels of Moncton society. Thernstrom5 uses five categories: (1) high white-collar occupations, (2) low white-collar, (3) skilled blue-collar occupations, (4) semi-skilled and service workers, (5) unskilled labourers and menial service workers. Moncton’s seventeen elected hospital board trustees contained thirteen (76.5 per cent) from category 1, three (17.6 per cent) from category 2, and one (5.9 per cent) from category 3. White-collar, and particularly high white-collar, dominance is clear. What was missing from the board was any female representation, despite a formal request by the Ladies’ Aid in 1908.6 In spite of this rebuff, the Ladies’ Aid Association, officially and enthusiastically formed on 13 June 1898, the day after the hospital’s inaugural open house, played an extremely active role. At the organization’s initial meeting,7 the composition of its executive and membership revealed strong ties to the board membership and to the same middle-class respectability. Mrs (H.C.) Ella Hannington, wife of the lawyer who was one of the reluctant “corporators” of 1895, took on the presidency, while Mrs (F.W.) Margaret Sumner, wife of the once reluctant mayor, was a vice-president along with Miss Ellen Hennigar. Secretarytreasurer was Miss Agnes McSweeney, schoolteacher and sister of board member Peter McSweeney. Other members who turned out at the founding meeting were the wives of hospital board members: Mrs (G.B.) Laura Willett, Mrs (J.S.) Hattie Marnie, Mrs (C.W.) Annie Robinson, and Mrs (J.M.) Sophia Ross. In addition, board member Hugh F. Hamilton’s sister, Miss Annie Hamilton, was active from the start along with treasurer Andrew H. Jones’s sister, Miss Bessie Jones. Mrs Mary Addy, a widow, was among the other founding members along with Mrs (R.A.) Mary Chapman, Mrs (C.A.) Bessie Murray, Mrs (J.J.) Lucy Walker, Mrs (G.) Beatrice McSweeney, Mrs (A.J.) Mary Gorham, Mrs (J.E.) Annie Masters, and Mrs (D.) Agnes Charters,

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wives of, respectively, a fishing inspector, a dentist, a chief clerk for the Intercolonial, a hotel owner, a merchant, a sea captain and industrial investor, and a railway clerk. Middle-class connections were clear from the outset, and within a few years the important alliance with the churches of Moncton was also confirmed. In 1904 vice-presidents of the Ladies’ Aid were elected to represent most of the various denominations. Among those first named to these posts were Presbyterians Mrs (E.) Margit Girvan and Mrs J.J. Wilbur, and Baptists Mrs (J.M.) Sophia Ross, Mrs Hannah Good, and Mrs (B.) Mary Lewis, a widow. Representing the Central Methodist church was Mrs Lydia Dernier, Wesley Memorial had Mrs (J.S.) Augusta Rayworth, while Episcopalians were represented by Mrs (G.B.) Laura Willett. Excluding widow Mary Lewis, occupational census data reveals the vice-presidential spouses as, respectively, a laundry operator, an occupation unknown, a merchant, an upholsterer, a sea captain, a customs officer and a real estate agent.8 Viewed through the analytic categories of Thernstrom, the women hospital supporters closely matched the board membership. Excluding the six unknown, unmarried, or widowed women, the occupations of the remaining twenty women, or, more precisely, their spouses’ occupations for the overwhelming majority, contained fourteen from the category 1 high white-collar grouping (70 per cent), five from the category 2 low white-collar grouping (25 per cent), and one from the category 3 skilled blue-collar grouping (5 per cent). While the ladies were active hospital supporters but unrepresented on the board, the doctors of Moncton were both active in the cause and well represented on the board. In the hospital’s first decade, local physicians were a substantial presence among the trustees, with eight serving terms as independently elected board members, either as appointed representatives of the medical society or as municipal representatives of the city of Moncton.9 This service, while commendable and clearly in the best interests of the physicians and the hospital, was somewhat of a conflict of interest in that it was the board that voted each year on members of the hospital medical staff. The bylaws provided for board appointment of “a Visiting Staff consisting of six members, and a Consulting Staff of two at the beginning of each Hospital year.” All “licensed Practitioners” of the city were eligible for these staff appointments, and any other qualified physicians in Moncton could minister to their own paying patients in the private wards and use the operating room. The appointed staff cared for public patients free of charge, performing their duties “as a charity to the sick and disabled patients,” although they of course could charge their own “private patients” who were paying private hospital fees. It was intended that eventually two of these appointed visiting staff would “attend the

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public patients” for successive two-month terms,10 but, when the hospital’s first-year roster is examined, thirteen-doctors were each doing one month’s service over a thirteen-month period.11 Osteopathic physician R.M. Buckmaster was excluded from this list but every other active doctor in Moncton was included.12 Analysis of the roster list provides some insight concerning the medical education and training of Moncton’s physicians at the turn of the last century. To be sure, assessing the quality of medical training in the pre-1900 period, when all would have graduated, is no easy chore. Medical education in the United States and Canada underwent a revolutionary change from 1870 that culminated in the scathing and thorough examination offered by Abraham Flexner in his famous 1910 report. While Flexner admitted that “[i]n Canada conditions have never become so badly demoralized as in the United States,”13 the reality was that a majority of Moncton’s doctors in 1900 had received their medical degrees in the United States. Compared to 1910 figures available on the 549 registered Nova Scotian doctors, Moncton relied a little more substantially on American-trained practitioners. In Nova Scotia in that year, 54.6 per cent of its doctors trained in Canada, 37.9 per cent in the U.S., and 7.5 per cent in Great Britain.14 In 1898– 99, of Moncton’s thirteen hospital physicians eight were American trained (61.5 per cent), four Canadian trained (30.8 per cent), and one (7.7 per cent) Great Britain trained.15 This strong American connection might be of some concern since Flexner’s use of “demoralized” referred to the many degree mills and proprietary medical schools south of the border that had spewed forth “an enormous over-production of uneducated and ill trained medical practitioners.”16 If Flexner had had his way many of these medical schools would have been closed and those surviving linked to universities and hospitals providing a proper scientific, laboratory-oriented training along with the necessary clinical opportunities. The best of the American and Canadian medical schools were already well into this transformation by the 1880s and 1890s,17 long before Flexner produced his study, but even among the best schools, the curriculum development, lengthening of programs, improved admission and evaluation standards, full-time faculty with a research orientation, and proper university and hospital linkages were not always achieved easily or immediately. What is sometimes not appreciated is the reality of what was considered an acceptable medical education in post-civil war America. At that time, admission requirements were low, instruction was brief, terms were short, and lectures were used instead of participation in laboratories, clinics, and hospital wards. As Ludmerer describes, “except for

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the enterprising and affluent few who would bribe patients into submitting to an examination, students would often graduate without ever having touched a patient.”18 Consequently, a medical education often consisted of two four-month terms of lectures, with the “second term identical to the first,” with no gradation of courses so they could be taken in a proper order, and no written exams. After only a brief set of oral questions, the M.D. degree was awarded. Even the minimum age requirement of twenty-one could be waived on occasion. Reform of curriculum, standards, and the professorate was launched at Harvard in 1871 but a suggestion from the president, Charles Eliot, that as a starting measure written examinations should be required for graduation brought a revealing response. The professor of surgery “vigorously objected, stating that over half of Harvard’s medical students could barely write.”19 Nonetheless, reforms came throughout the 1870 to 1900 period with institutions such as Harvard and, later, Johns Hopkins leading the way. Although too many totally inadequate schools still existed, by the time of Flexner’s 1910 report a great deal had been accomplished. In Canada, when Flexner looked at the eight medical schools then operating, he found: “Western University [London] is as bad as anything to be found on this side of the line [in the United States]; Laval and Halifax Medical College are feeble; Winnipeg [University of Manitoba] and Kingston [Queen’s University] represent a distinct effort toward higher ideals; McGill and Toronto are excellent.”20 Flexner’s observations could be harsh, and upset medical school administrators in both Canada and the U.S. responded with vigorous defences of their schools if they had been singled out for major deficiencies. In Nova Scotia, Dr D. A. Campbell felt that his own school, the Halifax Medical College, which Flexner had blasted for having “an ordinary, illsmelling dissecting room and a single utterly wretched laboratory for pathology, bacteriology, and histology,”21 among other weaknesses, was among the inadequate schools “marked for slaughter.”22 While some of the criticisms were unfair, and major changes had occurred that soon would be followed by complete integration with Dalhousie University and the development of a far stronger school, this school had been a key supplier of Nova Scotian doctors. Strangely enough, when the thirteen Moncton physicians are examined, not a single one was Halifax trained. Indeed, all the Canadian- and American-trained physicians serving the hospital in its early years were graduates of schools that met most of Flexner’s high standards. Admittedly, Moncton’s two Harvard medical school graduates, James D. Ross in 1862 and William Cruise in 1867, both long-practising veterans of the profession in the city, were prereform graduates. But at least their alma mater, after initial resistance, proved most receptive to and successful at change and would be among

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Flexner’s best schools by 1910. Two other of Moncton’s Americantrained physicians came from institutions that followed the Harvard pattern of a strong school eventually emerging with a reputation for welltrained graduates: Dr Robert L. Botsford graduated from Philadelphia’s Jefferson Medical College in 1869 while A. Henry Chandler was an 1857 graduate of the University of Pennsylvania. Both schools earned respect for their strength and “high quality,”23 and, although Flexner had some reservations, he hoped a merger of these Philadelphia institutions would further improve Pennsylvania medical education. This did become a matter of discussion but talks broke down in 1916 because of the inevitable difficulties in merging “strong medical schools.” Jefferson Medical College would eventually become a university in its own right.24 The remaining four American-trained Moncton physicians received their medical education at New York institutions. Henry H. Coleman graduated in 1877 from New York University, Clinton T. Purdy earned his degree at the University of New York in 1884, Edward O. Steeves graduated from the University of the City of New York in 1885, while Leveritt H. Price received his degree from Bellevue Hospital Medical College in 1892.25 All these institutions were forerunners of, linked with, and eventually a part of the medical department of New York University. Because of a willingness to reform and upgrade, along with strong hospital linkages, New York University was considered one of the best American medical schools.26 While Flexner would have some caveats, he believed New York’s “vast hospital and university resources should make it the Berlin or Vienna of the continent,” although more financial support was required as well as more of an emphasis on graduate education and clinical affiliations.27 Turning to Moncton’s four Canadian-trained physicians, all were graduates of institutions that passed muster with Flexner. Oscar J. McCully graduated from McGill University in 1879 and Fred J. White earned his medical degree at the same institution in 1886, a school that Flexner later rated as excellent.28 Louis N. Bourque, the first Acadian doctor in Moncton, graduated from the University of Victoria College in 1876. This Montreal-based, French-language medical school was a branch of the Methodist institution that would shortly thereafter become a part of the University of Toronto. By Flexner’s time, Toronto also rated a stamp of excellence.29 Finally, among the Canadian trained, Ambrose R. Myers graduated from Queen’s University in 1894, an institution rated by Flexner as below McGill and Toronto but still headed in the right direction.30 The sole member of the Moncton Hospital’s thirteen-doctor core to be educated abroad was Gaius T. Smith, who earned his M.B.Ch.B. at the University of Edinburgh in 1887, followed by an M.D. in 1890 from the same university,31 which

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was regarded as one of Great Britain’s best medical schools. It seems safe to conclude that, although the older doctors serving Moncton might have come through a notably deficient system, their schools and staff were among the better and more successful institutions and faculties prior to and during the age of reform in medical education. Moreover, their younger colleagues benefitted from the progressive changes implemented at what were later acknowledged to be among the strongest medical schools in Canada, the United States, and Great Britain. When the willingness to undertake further graduate work or specialized studies, demonstrated for example by McCully, Chandler, and White in London and Myers in London, Paris, and Berlin, is added to the initial training, along with the years of practical experience accumulated, the Moncton Hospital and community were well served by the medical profession. The hospital and its constituency clearly were spared the degree mill recipients about whom Flexner was so validly apprehensive.32 Qualified and experienced physicians were ready to serve the Moncton Hospital, but it quickly became clear that their service and the hospital’s capacity to meet the community’s needs were badly compromised by the limited almshouse space available. Both paying and nonpaying and Monctonian and non-Monctonian patients soon were using the renovated facility. But its success brought a need to expand, and expansion meant additional costs that had to be met by increased revenue, drawn from the patients themselves, private donations, or public funds. It was a precarious and circular exercise as success led to greater revenues but also to greater pressures for space and staff and thus even more revenues. The board, the Ladies’ Aid, and the press publicized the problems created by the institution’s success. Within a few months of the hospital opening its doors, the public was receiving a steady diet of reminders about the institution’s need for more support. In September 1898 the Daily Times reported on the good work accomplished by the new hospital and the clear need that had been met. Already, however, it was obvious that “the institution is likely to be taxed to its utmost capacity in the near future to accommodate needy cases.”33 One year later, since recently “the hospital has been practically full of non-paying patients ([with] but three exceptions),” George Willett was forced to issue an “urgent appeal to the people of Moncton” for financial support. There was about $200 in unpaid running expenses with only “six dollars on hand”: “funds are necessary to carry on the institution.”34 Through its early years the hospital was operating almost on a handto-mouth basis. Church collections met part of the cost of new furnaces and the fuel required. Concerts and benefits were organized, sometimes with disappointing results, free drugs were solicited from local pharma-

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cies, and a very successful “hospital festival and tea” on the “spacious grounds at Mr. and Mrs. W.F. Humphrey’s residence” generated $175 in support.35 The Ladies’ Aid was constantly active, and repeatedly thanked by the board, and was already looking to future hospital needs such as an ambulance.36 Despite such schemes and support, financial problems persisted even when all private rooms were occupied. By August 1901 the inadequacy of the available space was evident, since it was reported that “many applications for admittance to both private and public wards have had to be refused.”37 To board members the finances and patient pressures had become so desperate by May 1900 that they chose to remind the public that without expansion of space and financial support the institution might have to be abandoned. A motion was passed unanimously at a board meeting “that the time has now arrived when we must either close our hospital on account of its present location or procure other quarters; therefore be it resolved that we appoint a committee to see whatever can be done regarding the procuring of a site in the city and probable cost of a suitable building, said committee to report to the Board at an early date.”38 At the board’s public meeting, which followed in June, George Willett voiced his “hope that in the near future our good people will decide to procure a Hospital within the city limits and thereby place us on a better footing from every point of view.” The same message was contained in a pamphlet issued shortly thereafter that outlined the hospital’s facilities and work in the first two years and reprinted the several presidential reports. It functioned as both the justification for and the inauguration of a fund-raising campaign for a new site and building.39 Over the next several years, culminating in November 1903 with the opening of a new and considerably more spacious fifty-bed Moncton Hospital on King Street, a successful and well-publicized fund-raising campaign produced donations exceeding $20,000. The response from Moncton and surrounding areas was heartening and represented a resounding vote of confidence in the hospital’s contribution. Both the private and public sectors responded generously. Leading the way was the Ladies’ Aid, with numerous endeavours and donations, along with another group of women called the Ladies’ Hospital Sewing Circle, led by Mrs (W.F.) Emma Humphrey. Together the two groups raised over $5,000 for the hospital fund. The Ladies’ Hospital Sewing Circle was first off the mark with over $2,000 achieved by March 1902 to purchase the new site selected within the boundaries of Moncton, the Harris homestead on King Street.40 The Ladies’ Aid and the Ladies’ Hospital Sewing Circle actively solicited individual private donations as well as raising funds through public concerts, teas, “At Homes,” parlour concerts, bazaars, and soda fountain sales.41 The churches

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provided encouraging sermons and collections, with Fr Henry A. Meahan offering especially strenuous support at St Bernard’s Catholic church. He suggested “that every wage earner lay aside the full earnings of one full day and give that amount to the hospital building fund.”42 Workers in various industrial enterprises, the male and female employees of the cotton factory, for example, gave at work, and a major source of support was the Intercolonial Railway, with its employees in the different shops combining to contribute $295.25. The largest private donations came from outside Moncton as Lady Sarah M. Smith of Dorchester, widow of Sir Albert J.M. Smith, gave $1,200, while William F. Humphrey, one of Westmorland’s mpp s, donated $500. Government grants were vitally important and a now firmly committed Moncton city council gave $5,000, while Westmorland county council provided $2,000 and Kent county donated $500.43 Of the approximately $20,000 raised, 37.5 per cent came from municipal and county governments and the remainder from private contributions.44 As the campaign progressed, the press reported and endorsed all fund-raising endeavours. The Daily Times was convinced that the necessity of a hospital “in such a central place as Moncton” had been so amply demonstrated “to the people of Moncton … [and] to the people of the counties of Westmorland, Albert and Kent that they should heartily lend the greatest encouragement possible to the movement for a more commodious and modern building within the city.”45 The building committee, chaired by George Willett, provided regular reports in the press as the donation total moved steadily upward. By January 1903, excluding the $2,000 building site donation, $11,928.18 had been received. Architects’ fees, for F. Neil Brodie of Saint John, as well as a substantial portion of the contractor’s costs – the tender had been awarded to T.B. and Morris E. LeBlanc – had been paid. It was now estimated that the probable cost “of finishing the interior will be in the vicinity of $8,000; therefore it will be seen that at least $5,500 requires to be raised for the completion of the building.” Interior tenders were awarded and, by late April, plumbing, heating, and lighting were being put in, with the “whole interior … to be completed by the later part of the summer.” The prediction now was that $4,000 was still required to cover all contracts awarded. On 11 November 1903, the Moncton Hospital opened on King Street, where it would remain for half a century. On this day it was reported that total donations received were $19,843.70, with $626 pledged but not yet collected, and a balance of $2,391.30 “yet required to complete free of debt.”46 The Moncton Hospital supporters, the city of Moncton, and the broader surrounding community served by the hospital glowed with pride at what had been achieved.

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At the opening day ceremonies prominent local, provincial, and federal politicians combined with hospital representatives and religious leaders to praise and marvel at the accomplishment. Press photographs captured an edifice that was a far cry from the old almshouse. The main section of the building was set back slightly, with two wings extending forward like welcoming arms. It was an impressive sight and almost all the speakers expressed amazement at the speedy construction of such an imposing structure, as well as at the generosity of the many donors. Unlike at the hospital’s first opening five years before, George Willett opened the festivities with an acknowledgment that would be echoed by several speakers. He underlined “the grand work done by the ladies” and said that “if it had not been for their energetic efforts and material support we would not have this building today.” Provincial premier Lemuel J. Tweedie praised the contributions of the “people of the county of Westmorland and citizens of Moncton,” which had produced an institution without equal in the province of New Brunswick. Westmorland’s mp Henry R. Emmerson likewise commented on “the very generous subscriptions which have come in from the city and county,” while Senator Josiah Wood described the building “as a lasting monument to the energy of those who had charge of its construction” and a revelation of “the wonderful progress of the age in which we live.” So moved was the senator from Sackville that before the day was out he donated another $100 to the hospital cause! Speaker after speaker continued in the same vein, and even religious differences were forgotten. On behalf of the “Evangelical Alliance,” Rev. J.E. Brown praised this “undenominational institution,” while Fr Meahan picked up the theme that “the denominational question should never interfere with a good work” such as the creation of a hospital. Only Warden Amos Trueman, representing Westmorland county, measured his words as his council had strictly measured its hospital grants, with the by no means overwhelming oratorical contribution that “the county council had been disposed to do what was fair.” The “large gathering”47 that heard the speakers on that day could disperse confident that Willett’s June 1901 dream that “a new and modern well equipped hospital will be erected in the very near future”48 had indeed been achieved. A well-trained roster of doctors combined with sparkling new facilities to earn the respect of patients; it was an institution where the sick went for the betterment of their health rather than as “a brief prelude to an unpleasant demise.” This once common but now fading image of hospitals as “gateways to death”49 was not a problem in Moncton if the steady increase in the number of patients admitted was any indication. The charity institution image, initially exacerbated by the hospital’s

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almshouse location, remained a more difficult problem. In other communities and in other hospital studies, a frequently applied test of an institution’s ability to shed this image was the number of paying patients and the amount of revenue they provided. Victoria General Hospital in Halifax worked hard to make itself attractive to middle-class patients in the 1890s and 1900s and made careful distinctions between private and public patients to attract paying patients.50 Staff physicians at the Hamilton City Hospital recommended the construction of private wards in 1896 and, one year later, an addition was built “to attract the affluent.”51 By 1893, 20 per cent of Kingston General’s revenue came from paying patients, Montreal General achieved a 29 per cent level in 1907, while at Owen Sound General and Marine Hospital, by 1905 “the fees of paying private patients already had become the hospital’s single most important source of income.”52 At the Moncton Hospital, all patients had to be recommended for admission by one of the staff doctors, with the insane, incurable, or contagious barred from entry. Those who possessed “the means” to pay, theoretically decided by the president of the hospital board, were to be charged $3 per week, or 43 cents per day, in the public wards. In fact, very few public ward occupants paid anything; instead those who could afford it opted for the private ward facilities at a cost “to be agreed upon and arranged with the President, and to range from six to ten dollars per week,”53 or 86 cents to $1.43 per day. Nonpaying patients were cared for by the medical doctors appointed to the hospital staff while paying patients had access to their own physicians. The “free patients” initially had possible work responsibilities: if they were “able in the opinion of the physicians and surgeons,” they “shall assist in nursing others, or in such services as the Matron may require.” Retiring and rising hours, along with other rules, were carefully set out. While visitors were allowed in the private wards “at any suitable hour in the day time,” the “free patients” had only two hours for visiting privileges on Tuesday, Friday, and Saturday.54 At the end of the Moncton Hospital’s second year of operation George Willett was pleased to report that “receipts from paying patients … considerably increased during the term which must be satisfactory to us all, thereby proving the confidence shown by the public in our methods and management.”55 While some years witnessed a slip downward in the number of paying patients, the general trend was steadily upward. In 1898–99, approximately 19 out of 70 patients admitted were paying; by 1903–04, in a considerably enlarged building, 83 out of 181 patients were paying; in 1908–09, 288 out of 497 were paying patients. At the same time, in 1905–06 the revenue these patients provided quickly became, as in the case of the Owen Sound hospital, by far the largest support of the hospital. Paying patients

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Figure 1 Population of Westmorland, Kent and Albert counties and the City of Moncton, 1901–1951 60

POPULATION Thousands

50 Westmorland

40

Kent 30

Albert City of Moncton

20 10 0 1901

1911

1821

1931

1941

1951

Year

note: Moncton’s population has been separated from the Westmorland county total. sources: Canada, Dominion Bureau of Statistics, Seventh Census Of Canada, 1931, 2: 35–6, 38; Eighth Census Of Canada, 1941, 2: 5, 9; Ninth Census Of Canada, 1951, 1: 2–1.

provided $362.84 out of $1,730.42 total revenue (20.9 per cent) in 1898–99, $4,545.55 out of $8,352.34 total revenue (54.4 per cent) in 1905–06, and $7,345.14 out of $12,656.45 total revenue (58 per cent) in 1908–09. Paying patients as a percentage of total patients had risen from 27.1 per cent in the first year to 57.9 per cent in 1908–09.56 Hospital board members watched these numbers carefully but were equally attentive to where patients using the Moncton Hospital came from. Moncton was the all-important home base, but patients from the counties had to be attracted as well. In truth, at least initially, in terms of population, Moncton offered the smallest potential clientele compared to Westmorland, Kent, and Albert counties. But, as figure 1 demonstrates, there would be substantial shifts over time in the makeup of the potential clientele, with Moncton and Westmorland county becoming the growth areas while Kent and Albert counties remained relatively stable.57 By 1911, Moncton’s population had increased to 14.4 per cent of the hospital’s potential clientele, edging it ahead of Albert county, which slipped to 12.3 per cent. Moncton’s population growth further accelerated during the war years, outdistancing the pace of growth in the other primary areas served by the hospital. At the

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Figure 2 Number of patients by residence, 1905–1953 Moncton

2,400 2,400 2,000 2,000

Westmorland

1,600 1,600 1,200 1,200 800 800 400 400 00

Kent Albert Others 1905–06 1908–09 1913–14 1919–20 1924–25 1929–30 1933 1935 1939 1945 1950 1953

NUMBER OF PATIENTS

2,800 2,800

Year

sources: Daily Times (Moncton), 14 June 1906, 10 June 1909, 11 June 1914; armh 1920, 12; armh 1925, 18; armh 1930, 24–5; rmh 1933, 28–30; rmh 1935, 28–9; rmh 1939, 32; rmh 1945, 32, 34–5, 37; rmh 1950, 21, 23; rmh 1953, 22–3, 31, all mha.

same time, by 1921 rural depopulation took its toll in Kent and Albert counties as both dropped in population from 24,376 to 23,916 and from 9,691 to 8,607 respectively, or, in terms of potential clients served, from 31 to 27.8 per cent and from 12.3 per cent to 10 per cent. The changes in the size and composition of the potential population served by the Moncton Hospital were reflected in the shifting usage patterns among patients treated. As the population increased in southeastern New Brunswick, hospital admissions grew from seventy patients in its first year of operation58 to 6,466 in 1953,59 necessitating an increase in the Moncton Hospital’s bed capacity from the original seventeen to fifty in 1903, 125 in 1930, and 225 in 1953. Despite Moncton’s smaller population, compared to Westmorland county, the city quickly became the major user of the hospital, accounting for 51.9 per cent of the patients in 1905–06. It maintained that position until 1953, although as figure 2 indicates, Westmorland county became the second most important user and closed the gap considerably during and after World War II. In 1945, Westmorlanders (excluding Monctonians) were 36.3 per cent of patients admitted, compared to Moncton’s 44.2 per cent, and by 1953 county residents were 36.7 per cent of the hospital’s total patients while Moncton contributed 42.2 per cent. Kent and

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Albert counties lagged considerably behind, although Albert County gradually supplanted Kent as the hospital’s third most important customer. Kent provided 15.9 per cent of the hospital’s clientele in 1908–09 compared to Albert county’s 4.6 per cent, but by the late 1920s the largely French-speaking residents of Kent were serviced by the newly opened Hôtel-Dieu and redirected themselves and a portion of the county grant accordingly. Only 1.9 per cent of Moncton Hospital’s patients in 1939 were from Kent county, and by 1945 it was no longer listed separately in hospital statistics. Albert county, on the other hand, contributed increasing numbers until in 1953 its residents amounted to 12.9 per cent of the Moncton Hospital’s patients. The only substantial downturn in patient admissions came in the early thirties and affected all the counties as well as Moncton. The social mix of patients is as important as place of residence, if more difficult to unravel. David Rosner has made good use of Stephan Thernstrom’s occupational categories to capture the patient makeup and mix at Brooklyn Hospital from 1892 to 1904. By the latter date, with 24.3 per cent of the patient population drawn from white-collar workers and 75.7 per cent classified as blue-collar workers, he concludes that the hospital “was still predominantly a working-class facility.”60 If that was the case, the Moncton Hospital in 1910–11 was even more working class, with a patient mix of 20.7 per cent white-collar workers and 79.3 per cent blue-collar among those whose occupations were known. But pressing Thernstrom into service requires a number of qualifications. Most importantly, occupational information in the Moncton sources is initially lacking, then appears, and then disappears, making the shifts over a period of time difficult to track. As well, Thernstrom’s rankings are for a male and urban labour force. In the Moncton case, female and rural occupations must be fitted in, and are added below, but housewives or schoolgirls simply do not fit the existing categories. Nevertheless, with these qualifications, a 1910–11 patient occupational listing at the Moncton Hospital is revealing.61 Some 457 people were listed in the hospital’s “Occupation of Patients” report for that year, but 211 must be excluded because no social class occupation is provided. This leaves the following, male-biased, categorization of 246 persons: Category 1: High white-collar – Total 9 (3.7 per cent) Composed of merchant (3), contractor (2), clergyman (1), doctor (1), lawyer (1), teacher (1) Category 2: Low white-collar – Total 42 (17 per cent) Composed of clerk (13), nurse (6), accountant (4), agent (4), bookkeeper (3), commercial traveler (3), bank clerk (2), foreman (2), stenographer (2), car inspector (1), conductor (1), mail clerk (1)

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Category 3: Skilled blue-collar – Total 49 (19.9 per cent) Composed of machinist (10), carpenter (9), moulder (4), painter (4), seamstress (3), blacksmith (2), bricklayer (2), electrician (2), engineer (2), fireman (2), jeweller (2), plumber (2), millwright (1), printer (1), sawyer (1), tailoress (1), tinsmith (1) Category 4: Blue-collar semi-skilled and service workers – Total 100 (40.7 per cent) Composed of farmer (40), housemaid (35), housekeeper (4), sailor (4), brakeman (2), hunter (2), watchman (2), horse-jockey and teamster (2), cook and chef (2), barber (1), fisherman (1), janitor (1), laundress (1), newsdealer (1), spinner (1), waitress (1) Category 5: Blue-collar unskilled and menial service workers – Total 46 (18.7 per cent) Composed of labourer (44), lumberman (2) Moncton’s greater blue-collar presence compared to the Brooklyn Hospital has already been mentioned. The table below gives further comparison of the percentage figures in each of the categories, and reveals several additional similarities and differences.

Category 1 Category 2 Category 3 Category 4 Category 5

Brooklyn Hospital 1904 Moncton Hospital 1910–11 1.1% 3.7% 23.2% 17.0% 18.9% 19.9% 31.0% 40.7% 25.8% 18.7%

Both hospitals enjoyed their greatest success in attracting patients from category 4 (Blue-collar semi-skilled and service workers) and their least success in category 1 (High white-collar). But in category 4 the Moncton Hospital was considerably more successful than its Brooklyn counterpart, although the addition of forty farmers inflates the Moncton numbers. Likewise in category 1, if the low numbers in Brooklyn can be interpreted by Rosner as evidence that wealthy patients were not “flocking to the hospital,”62 the same was true in Moncton. Nevertheless, the Moncton percentage in this category more than tripled that of Brooklyn, although in both cases the actual number of patients was very small (eighteen in Brooklyn and nine in Moncton). On the other hand, the category 5 percentages reveal Brooklyn’s greater success in serving unskilled blue-collar and menial service workers compared to Moncton. What remains clear in both institutions, however, is the heavily blue-collar, working-class usage of hospital facilities. In sharp contrast to the social composition of the Moncton Hospital board and

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the Ladies’ Aid, while all levels of society were using the Moncton institution, the major social classes employing it were not the leaders and promoters of the hospital enterprise. Less definitive analysis can be offered concerning what the Moncton Hospital’s patients were treated for, although patient diagnostic patterns that emerge parallel what was occurring at other North American hospitals. The discoveries of Joseph Lister, Robert Koch, and others allowed anaesthesia and antiseptics to expand considerably the horizons of surgery: advances in controlling pain and infection encouraged surgeons to operate earlier, more frequently, and for a wider variety of ills.63 By the late 1890s and early 1900s, in hospitals large and small, surgery became the major solution to patient ills and Moncton physicians joined wholeheartedly in the surgical interventions now possible. Patients at the Moncton Hospital were categorized as medical or surgical and the balance quickly swung heavily in favour of the latter. Despite inconsistent record-keeping, which hinders a systematic charting of how medical cases were diagnosed and what type of surgery was carried out, hospital records reveal that in 1900–01 Moncton’s patients were 50.5 per cent medical and 49.5 per cent surgical; by 1904–05, this had shifted to 25.6 per cent medical and 74.4 per cent surgical; and in 1910–11 it remained a 26.2 per cent medical and 73.8 per cent surgical split.64 At a comparable small hospital in Batavia, New York, surgical cases increased from 48.5 per cent in 1904 to 70 per cent in 1914. In Batavia appendectomies were the leading operation performed, while tonsillectomies and adenoidectomies were not far behind.65 Likewise in Moncton in 1910–11 thirty-eight appendectomies led among operations performed, followed by thirty tonsillectomies and adenoidectomies.66 Among the non-surgical, medical cases treated at the Moncton Hospital, there was little change in the hospital’s first decade. In 1898– 99, ten typhoid fever and eight neurasthenia cases led the list of patient medical problems, while in the 1910–11 report on “Medical Cases,” twenty-three typhoid fever and thriteen neurasthenia cases still headed the list, followed by nine each of “La Grippe,” pneumonia, and rheumatism, and five of alcoholism.67 The funding situation of the Moncton Hospital also closely matched the funding realities experienced by hospitals across Canada and the United States. Independent hospitals such as Moncton’s, launched largely with broad-based private support, quickly turned to a reliance upon paying patients because government support was minimal and private philanthropy was limited. Although at certain times, and in certain states, government funding could be substantial and significant,68 through most of the first half of the twentieth century a “long-standing governmental unwillingness to intrude in the delivery” of hospital care

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prevailed.69 A substantial Canadian federal government presence only arrived in the late 1940s; the limited and very token annual provincial government grant revealed a strong reluctance to be overly involved in health care spending. The conspicuous absence of any provincial government contribution to the cost of the new Moncton Hospital in 1903 indicated the provincial assumption that the funding of such buildings or extensions should be met by the local governments and private donations. Still, at least a small provincial grant arrived annually, rising as high as $700 in 1907 but declining to $500 in 1909. The city of Moncton became the hospital’s major source of government funds since, in addition to its contribution to the construction of the new hospital building, the city council’s annual grant increased steadily, reaching $1,200 in 1906 and $1,500 in 1909. Support from another level of government emerged in 1900, when the Westmorland county council provided $200. By 1906, this had been increased to $600 and Kent county was also contributing, on a very irregular basis, $200. In 1909, because of a special additional grant, Westmorland county contributed $2,000, but begging pilgrimages by hospital board members had become an annual requirement to extract such support. The total annual government grant support increased from $500 in 1898–99 to $2,700 in 1905–06 and to $4,000 in 1908–09, excluding the special building fund support provided at the municipal and county levels. As a percentage of total revenue in those years, government support was 28.9, 32.3, and 31.6 per cent respectively, an increase well below the increase and importance of private patient revenues.70 But these percentages were considerably higher than the 8 per cent that Rosemary Stevens estimates as the 1903 U.S. government support for hospital care. She also points out the large variations in state support to hospitals, which ranged from 5.5 per cent of hospital costs in Virginia to 33.4 per cent in the District of Columbia, with some states providing no government aid at all.71 The consistent support by Moncton’s city council was a refreshing change in attitude from the reluctance of the mid-1890s, but the membership of council itself had undergone a rewarding renovation of sorts, from the hospital’s point of view. Probably as a result of the earlier indifference demonstrated by the mayor and council, Moncton’s physicians and hospital supporters actively participated in municipal politics in the first decade of the twentieth century. Frederick Sumner returned to the mayor’s office for a one-year term in 1900, while Moncton physicians won the mayoralty in 1906, 1907, and 1908 with doctors Edward Steeves, Fred White, and Clinton Purdy each serving one-year terms. They were followed by former board president and constant board member George Willett as mayor in 1909. The physi-

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cians were also extremely active on Moncton’s eight-member city council: Steeves served on council as early as 1895 and also had terms in 1899, 1904, and 1905; Purdy served three terms as alderman from 1904 to 1906; Dr Gaius Smith served a 1900 term; and Dr Louis Bourque was the most active among the physicians, serving twelve terms in the period from 1900 to 1921.72 Consequently, city council was far more receptive to the hospital’s need for an increasing annual grant and it provided even more substantial support on special occasions, such as the building fund appeal of 1902–03. The atmosphere at the county level differed considerably. Strong arguments and annual presentations were required, which sometimes met with hard questions or strings attached to the grant, before increased support was forthcoming. In presenting their case, hospital board members had solid evidence that the Moncton Hospital from its opening days onward served Moncton’s citizens as well as non-Moncton residents drawn largely from the surrounding counties. In 1908–09 Moncton provided 45 per cent of the hospital’s patients, Westmorland provided 21.7 per cent, Kent 15.9, Albert 4.6, and “Others” 12.8. That the Moncton Hospital had from inception served a far broader community than Moncton itself was a contradictory source of pride and concern to hospital board members. Willett described his institution as “deserving of liberal aid” in 1900 since, while it “was originally intended for the city and county, the spirit of charity has been so broad that patients have been admitted, and treated free, from the surrounding counties, and even some from outside the province.”73 In June 1907 Sumner, while proud of the hospital’s record of service, attempted to emphasize diplomatically Moncton’s more substantial support of the institution. He spoke of “the large amount being contributed by Moncton towards the maintenance of the hospital in comparison with what is being paid by the rest of the county [Moncton was in Westmorland county] and surrounding counties.” Softening his words somewhat, he continued that he was “not finding fault, but on the contrary thought all were contributing generously. But attention should be called to the proportionate amounts being contributed.”74 The point had been made and Sumner would make the same argument more bluntly when he led various hospital delegations in appearances before the Westmorland county council. In these requests for support, the hospital cause was helped by Moncton’s two representatives, usually aldermen, who served on the Westmorland county council. Help was needed as other county councillors could be prickly at times. In January 1904, county council heard a complaint from C.S. Hickman, representing Dorchester, that one of his constituents who had “been seriously injured about the head … was unable to get into

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the hospital as quickly as desirable.” Hickman believed that “inasmuch as the council was contributing to the hospital, some system for admitting the patients from the county without delay should be made.”75 Immediately one of Moncton’s representatives on council, city alderman James Doyle, pointed out that nothing in the hospital bylaws prevented immediate admission of all patients. But the matter did not stop there. Just a few days later a hospital delegation, consisting of James Ross, Andrew Jones, John Rayworth, and Dr Ambrose Myers, appeared before county council asking for a county grant of $2,000 in support of “the building fund.” First, however, they had to explain the situation surrounding the Dorchester patient. Then figures were presented concerning hospital costs and the number of county patients being admitted. Nevertheless, prior to any grant being made, whether annual or to the building fund, two Sackville councillors recommended a county committee meet with the hospital delegation to discuss possible grants as well as the “terms upon which same shall be granted” since “the county’s rights in regard to admitting patients to the hospital entered into this matter.” Admission problems were thrashed out since, after meeting with the hospital representatives, the county committee recommended $1,000 for the hospital building fund and $500 “towards running expenses of the institution.”76 Since the hospital board repeatedly pledged itself to the service of a community broader than Moncton, it usually moved quickly to accommodate county requests. Appointing county representatives to the board was one such gesture, while allowing county doctors to recommend patients for admission and even changing the name of the hospital itself – the Westmorland Hospital was suggested at one point – were other adjustments mooted at times. The result was annual headlines declaring “Generous Grant[s]” by Westmorland county, but the grants were invariably considerably lower than what was requested by hospital representatives. The rhetoric used in justifying increased grants or in opposing further county largesse revealed a growing strain in the city/county relationship over the constantly increasing costs. In 1908 Sumner reminded county council of the increased expenses faced by the hospital board that required an increased county grant. “A hospital,” he claimed, “was a necessity and the one in Moncton was as much the county’s as the city’s … It should be supported by the county as a whole.” He felt justified in “asking for a grant of $2,500” since “it was the duty of the county to support it generously.”77 When this sum was not achieved, Sumner was back the next year seeking $3,000 and arguing that “the county was getting off cheaply for this amount if they were to give their sick poor proper treatment.”78

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Generally the majority of the county council agreed and at least some support was provided. A minority of councillors, however, revealed a growing apprehension about this expense. Botsford’s representative, Fred Magee, urged more attention to private donations as a source of income since, while he personally would be happy to see a $3,000 grant, even the far lower subsidy approved the year before had been criticized by his constituents. He and his colleagues “as councillors had to sink their personal feelings and consult the wishes of the people they represented.”79 A year later it was Sackville’s representative who had the strongest reservations about continued increases in the hospital grant. After all, the hospital had enjoyed substantial increases in support, it was his understanding that “65 per cent of the inmates were from the city of Moncton,” and “to put the matter plainly he would like to know if we were not making Westmorland county pay for Kent county patients.” To their credit, Willett and Sumner, who were among the hospital delegation faced with this inaccurate outburst, handled it as gently as possible. Willett felt that the councillor might have been misled by figures that listed as Moncton patients many who “really belonged to the county.” Sumner admitted that some other counties were not carrying their fair share of the hospital burden and Kent county specifically “would have to pay a fair proportion of the cost or patients from that section [might] be refused.” Sumner was equally adept at fielding suggestions from other exasperated Westmorland county councillors. Perhaps the city of Moncton’s grant should be increased substantially; increased grants from the provincial government were a possibility but difficult since an increase for one hospital meant an increase for all hospitals supported; maybe monthly dues from factory employees could be achieved at some future time.80 The heated exchanges and careful explanations brought on by the annual supplications of hospital board members revealed a growing prickliness in the external relationship of the hospital with its county constituents. Within the internal confines of the new Moncton Hospital, continuity of board members and medical staff largely persisted, with one major exception. In March 1904 Margaret Grant resigned as matron of the hospital. She was succeeded by Miss Bessie Magee for a brief period, until the more permanent appointment of Miss Janet MacEachern was made in December 1904, along with a change in the title of her position to that of superintendent81 and a considerable expansion in her duties when the proposal for a nursing school was revived. At the board level in 1903–04 Willett was back as president, comfortably supported by executive colleagues Rayworth, Hamilton, and Jones. Among the physicians on staff, two doctors each did a two-month

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period of service, but the roster remained basically the same although shrunken in size. Doctors Chandler, Smith, Myers, Bourque, and White served the public patients along with Dr William A. Ferguson as the only new recruit. Ross and Price remained as consultants.82 The ladies did not rest on their laurels. In 1905 the hospital added an ambulance service when a $500 Ladies’ Aid contribution helped purchase a horse-drawn rubber-tired vehicle, which also was used parttime as a paddy wagon by the police.83 The next year over $2,000 was raised to purchase a “Nurses’ Home” for the hospital, an undertaking that demonstrated the Ladies’ Aid’s organizational abilities and commitment. As president Mrs (G.B.) Laura Willett reported, they were first approached by the hospital board concerning this project in September 1906. They proceeded to divide the city into eighteen districts and got “two ladies to undertake a district together and make a house to house canvass.” Clergymen were recruited to speak “a good word for us from their pulpits.” On 28 October hospital treasurer Andrew Jones was handed the first cheque for $1,200. The house that was marked for purchase had a $2,400 price tag and a mortgage of $1,100 against it, so the first instalment was used to “take over the mortgage and secure possession.” This was done by the hospital board but with a Ladies’ Aid stipulation that rent paid on the house until it was vacated on May 1st should go into the organization’s coffers, along with any further funds raised. Shortly into the new year another cheque for $500 was presented by the ladies. In early May 1907 the Nurses’ Home was officially opened, furnishing accommodation for twelve to fifteen nurses, and the total Ladies’ Aid contribution had reached $2,200. The now renovated, papered, and painted building was acclaimed as “a notable achievement.” In truth, “[b]ut for the Ladies’ Hospital Aid it is not at all likely that there would have been any opening of a Nurses’ Home.”84 At times the women’s well-organized efforts received tongue-in-cheek press coverage. A red tag sale in the fall of 1909 that realized $250 was described as an all-encompassing venture: “Alert young ladies and girls were stationed in almost all parts of the city and suburbs, and it was only with extreme difficulty that these wideawake young damsels were evaded.”85 Words of praise were constantly awarded for such efforts but the gendered limitations of the women’s world were also apparent. Silence and inaction greeted the Ladies’ Hospital Aid’s formal request in June 1908 that they be “given representation on the Hospital Board” by the appointment of their president and one other member.86 While there is no evidence that this negative response diminished the enthusiasm of female hospital supporters, criticism and suggestions of problems within the board and hospital occasionally surfaced. An item

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in the Moncton Transcript in September 1907 provoked several board meetings and considerable board indignation while also revealing doctor and nurse dissatisfaction. A rather vague article suggested that public hospitals were coming under increased scrutiny and Moncton’s own institution deserved such attention in the form of a provincially appointed commission charged with investigating the hospital. It was further alleged that a recent hospital board meeting, attended by board member and Liberal provincial premier Clifford W. Robinson,87 witnessed “a suggestion made by one of the trustees that the provincial government should appoint a provincial commission to inspect and enquire into, at regular periods, the affairs of all hospitals and kindred institutions in receipt of money from the public funds.” The writer felt that Moncton’s hospital warranted closer examination because of “a desire expressed in some quarters in the city of Moncton for an investigation into all matters pertaining to the Moncton hospital” that would be in the interest of “those who are affected by rumours which are circulated, in all probability, without a shadow of foundation.”88 It was all very murky and strangely enough, given that the Transcript was a fervently Liberal paper, Premier Robinson was placed squarely in the line of fire, as government leader and hospital board member. In a two-and-a-half-hour meeting several days later an outraged board attempted to deal with what were perceived to be charges of mismanagement, and turned on Robinson with hard questions. The premier claimed “he knew nothing about the item in question until after it appeared” and that it “was news to him and he was sorry to see it.” Other board members, however, continued to press the issue, arguing that these “alleged irregularities in the internal management of the hospital” must be addressed and refuted. President John Rayworth repeatedly asserted that if there were grievances and complaints what were they, who made them, and why didn’t the people raising the allegations appear at this meeting to present their arguments. Rayworth suggested adjournment until another meeting could be advertised at which any complaints could be heard. Instead several board members contributed rumours of criticism heard from graduate nurses, student nurses, and doctors. In the case of doctors’ complaints, specific individuals were named, some of whom were at the meeting while others were reached by phone. Dr Fred White was already present as a board member and quickly denied a rumoured grievance attributed to him, although he did wonder why the hospital “could not keep [its] nurses.” Robinson then further fueled the fire by reporting a conversation with Dr Clinton Purdy in which the latter had no grievance “except to say he thought it unfair that the medical staff was filled with tories.” Dr White, who in addition to being a board member and a physician on the hospital staff

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was mayor of Moncton and a loyal Conservative, exploded at this remark, stating that any man making such an assertion “should have a brick (metaphorically) thrown at him.” A Tory colleague on the board, Edouard Girouard, joined the mayor in defending the non-partisan nature of board decisions, while also helpfully specifying Liberal doctors who might be behind the outrageous insinuations concerning bias. More valuable was a hint he provided as to what might be the root of the problem. Girouard referred to the board selection of doctors for the hospital medical staff and maintained that “although a conservative he had always voted for Drs. Purdy and Myers. Politics had never entered his mind on this question. He thought all would be well as a marriage bell if all the doctors were on the medical staff.”89 Here was one of the sources of dissatisfaction within the hospital. Conspicuously missing from the doctors selected for service in 1907 were Purdy and Myers, both of whom had been on the list in 1906.90 When contacted by phone, Purdy suggested “that they appoint all the doctors on the staff,” and that it might be worthwhile “to call a meeting of all the doctors.” Myers was also reached by phone and then joined the meeting. Clearly unhappy with the situation, he explained that he had no desire to make charges and drag “private patients through the mire” to prove allegations. Nonetheless, “things had not been pleasant for him at the hospital” and he advised the board to ask the nurses why they were leaving “if they wanted to investigate affairs.” Prior to Myers’ appearance the board had agreed as to the “absurdity” of the charge that political partisanship influenced the selection of physicians since “a majority of the Board are liberals.” After Myers’ departure it was decided to question the nurses about the situation and to send a delegation, led by Premier Robinson, to the Transcript offices seeking a correction of the offensive newspaper item.91 A week later the board, as the Daily Times put it, “went on another fishing expedition” in a three-and-a-half-hour session interviewing almost all the nurses, both students and graduate, on staff. The written replies of student nurses who had left the hospital were read and, while one expressed dissatisfaction with the management, no details were provided. As the student nurses testified, one by one they made clear their satisfaction with the matron and the training and treatment they were receiving. Alena J. MacMaster, first to be summoned by the board, captured the sentiments of her student colleagues with her report that “she was well satisfied with the training she was receiving and knew of no grounds of complaint.” Far less co-operative were “Miss Miller and Miss Sharpe, the two graduate nurses of the staff [who] reluctantly appeared before the board, saying that they had not

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wished to have anything to do with the investigation.” Sticking to this position, they refused to answer any board questions, although Miller did admit to making “statements in reference to the hospital outside of the institution.” The board apparently was left in “more of a mystery than ever” but did decide to seek information from other hospitals about their regulations governing nurses’ training schools.92 There matters rested for a few days, until an announcement was made that several nurses were about to be fired, or as the press delicately put it, “will shortly sever their connection with the Hospital.” This was followed by a brief report that “Miss Miller and Miss Sharpe have resigned their positions as trained nurses on the hospital staff.”93 Thus were nurses’ “problems” resolved. Doctors’ problems were another, gentler matter. The next year, as well as becoming mayor of Moncton, Clinton Purdy was back on the medical staff;94 Myers would also soon return. The board quietly expanded the number of doctors appointed in 1910 by keeping the visiting physicians at six but also appointing three specialists and four consulting staff.95 The growing pains among the nursing staff, both graduate and student, were predictable. The nursing staff assumed a significant part of the additional burden as the hospital expanded from 312 patients in 1905–06 to 497 in 1908–09. The number of nursing staff increased largely because of an increased intake of student nurses while the number of graduate nurses was held to three or four. This was a recipe for overwork and complaints: the same situation provoked written complaints and a near revolt at the Kingston General Hospital in 1908.96 Complicating matters further was the board’s inclination to hold the core staff of physicians, aided of course by their colleagues treating the private and paying patients, at a relatively stable level while increasing nursing numbers. Despite such staffing problems, an improved quality of patient care offered by both physicians and nurses might be substantiated by the decline in the average number of days per patient spent in the hospital (from 29.3 days in 1900 to 17.5 days in 1908),97 although this decline may also be attributable to a desire to move an increasing number of patients through the hospital more rapidly. As the nursing presence grew, frequent comments in the press about notable operations performed on grateful patients by skilled physicians were matched by patients’ comments about the quality of the nursing care. Mr R.T. Farrell, for example, was grateful to doctors White and Price but added comments on the “attentive” staff, and he desired “particularly to speak of the superintendent [in 1909] Miss MacDonald, and Miss McConnell, the nurse who had special charge of him.”98 Likewise a Dorchester patient, Mrs Edward Cook, was happy to depart from the hospital three weeks after successful surgery by Dr Ferguson assisted

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by Dr R.M. Copp of Sackville, but she also singled out others: “The superintendent, Miss MacDonald, is deserving of all praise for her kindness and thoughtfulness; also Miss McConnell, the special nurse who attended her, not omitting Miss Fraser and Miss Gaudet.”99 Employment of student nurses had been an integral component of the health care blueprint presented by Annie Purdy in 1895. At this early date she had suggested that well-educated young women who wished to enter the nursing profession should be admitted to a twoyear program “of work in the wards, [and] lectures from the superintendent nurses and doctors of the staff.” As a cost-saving measure, a nurses’ training school was attractive for two reasons. Purdy pointed out that this nursing service could be achieved for a “small outlay” since student nurses “only receive their board and washing and a small sum each month for pocket-money, their education being considered an equivalent for their services.” In addition, “after a time they become a source of income as they are sent out during their second year of training into private families and their earnings are paid into the hospital treasury.”100 As with many of Purdy’s other predictions and suggestions, much of what she proposed would come to pass, although it was only after the hospital was moved to the King Street site that a nurses’ training school could be attempted. Such schools were very much a part of many other hospital schemes: their numbers had increased in Canada from only one in 1874 (in St Catharines, Ontario) to 170 in 1909.101 In the Maritimes, four hospitals had established nurses’ training schools prior to 1900, in Fredericton, Saint John, Halifax, and Charlottetown.102 Hospital administrators quickly appreciated the “value of nurses for developing a clientele and providing inexpensive labour,”103 and at the Moncton Hospital board’s annual meeting in June 1904 Ambrose Myers suggested the establishment of “a training home for nurses.” His words were seconded by George Willett, who argued that nurses were in short supply but such a school would “facilitate matters greatly.”104 In 1906 the financial need for such a school was underlined by the treasurer’s report, which emphasized one area of expenditure that had “greatly increased.” During the year from 1905 to 1906 the amount expended for “the salaries of nurses and help” had gone from $1,995.94 to $2,772.70.105 If a training school was to be established a nurses’ residence was needed, which the Ladies’ Aid and other donors such as Frederick Sumner, who contributed $400, delivered in May 1907. It was now assumed that “the difficulty we have experienced in the past of securing nurses will soon be obviated.”106 The Moncton Hospital Training School for Nurses was opened that year, and in June 1908 the board heard the encouraging news that there was “a class of

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eleven young ladies of excellent ability and adaptability to their chosen profession.” They not only were receiving professional training but were contributing their services to the institution directly within the hospital and also working, when they could be spared, “within the city limits at reasonable rates” in households that requested their services. The revenue added to the hospital’s coffers, which amounted to $161.40 in 1908 and $367.80 in 1909, was not huge, but the community responsibility and outreach commitment of the hospital could only strengthen its image. Administrators such as board president Rayworth felt compelled to praise the nurses for their contributions and extra efforts since the “large number of patients” cared for often required their “work after hours,” to which they “cheerfully respond[ed].”107 The type of education and training received attracted thirty applicants in 1908–09, when four probationers were admitted and there were twelve nurses in training. Lecture courses offered by physicians for the school that year covered Anaesthetics by Dr L.C. Harris, Anatomy and Physiology by Dr Fred White, Materia Medica by Dr Fred Richard, Surgical Nursing and Emergencies by Dr William Ferguson, Obstetrics by Dr Louis Bourque, Special Diseases by Dr Sherman Burgess, and Medical Diseases by Dr James MacNaughton.108 Superintendent Janet MacEachern and her assistant, Miss Sophie G. MacDonald, also lectured the student nurses on Anatomy, Materia Medica and Nursing, and the Theory of Obstetrics and Practical Nursing respectively.109 In addition to this theoretical foundation, offered after the students finished their shifts in the wards, the practical training in basic areas of health care likely duplicated what was commonly provided in all the Nova Scotian nursing schools. Emphasis was placed on four areas: sickroom care (food for patients, cleaning, disinfecting, making beds); monitoring patients’ physiological symptoms (pulse, breathing, reaction to medicine, for example); applying bandages, administering enemas, and other examples of bedside care; preparation of patients for operations and assistance in the operating room.110 The program quickly evolved into three years of training, although the first two graduates completed their studies in September 1909, after approximately two and a half years, while another six graduates were expected by the spring of 1910.111 Much of the literature dealing with nurses’ training in this period, and their treatment by hospital boards and doctors, is openly critical of the tendency towards exploitation and lack of respect. Educational needs, such as lecture and study time, were neglected in favour of long hours in ward work so that “the practical always outweighed the theoretical.”112 Indeed to some physicians, there was a danger in ever allowing the theoretical to outweigh the practical, since “the tremendous

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burden of theoretical instruction – most of which is quite inapplicable in practice – is not only needless, but doubtless harmful.”113 Added to this unbalanced educational approach and somewhat hostile, or at the very least suspicious, perception of overeducated nurses, were the forceful and open reminders about nurses’ “subordinate position in the health care hierarchy.” This was achieved by “stringent standard[s]” of behaviour required of nurses that could be instilled by regimentation, discipline, and scrutiny of all aspects of life in the nurses’ residence and in the hospital. These attitudes were a reflection of an early twentiethcentury world that assumed that outside the home, their special and proper sphere, “women should adopt at least a demeanour of deference to male authority.”114 Career choices were limited, and nursing and teaching were professions where “affectionate solicitude,” “unimpeachable fidelity,” and the care and nurturing, all innate characteristics of truly virtuous women, uniquely equipped them for such roles. Women could be admitted to these professions, at attractively low cost or low wages, because of qualities linked with their gender rather than because of “their acquired or learned skill[s].”115 Underlying and linking together these strands of perception and policy was a traditional view of nursing that clashed with the reality of the nursing experience. The traditional view centred on “the combined influences of Florence Nightingale and scientific medical discoveries which transformed nursing into a modern profession.” Modern-day scholars, on the other hand, document a profession “transformed from untrained, volunteer labour which functioned separate from medicine to trained, skilled, paid labour which served as the working class of the medical hierarchy.”116 Nurses at the Moncton Hospital should be placed in the latter context, although the limited evidence available reveals the prevalence of the traditional view and of the restrictive perceptions already outlined. When the physician veterans of the Moncton medical profession, doctors Ross and McCully, spoke at nursing graduation ceremonies their choice of words and arguments was revealing.117 Ross briefly reminded the first two graduates of Moncton’s nursing program that they had chosen a “responsible” and “honorable” profession and must bear in mind “the need of exercising patience and discretion” in their work.118 The six “young ladies” receiving their diplomas in January 1911 were given a much more detailed exposition by Dr McCully concerning the “responsibility” of a profession that had earned his “admiration and respect.” While he occasionally commented on the skills they had acquired, for the most part his elaborate oration dealt with the qualities of the virtuous woman, the model of Florence Nightingale, and the all-important contribution of the rise of modern scientific medicine as represented by advances in

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the medical profession. To McCully, among those professions that were “open to women and that are supremely their own, there is only one, which in its responsibility equals yours.” Not surprisingly, he proceeded to link nursing with teaching. The female teacher could become “virtually a mother to that family” of children entrusted to her care in their crucial formative years. Moreover, placing female characteristics above intellectual skills, “[i]t is not so much what knowledge she imparts to their young minds, but her manner, her bearing, her accent, her every act is watched and copied – her character sheds abroad an influence, which is inhaled as so much air, and thus she molds that of her pupil for good or evil as the case may be.” This “responsibility” was “great” and, of course, was “far greater than the remuneration” provided. His linkage with the equally “responsible” nursing profession came in an oratorical flourish that seemed never-ending: “If your work had no more far-reaching effect than the comfort, even the life of a few individual patients with whom you come into contact, it would be equal in dignity to that of the lady teacher, but when we consider that you stand for all that is noble kind and self-sacrificing as embodied in the character of the founder of your profession and patron saint, Florence Nightingale, that you are the evangelist sent forth to preach to the world the gospel of cleanliness and correct living – that you are the apostles of those great immortals – Semmolweiss, Pasteur and Lister, who have done so much to banish pain and preventable disease from the earth, then your influence can have no bounds set to its beneficence.” While there were those who might consider nurses’ work “menial,” to McCully it was “most noble … and today commands the respect of every worthy person.” Graduates were then reminded, at some length and with the recitation of passages from Longfellow’s “Lady with a Lamp,” how Florence Nightingale had taken what was perceived as menial and raised “the care of the sick by women … to the dignity of a profession.”119 She had been, he argued, the “first to insist on a systematic training for nurses,” and “the strength of her intellect, her sweetness of character, her strength of will, her high social position has given to the world a calling for women, which is supremely her own.” Her legacy was their legacy but, in addition, another major inheritance had been entrusted to them: “the present standing of medicine and surgery.” After reviewing the vastly improved quality of medical surgery along with “the labours and discoveries” of medical science, McCully underlined the complementarity of nurse and doctor. As graduate nurses, he stated, “You go out tonight benefitted by and heirs to all the progress made in medicine – here the progress may not be so spectacular but equally scientific – here the nurse is very properly

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magnified at the expense of the physician – at least, after he has made a correct diagnosis.” The nurse brought “correct hygiene,” proper diet, the “gospel of fresh air” and a “healthful environment,” but obviously she functioned as the doctor’s helpmate. If her admired but subordinate position was clear, buried in McCully’s presentation was another pointed reminder that the nursing profession, as he interpreted Florence Nightingale’s “notes on nursing,” should never be allowed to degenerate into merely another skilled trade. In her”immortal classic,” he claimed, “she sets forth that nursing is not merely a trade – so much work of a certain kind for so much money – it must possess the generosity and self-sacrifice such as is only capable to those who practice an art, never to those who drive a trade.”120 If there was some uneasiness within the ranks of graduate and student nurses at the Moncton Hospital, if it was difficult at times to retain nurses, and if the services of some had to be dispensed with, perhaps a major factor was the circumscribed and traditional perception and role articulated, admittedly with sincerity and genuine admiration, by Dr Oscar McCully. Yet at the same time the general satisfaction and eventual achievements of graduates emerging from the system more than balanced, over the long haul, a training that concealed by noble words and inflated rhetoric the harsh realities of an overworked and underpaid nursing staff. The situation at other nursing schools probably was equally applicable to Moncton: “For students who lasted to graduation the positive features of their training outweighed the negative and nurses found ways to resist the worst features of hospital training.”121 When the first two graduates of the nursing program were honoured in September 1909, “the ladies predominated” among the “large number who gathered.” The achievement of a nurses’ training school and the graduation of Alena MacMaster and Lillian Barnes were acclaimed as “another milestone in the history of this institution which has been such an eminent success from the day of its inception up to the present time.” Major speakers such as Mayor George Willett, Dr James Ross, and board President Frederick Sumner provided sketches of the hospital’s history, and a few of its problems, as well as praising its board and other supporters, especially “the work of the ladies’ aid.” The celebration singled out, however, the special contribution of the retiring superintendent/matron, Janet MacEachern, who was being replaced by her assistant, Sophie MacDonald. Surrounding the platform reserved for the speakers were the hospital board members “and the nursing staff, about fifteen in number,” who heard generous tributes to MacEachern capped with the gift of a “writing table and chair.” Her services in superintending “the work of the institution” were much appreciated,

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and special attention was given to her successful organization and direction of “the Training School for Nurses.” Sumner could not resist the opportunity to chart future directions. It was his conviction that “[e]ventually, this county would require a hospital of its own and this one would be needed solely for the city.” Dr Ross also reminded the audience that a “great many things were needed and it would not be long before we would want the building enlarged.” While the shadow of the almshouse years was long gone, much remained to be done: as Ross put it, “our hospital is not yet finished.”122

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3 Continuity with Significant Discontinuities

If we apply one of the standard measurements of a hospital, the number of beds within the institution, there was little change at the Moncton Hospital from 1910 to 1920: it began the decade with fifty beds and ended it with the same number. Yet the number of patients admitted more than doubled, and many significant changes occurred throughout the hospital; the appearance of continuity was far overshadowed by the reality of tranquil and not so tranquil discontinuity. Perhaps it was a bit of an exaggeration for a newspaper headline to proclaim in May 1919 that “The Hospital Is The Property Of The People,”1 but it was at least accurate to argue that, after much criticism and contention, the hospital functioned under a more representative board, and the institution’s identity was being questioned and transformed. Among the medical staff, while the roster of doctors seemed remarkably similar each year, fundamental change was underway. In the superintendency and among senior nurses, however, regular changes were the norm, and only a critically important appointment of a new superintendent in 1919 achieved stability. Above all, new government legislation restructured the old board and inaugurated a new era with new players. But if the hospital had indeed moved closer to control by its major constituents, questions remained as to who the major constituents really were and what proportion of responsibility, or control, they should assume. While 458 patients were admitted to the Moncton Hospital in 1910– 11, the number grew to 1,197 in 1919–20, an increase of over 160 per cent that testified to the widespread acceptance and use of hospital facilities. Hospital usage accelerated generally in the early twentieth cen-

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tury, for a variety of reasons. New urban living patterns that made home familial care for the ill difficult if not impossible, the attraction of a place of care for the casualties among a growing industrial labour force and the sick transients of a mobile and commercial society, the need to protect the community by isolating those with contagious diseases, and the improved image of hospitals as no longer serving only the pauper and social dependent were all factors at work,2 and all were applicable in Moncton. To these could be added the pull exerted on a rural hinterland by the expertise available in a regional, urban medical centre, the growing awareness of the advanced medical science found in hospitals, and the shift in emphasis by the medical profession itself from home or private office treatment to the clean, well-equipped, and staffed care available within the modern hospital. Within Moncton, eleven of the twelve doctors serving the community in 1919,3 with the usual exclusion of the city’s lone osteopath, had staff positions at the hospital. While sometimes there might be bitter disagreement about who should be on the visiting staff and who should be relegated to a consultant role, at least all were united in their commitment to the hospital. Particularly if the hospital board awarded a visiting physician appointment, hospital service presented the opportunity to serve the poor of the community without fee. But it also offered greater experience with a wider variety of cases, more access to patients who, while unable to pay when first treated, might eventually become paying patients of the doctor who ministered to them, and, above all, an enhanced reputation and status within both the medical and wider communities. Thus, social concern could be combined with professional improvement and advancement by the medical profession’s linkage with, use of, and direction of patients to the hospital. To the rural doctor, the city hospital offered both a challenge and opportunity. The growing number of rural patients referred to the Moncton Hospital was an important component in the hospital’s growth. Despite the restrictive wording of hospital bylaws, rural doctors were already assisting at operations in the hospital’s first decade. County physicians were soon agitating, through their county council, for at least consultant status and the right of their patients, or county patients in general, to have the Moncton doctor of their choice. Given the geographic distance from the hospital of some county doctors, visiting status and active service were somewhat unrealistic, but in their guidance of their patients they revealed a desire to refer patients to specific Moncton colleagues, not necessarily only to those who had won the annual hospital board stamp of approval as visiting staff physicians. Although they could not yet make as much use of hospital facilities as their city colleagues, county doctors were as sensitive as their urban

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colleagues to the advantages of hospital treatment for their patients. Rural physicians were also caught up in what S.E.D. Shortt describes as the “revolution,” in which improved highways and the automobile brought medical services to isolated areas.4 Patients now had greater access to the well-publicized services available from the urban hospital and its physicians, while the rural doctors themselves relished the opportunity to sharpen their skills in this institutional environment. Indeed the modern hospital would bring relocation of some country doctors to urban centres, paralleling the situation in the United States where, from 1914 to 1927, one-third of the towns with populations under 1,000 would lose their physician.5 In both the rural hinterland and the metropolitan centre the surgical emphasis in patient treatment was another factor compelling patients and doctors toward hospitalization. Surgery and recovery in a home environment, however clean and comfortable, could not match the safer, sterilized, and better-equipped operating rooms, followed by constant and professional care in hospital wards or private rooms. Patients continued to be categorized as either medical or surgical, with surgery prescribed for the overwhelming majority. Moncton Hospital patients in 1913–14 were 74.4 per cent surgical and 25.6 per cent medical, while in 1917–18 the division was 81.1 per cent surgical and 18.9 per cent medical. Tonsillectomies and adenoidectomies edged ahead of appendectomies as the most popular operations, with hysterectomies a distant third. In 1917–18, for example, out of 694 surgical cases, tonsillectomies and adenoidectomies numbered 149, appendectomies 112, and hysterectomies 12. Diagnosis of medical cases demonstrated a similar consistency as typhoid fever, La Grippe, alcoholism, and syphilis were usually the major problems, joined by pneumonia and tuberculosis in 1917–18. The influenza epidemic from October to November of 1918 did not disrupt this diagnostic pattern – because the hospital itself could not cope with the number of flu victims, a separate emergency facility was created in the new First Baptist Church.6 In terms of the clientele served and support received, at first glance the patterns of the hospital’s first decade seemed to continue, but in reality there were a number of significant alterations. Moncton’s population growth accelerated during the war years, outdistancing the pace of growth in Westmorland, Kent, and Albert counties. Although smaller in population than two of the counties served,7 from 1910 to 1920 the city of Moncton improved its position as the major user of the hospital. At the opening of the decade, Moncton contributed 42.8 per cent and Westmorland county 31.4 per cent of the hospital’s patients, while at the close 48.5 per cent were from the city and 27.9 per cent from the county. The other counties lagged well behind, with Kent contributing

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13.3 per cent of the hospital’s patients in 1910–11 and 10.6 per cent in 1919–20. Albert county was 5.3 per cent of the 1910–11 patient population and “Others” were 7.2 per cent, while by 1919–20 Albert, which slid to 2.9 per cent in 1913–14, was lumped in the “Others” category, which totalled 13 per cent.8 Not only was Moncton the major user through these years but urban patients contributed the highest ratio of paying clients compared to non-paying. This was somewhat concealed in the overall figures since they only reveal a widening gap between the number of private versus public patients. While in 1910–11 61.4 per cent of the patients admitted were private and 38.6 per cent public, this ratio steadily increased in favour of the private side, reaching 66.5 per cent paying versus 33.5 per cent non-paying in 1917–18. When these figures are broken down into the patients’ residences, however, it was the Moncton residents who were much more likely to be paying for their hospital services. From a 59.7 per cent to 40.3 per cent private/public ratio in 1910–11, Monctonians rose to 72.7 per cent private and only 27.3 per cent public in 1917–18. To the chagrin of the Moncton Hospital board, Westmorland county’s ratio moved in the opposite direction. The percentage of county paying patients admitted in the same time period declined from 63.2 to 51.9 while non-paying patients rose from 36.8 to 48.1. The number of patients admitted from other counties and elsewhere was far less substantial, but their private/public ratio followed the Moncton trajectory rather than that of Westmorland. To be sure, Westmorland recovered to a 78.1:21.9 per cent private/public ratio in 1919–20, but this still lagged behind Moncton’s 85.2:14.8 per cent ratio, and the overall hospital ratio of 82.7:17.3 per cent in the same year. As the decade progressed, the hospital board’s perception of city patients largely paying their way and too many non-paying Westmorland county patients was at the root of criticisms of county council hospital support, which badly ruptured the hospital’s relationship with its major county constituent. The increase in the total number of patients served and the changing ratio of private/public clients had an obvious impact on the revenues of the hospital and its grant requirements. In general, if paying patients’ contributions are considered as a percentage of the hospital’s annual total revenues, the institution became overwhelmingly dependent on these fees. There were a few years when the percentage of private patient revenues dipped, because of a special Westmorland county grant of $4,500 in 1913–14, or because of a particularly generous $8,000 donation by Harvey Horseman in 1915–16, for example. Nevertheless, these one-time revenue gains were eclipsed by the steadier and more substantial growth in private patient revenues. These increased from

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$6,291.35 in 1910–11, or 55.9 per cent of the hospital’s annual revenue, to $25,079.90 in 1918–19, or 73.3 per cent of total annual revenue.9 Government funding increases came nowhere near matching private patient revenue growth. The provincial government grant remained steady at $700 per year through the entire decade. Moncton’s annual grant fluctuated from a minimum of $1,500 to as high as $4,000 and closed out the decade at $3,500 for 1918–19. The grant from Westmorland county council likewise rose and fell, from a low of $2,000 to a high of $4,500, and amounted to $2,250 in 1918–19. Support from other counties was meagre to non-existent. There is no evidence of any Albert county support. Kent county gave $1,000 in 1917–18, after giving nothing the year before, but more frequently it was in the $300 to $500 range, with $500 granted in 1918–19. If 1910–11 and 1918–19 are compared, government grants were 39.1 per cent of total hospital revenue at the beginning of the decade and 20.3 per cent by the end.10 Revenues increased as private patient numbers grew, but inflation combined with other escalating expenses to increase the per-day patient cost from 99 cents in 1899 to $1.48 in 1910–11, and it more than doubled to $3.20 in 1917–18.11 Staff salaries grew, and new expenditures were required for equipment and for the renovation of the nurses’ residence, along with the construction of a doctors’ room in the hospital. The board was forced to mortgage the nurses’ residence and use those funds, along with a portion of the Horseman donation, to reduce what had become by 1915 a bank demand note and overdraft totaling $9,937.64.12 To meet rising costs, fees were increased. In 1914, 43 cents per day remained the basic public ward rate, although unpaid by most public ward occupants, while the private room rate was increased to $1.71 per day.13 In April 1918 a sliding scale for semi-private wards and private rooms was introduced that ranged from $2 to $3.71 per day, while surgery charges went to $10 for major operations and $3 to $5 for minor operations.14 The new x-ray department, opened with much fanfare in 1912, proved particularly lucrative. By 1914 this department had carried out seventy-one patient examinations at a private patient charge ranging from $5 to $10; public ward patients were not charged. Six years later, the number of patients x-rayed had leaped to 451, and charges for chest and stomach x-rays, the main services provided, had swollen to $15 and $25 respectively.15 The increased fees in all hospital services, however, were occurring at the same time as, or were possibly a cause of, shorter hospital stays. The average number of days per patient dropped from 12.5 in 1914–15 to 9.2 in 1917–18.16 This decline may have been due to greater efficiency by the hospital staff, pressures to lower the time spent in the hospital in order to ac-

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commodate the increased numbers seeking admission, or, as hinted above, a patient desire for a shorter stay in order to limit expenses. Nonetheless, the board, which was very aware that it was Moncton patients who were making increased use of the hospital and paying for services in greater numbers than their county cousins, not surprisingly sought greater government support, especially from the county. At the provincial level, as in other provinces, expenditures on rising health costs were far from welcomed, but the growing awareness of public health problems forced governments to expand their involvement. They did so reluctantly and the New Brunswick government‘s experience with hospital care for tuberculosis, “the number one killer” in the province at the beginning of the twentieth century, reinforced this hesitance. Faced with a substantial private donation of buildings and land, the New Brunswick government established the Jordan Memorial Sanatorium in River Glade, which welcomed its first patients in 1913. Per diem costs and political criticism quickly mounted: in 1916 the government was contributing $25,000 to the Jordan Sanatorium while giving a total of $10,000 to the general hospitals in the province. This experiment with “government-run health institutions” had become “a sink-hole for money” and, ironically, was not “an effective form of control” for the disease.17 A desire “to evade financial commitment lingered” in the area of tuberculosis treatment and no doubt influenced the government’s general policy of carefully restricted aid to hospitals. The provincial government continued to emphasize local (i.e. municipal and county) responsibility, along with private patient funds, as the financial foundation of hospitals. At the local level Frederick Sumner’s public pronouncements were diplomatically balanced to urge both the city and county councils to face up to their increased hospital responsibilities. In June 1913 he urged the city council to increase its annual grant to $3,000 while the county council contribution should rise to $5,000. Two years later, on his retirement as hospital president, he urged “county and civic grants” of $5,000 each. Increased support was required, he argued, to allow the badly needed expansion of services and to provide treatment for the paying as well as the non-paying patient, and because the “first duty of a community” was “to provide a hospital and then donate enough for its upkeep.”18 Despite some reservations and complaints, from county doctors as well as from a few county councillors, the county usually responded with supportive words and at least one substantial funding increase. Indeed the county council even swallowed, however briefly, a proposal from the hospital board that payment on a per-patient basis for public patients should replace the annual grant

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system. This supportive mood gradually withered in the face of some rather high-handed blustering by the board. Early in 1911 the county council’s generous assessment of the hospital’s utility was matched by reservations concerning Moncton’s real financial contribution. A committee appointed to examine county support recommended a continuation of the $2,000 grant of the year before but went on to point out that Moncton city council only granted support to the tune of $1,500. The city then charged the hospital over $600 for water and light services, which “after deduction makes their grant seem small indeed in comparison with that of the county.” A consistent booster of the hospital, Councillor Medley G. Siddall, praised the “splendid institution,” which was doing “grand work,” but even he suggested reminding the city council that perhaps the county grant should “not exceed that of the city of Moncton.”19 One year later Siddall again extolled the “great work” of the hospital as he moved continuation of the annual grant at the same level, but some critics, while supporting his motion, pointed out that counties like Kent had given nothing to the hospital the year before and the hospital board “was lax” in not seeking such grant support.20 A request from Sumner for an additional $1,000 thus fell upon deaf ears but more active solicitation was soon underway. A tour of the hospital facility was arranged for county councillors so they could see “the newly-finished and outfitted ‘Doctors’ Room’ and the new X-ray apparatus.” By such first-hand experience it was hoped that “a more generous grant” could be secured to help “the city carry out the enlargements in staff and buildings, which will soon be imperative.”21 So impressed were the county councillors that a special grant of $2,000 was proposed in support of the hospital, which would bring Westmorland’s total support for 1913–14 to $4,500. But this special grant had required a visit to county council by a team of board members equipped with facts and figures and helped by the arguments and manoeuvres of supportive councillors. The hospital delegation, composed of Sumner, John H. Harris, James A. Geary, and George Willett, now sheriff of the county, was given ample opportunity to provide concrete figures about the hospital’s finances. The institution’s growing deficit was emphasized while the delegation answered, primarily through Sumner, some of the remarks of less than sympathetic councillors. J.W.S. Black from Sackville parish and Fred Magee from Botsford were particularly blunt in urging a larger grant from the city of Moncton, a county review of the method of payment for the poor patients whose numbers varied from parish to parish, and a more business-like approach by the hospital. Sumner responded quickly by acknowledging that counties like Kent had been negligent in their contributions and agreeing that there should be more of “a business basis

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in the matter of grants,” rather than requests such as this for special support. Very aware that Moncton itself might be considered somewhat negligent in its contributions, Medley Siddall argued that the city’s grant was only a part of its support. Just a week earlier, he contended, a picnic he attended had realized about $1,200 in support of the hospital, 90 per cent of which came from the “citizens of Moncton.” Despite such arguments, when it came to the vote it was ruled that only one annual grant for the hospital was legally allowed and, while most councillors supported the legitimacy of the hospital’s case, a motion for a special grant was out of order. Siddall rescued the situation when the council reconvened in an evening session by moving, and gaining eight-to-three approval, for a special grant “subject to ratification” by the provincial legislature.22 By January 1914, with the special grant now legitimized by the New Brunswick legislature, the county council formally raised its annual grant to $2,500 and added the special $2,000 grant for the hospital. Yet this passed only after Sumner again made a formal request supported by detailed figures. At the same time the county council made clear it was going to continue to demand appearances by a “hospital delegation,” which should come armed “with a financial statement and give other details as to management” and other matters.23 A year later, despite suggestions to amend the grant to $2,000 or $1,500, amid argument that wartime expenses made the hospital grant unsustainable, it remained at $2,500 for 1914–15.24 But the next year brought criticisms of the hospital’s management to the fore, and exposed the board’s exasperation at the growing questions and criticisms as well as the increasing number of public patients arriving from Westmorland county. Two major issues emerged that badly soured the county/hospital relationship, and both were rooted in what appeared to be arbitrary actions of the hospital board. In July 1915 the county council was presented with a petition signed by twelve Westmorland county doctors, which complained about the policy by which the Moncton Hospital selected its visiting staff of doctors. The physicians argued that patients entering the public wards had “to employ the physician or surgeon then doing service in the wards,” thereby denying public patients “the privilege of employing the medical attendant in whom they [had] the most confidence.” The practice of non-paying patients being treated only by the physicians elected by the hospital board was in accordance with the hospital’s bylaws, so the county doctors urged a change whereby patients could be treated by doctors of their choice, provided “said attendant [was] a qualified physician living and practising in the City of Moncton, and having offered his services to the hospital without fee.”

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As debate unfolded over the next seven months, what seemed a request for a limited change in hospital policy mushroomed into an indictment of the board’s management and decision-making. Shediac doctor Alphonse Sormany was present at the July 1915 meeting as spokesman for the proposed change, while George Willett, hospital board member, was in attendance to speak against the proposal. Both over time eventually indicated what lay behind the request. Willett was the first to let slip that the trustees tried to select “the very best men” every year as hospital staff, and “in some cases some of the very best men had been dropped in some years.” In a later meeting, in January 1916, Sormany was more direct about what sparked the county physicians’ proposal. He contended that “it was important to have good surgeons on the hospital staff” and “a great mistake had been made when a certain surgeon in Moncton had been left off the medical staff last year.”25 The roster of six doctors selected by the board for 1914 and 1915 reveals two possible candidates for exclusion, both of whom had been at the centre of controversy earlier in the hospital’s history. In June 1914 Dr Purdy was placed on the consulting staff, rather than among the six elected, while in June 1915 Dr Myers found himself relegated to consulting status.26 Sormany could have been referring to either physician, although probably the reference was to Myers, with his well-known surgical abilities. Was consulting a less honorific role? To Dr Henry Coleman, it certainly was. Consistently re-elected as the doctors’ representative on the board in this period, he complained loudly at one board meeting that the “consulting physicians were only considered as ornaments.” He believed that they should be actually consulted “in case of a major operation.”27 Several times during these board elections, medical staff had presented motions to expand the number of visiting staff from six to eight (Dr McCully did so in 1911 and Coleman tried again in 1912), but on each occasion their attempts were blocked by other board members, who kept the number of visiting staff at six.28 Medical staff decisions by the hospital board of trustees were obviously a sore point among both some Moncton physicians and their county colleagues, but a limited expansion of the number of visiting staff, or a responsiveness to the county physicians’ proposal, could have solved the problem. Instead, some board members dug in on the issue and gave already unsympathetic county councillors further evidence of problems on the board. In the first exchange on this question, in July 1915, George Willett was adamant that the proposed change would cause substantial “inconvenience,” it would not work out “satisfactorily,” and in any event poor patients were receiving “the very best of medical skills” and

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were not “neglected in any way” by existing board policy. Sackville councillor C.C. Campbell supported Willett, pointing out that “the doctors and officers of the Moncton hospital devoted considerable time” to the institution, and the hospital seemed to him “well managed.” Eventually it was agreed to postpone further discussion until Clifford Robinson, board member and hospital vice-president, arrived later that day. When Robinson joined the discussions at the council’s evening session, along with another board member, John Rayworth, evidence emerged of board divisions on the staffing question as well as of council suspicions of the board’s capability. Robinson assured the councillors that their input concerning this possible change in staffing bylaws would be welcomed by the hospital board, although “some members … had very strong views on the question of electing a hospital staff.” “Personally,” Robinson indicated, “in the past, he had favored some change in the method of electing a medical staff.” Rayworth, however, emphasized the board’s commitment to the “very best system” of caring for the sick poor and cautioned against any immediate change before careful thought. Perhaps the matter could be delayed “until the next session” and a compromise could be worked out to meet the petitioners’ desires. Instead the councillors supported what was now being described as an “open door policy,” and some ventured to suggest the need for “changes every year in the Hospital Board” as a remedy to such problems as the injustice of dropping “a certain doctor.” At this point Robinson was moved to defend the board, maintaining that the hospital “was pretty well run”; furthermore, the proposed change might create problems, and there appeared to be “a mistaken impression that the Hospital Board was run by a ring.” The Westmorland council remained convinced that change was necessary and supported the proposal of the county physicians by unanimously voting in favour of the petition.29 The ball was in the board’s court. When the hospital board refused to move on this matter by January 1916, it faced an irate council still demanding change and initially willing to vote down any grant at all for the hospital. On its part, the hospital board now created the second divisive issue by threatening to deny hospital services to non-paying Westmorland county patients unless adequate county funding support was arranged. County criticisms of hospital board high-handedness rose to a new peak. On 19 January 1916, Westmorland county council met and the Moncton Hospital was high on its agenda. A hospital delegation consisting of president James Doyle, Hugh Hamilton, A. Cavour Chapman, and George Willett appeared at the afternoon session for a two-hour discussion. Doyle lacked the diplomacy once provided by Frederick Sumner as he brusquely informed the councillors that he wished they “were better

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acquainted with the affairs of the Moncton Hospital” so that “it would not be necessary for a delegation to come to the council and ask for a grant.” They were here to lay their “claims,” however, partially because of a letter that had appeared in the press suggesting “that the county grant to the hospital might be dropped this year.” Hamilton moved quickly to the core of the delegation’s presentation by pointing out that in the past year 108 public patients had been admitted from Westmorland county for a total of 2,076 hospital days at a cost of $3,930. Since the county grant was only $2,500, “there was a deficit of $1,135 [sic] for keeping public patients from the county.” Willett handled the proposed medical staffing change equally swiftly by reiterating that “patients sent to the public wards received the best medical treatment free of charge.” Moreover, he suggested what might be the future funding arrangement between county council and hospital: the county should pay the full bill for its public patients and do away with the annual grant. Dr Sormany was present and made his case for bylaw changes, an open door policy by which public patients could ask for the services of any Moncton physician, and expressed his hope that with such a change “as generous a grant as possible” could be approved. Several councillors echoed their support for the bylaw change. When a motion was finally moved that the usual grant of $2,500 should be made, inflammatory comments by Doyle and Chapman did not help the hospital cause. Chapman emphasized that the proposed grant was insufficient to pay for the county’s public patients since approximately $4,000 was necessary, while Doyle thought that “very probably this would be the last time a delegation from the Moncton Hospital would wait on the County Council. In future they would send a statement to the Council Board and let them deal with it as they wished.” The mood of several other councillors was no doubt captured by Botsford representative Wilbur Allen, who blurted out: “The Hospital Board delegates were bluntly telling the council to pay for the county patients or get out.” An attempt to lower the grant to $1,500 was ruled out of order and then the motion for a grant of $2,500 was voted on. Council split with eight in favour and eight opposed, and the motion was lost.30 It was a drastic measure to withdraw all support from an institution that most councillors acknowledged was vital to the health of the county. Consequently, after the satisfaction of publicly rebuking the hospital delegation, when the county council reconvened the next day, a motion authorizing a $2,500 grant was passed. But “$1,500 of said amount [was] not to be paid until satisfactory arrangements can be made on or before the July session, with trustees of said hospital.”31 The following June the hospital board clarified the only “satisfactory

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arrangements” it would accept. These were a variation of Hamilton’s figures and Willett’s formula, with a threat to withdraw hospital services thrown in. The board unanimously passed the motion that since the county grant was only $2,500, and during the most recent year eighty-six public county patients had been treated at a cost of $1.83 per day for 1,922 days for a total cost of $3,517.26, the county council faced two options. It could “increase [the] annual grant to $3,000 for the present year, or, pay at the rate of cost per patient per diem.” In the event that council found these conditions unacceptable, “we will be compelled to refuse all non-paying patients from the County of Westmorland.” The same ultimatum was issued to Kent county, except that the annual grant requested was $1,000.32 By the time this funding proposal was presented to Westmorland county council, the hospital board had rubbed further salt in the wound by a request for immediate payment of the “$1,500 balance due on this year’s grant.”33 The council’s reaction was surprisingly acquiescent. Within the county council there were those who felt that payment on a per diem rate might be a less expensive approach for their own parishes if the rate was carefully controlled and was paid on a parish residence basis where overseers of the poor would determine eligibility. Residents of parishes some distance from Moncton had not used the hospital as much as those in closer proximity, while in the more prosperous parishes fewer public patients had used the hospital in any event. Thus, to some parish councillors, the old grant system had meant they were assessed on the same basis as poorer neighbours living closer to Moncton who made greater use of the hospital facilities. Here was an opportunity to lower the cost to their constituents. As one councillor put it, each parish should pay “for the poor patients sent to the Hospital by the overseers of the respective parishes. By that measure they would be paying for what they got and getting what they paid for.” Only Medley Siddall was perceptive enough to see an escalation of costs to certain parishes, which “would probably cost the county more like $5,000 than the $2,500 grant” as well as the disservice to poor patients: “If the sick were to be left to the overseers of the poor they would not be very well cared for.”34 Nonetheless, the county council moved to the per diem by parish approach in two steps. In July 1916 council agreed to pay the remaining $1,500 of the annual grant, although some councillors could not resist getting in their last licks about the need for “a change in the Hospital Board” with comments that unless there was “a shakeup” in the board “eventually there would be no hospital.” This was followed in January 1917 by the abandonment of any annual grant in favour of each parish paying the Moncton Hospital “for each poor patient sent from said parish an

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amount not exceeding $2.00 per day, medical attendance included; Moncton City Hospital to notify the overseers of the poor in parishes.”35 Within the year the inadequacies of the new system were apparent to both the hospital board and county council, and changes in the board opened the way for a far more harmonious relationship. A. Cavour Chapman’s selection as president of the hospital board in June 1917, his position as alderman on Moncton city council, and his presence as one of Moncton’s two representatives on the Westmorland county council placed him in an ideal position to broker a new relationship. At the county council’s July 1917 meeting Chapman outlined the failure from the hospital’s point of view of the per diem system. Inflation costs meant, he explained, that “$2 a year or two ago means $3 today.” As well, the system was proving inefficient in terms of collection from the parishes and costly in that an extra bookkeeper would have to be hired “to render bills to the county for all poor patients.” What he proposed was a return to the annual grant system with the council immediately advancing the hospital “$1,000 on account.” Councillor C.C. Campbell supported Chapman. Although his own area, Sackville, had gained under the per diem system, the disadvantages were now clear in that, in the hands of overseers of the poor at the parish level, “some people would not go to the Hospital, and it was a hardship on some poor people.” Chapman’s request was approved, the county council contribution would rise to $2,500 for 1917–18, and the grant would be set at $2,250 for 1918–19. All this was achieved as county councillors now talked of “the best of good will toward the Hospital,” and its “excellent work.” In January 1918, Dorchester councillor A.A. Stevens captured the new mood: “The Moncton Hospital was a credit to any place and the people of Moncton were to be congratulated on the splendid institution being conducted and it was necessary to support it.”36 Changes made to the Moncton Hospital board of trustees were a vital factor in this complete turnaround in the board/county council relationship. The build-up to these changes, which were achieved by an act of the New Brunswick legislature in June 1917, revealed a hospital board whose decisions were being challenged by some of its urban constituents as well as by county critics. The number of board members had increased slightly in April 1916 with an amendment to the Moncton Hospital Act that authorized the city of Moncton to appoint three board members, the Westmorland county council to appoint three, and the addition of two women members for the first time, the president and secretary of the Ladies’ Hospital Aid.37 As noted earlier, up to this point, the individuals serving as elected trustees, and the executive they annually elected, had changed very little from year to year. The same

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board members were usually re-elected with little public interest, until 1916 when a campaign was launched for further changes to the board that caused some of the same criticisms, and board reactions, precipitated by the county accusations. To what extent the urban-rural complaints were linked is uncertain but there was probably a very strong connection as a result of the full coverage both hospital affairs received in the press. Frederick Sumner as president of the board, James Doyle as vicepresident, John Harris as treasurer, and Hugh Hamilton as secretary were annually re-elected from 1910 to June 1915, when Sumner was replaced in the presidency by Doyle, who in turn was succeeded as vicepresident by Clifford Robinson, a long-time board member and now a direct representative of Moncton in the provincial legislature. Sumner stepped down at that time to accept appointment as New Brunswick’s agent general in London. It was a fortuitous departure, since his colleagues were about to come under heavy attack, although Sumner would share some of the abuse when he briefly resurfaced on the board a year later. Paralleling the executive situation, familiar figures such as Edouard Girouard, George Willett, John Rayworth, James A. Geary, and Andrew H. Jones, among others, continued to serve as board members, while the medical community consistently selected Dr Henry Coleman as board representative. In 1916 and 1917, however, newspaper headlines trumpeted “lively” public meetings, “lengthy and spirited sessions,” the “demand for new blood,” the “Resignation Of Five Veteran Members,” and “Public Criticism In Some Quarters Believed Responsible For Retirement Of Valued Members.”38 Complaints by several physicians about the superintendent favouring “certain Doctors” and about compliant long-serving trustees led Moncton lawyer Francis (Frank) P. Murphy to champion board membership changes,39 although his initial actions to get himself and other new candidates elected to the board in 1916 did not appear that radical. His efforts provoked such a board reaction, however, that Murphy felt compelled to take the matter to court, where his contentions were hotly contested by the hospital board. Eventually intervention by the New Brunswick legislature produced victory for Murphy and a restructured, expanded, and more representative board. While the end result benefitted the Moncton Hospital, the outgoing board’s stubborn rearguard action left some long-serving and valuable board members under a cloud that obscured the vital contributions they had made over so many years. While there had been little public response or interest in the election of hospital board members, which occurred at the annual public meetings in June, the bylaws of 1901 allowed anyone attending the meeting

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who donated at least $5 to vote in these elections. Then the board executive would be chosen by the new board. As Murphy’s lawyer claimed in the eventual legal action, the hospital “corporation got along very well with the law for fifteen years and no repugnancy was discovered until some of the persons who paid their fees and were invited to vote did not vote to suit some other estimable persons on the inside.”40 But, the hospital board responded, the particular bylaw in question had been altered at a trustees’ meeting on 10 May 1916 “by striking out the $5.00 qualification and making it $1.00.” Furthermore, it was the plaintiff (Murphy) “who is a Barrister-at-Law, practising at Moncton” who “was acting professionally in the matter, [who] had drafted the change in the Bye-Laws, and submitted it for enactment and the fair inference from the evidence is that the new voters attended the meeting at the request of somebody and the qualification moneys of a large number were paid by them.” Thus on 14 June 1916, claimed the board’s lawyer, “38 persons came forward, paid $1.00 and claimed the right to vote and did vote for the election of trustees. This enabled these newcomers to control the meeting.” It was the board’s legal position that it now realized the bylaw had been illegal from the outset since “the corporation or trustees” had no power “to pass the Bye-Laws purporting to qualify persons who were not trustees or members of the corporation to vote.”41 Coverage in the press made the whole affair seem less conspiratorial, but the desire for a changed board was clear and the board’s legal argument, while judged valid in court, seemed contrived and based on a reluctance to admit critical newcomers to board membership. At the 14 June 1916 annual meeting there were three trustees whose terms expired – Hamilton, J.M. Lyons, and Girouard. Hamilton and Girouard were re-nominated and a number of other candidates, including Frank Murphy, were also nominated. After old hands and newcomers all voted, Reid McManus, Frank Murphy, and Camille Belliveau were elected. The new board then met, including Murphy, and elected James Doyle as president, Clifford Robinson as vice-president, and Reid McManus as treasurer. There were no volunteers for the secretary’s position, long held by the now defeated Hamilton. One week later, an “adjourned annual meeting” reconvened to hear the opinion of the hospital legal counsel that the bylaw concerning who could vote was illegal, that the election should be rescinded, and that the trustees alone should vote on the new trustees. Frank Murphy was present and disagreed at length with each contention of the hospital’s lawyer. The board split over the issue. Doyle emphasized that they had only been trying to get people to take an interest in attending the meeting when they made the one dollar bylaw change, and “did not know it was ille-

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gal until now.” Robinson believed “there was something in Mr. Murphy’s argument” that it had been a legitimate election. A. Cavour Chapman, a relative newcomer, having only joined the board in 1914, tried to mediate by urging resolution “in some amicable way” to “avoid eternal strife.” Sumner, recently returned from England, also seemed willing to accommodate change. Although initially leaning to acceptance of the hospital lawyer’s advice, he then offered to resign himself so someone else might be elected in his place and thus the question could be “amicably settled.” Failing that, Sumner moved that the disputed election of the three trustees should stand, but his motion was defeated. Instead a motion was moved and passed to rescind and annul the election, with only Dr Coleman, Clifford Robinson, and county councillor C.B. Keith dissenting. A new election was immediately held, with Murphy able to be nominated but now denied the right to vote. The result was the election of Reid McManus, Hugh Hamilton, and Camille Belliveau. Murphy continued to object and challenge, supported by the outspoken editor of the Moncton Transcript, John T. Hawke, who engaged in a “lively tilt” with Doyle to no avail. Hamilton was then restored as secretary on the executive.42 The “new blood,” or at least Frank Murphy and his interpretation of board electoral procedures, had been defeated. Murphy was unrelenting, and by the end of June was pursuing the issue in court, seeking restoration of his place on the board and injunctions against board actions.43 When his claims were dismissed in December, Murphy fought on with a higher court appeal, which was rendered unnecessary when the provincial legislature passed “An Act consolidating and amending the Acts relating to ‘The Moncton Hospital› on 22 June 1917. This legislative measure resulted from Robinson’s presence in the legislature and his support for Murphy’s position.44 The legislation totally vindicated Murphy and restructured the hospital board to make it a more representative body. Henceforth the board was to be composed of twenty-five members, twelve of whom were to be elected, six in each of the next two years, and each with two-year terms. Thirteen members of the new board were to be appointed for one-year terms: three by the “Governor-in-council,” three by Moncton city council, three by Westmorland county council, one by the Kent county council, one by “the Medical Society of the City of Moncton,” and two by the Ladies’ Hospital Aid. Both appointed and elected trustees could be re-appointed or re-elected. The legislation co-ordinated the arrival of the new trustees with the departure of the old. On the crucial matter of electoral procedures, the right to vote in trustees’ elections was given to all board members, to all persons who at any time contributed $25 to hospital funds, and to “all

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persons who shall have contributed two dollars ($2.00) during the year ending thirty days previous to the annual meeting.”45 Frank Murphy had prevailed. The new Hospital Act had not yet received final legislative approval when the hospital board held its annual meeting on 13 June 1917, but the board members revealed that they were aware of the change about to occur. Some had prepared written statements while others simply announced their intentions. Five of the “old directors,” described by a sympathetic Times reporter as “men who have been earnest and zealous workers in the cause ever since the hospital was first opened,” resigned or indicated they did not wish to accept re-appointment. Andrew Jones, the treasurer, was first to decline further board service, followed by vice-president Clifford Robinson (despite his support for Murphy and the new legislation), secretary Hugh Hamilton, founding president George Willett, and president James Doyle. In all cases where explanations were offered, there were gracious and grateful words. Only Hamilton seemed a bit defensive as he recalled that “it had been, especially in the earlier and struggling days, a pleasure to work side by side with my fellow-citizens, men who I am satisfied were not actuated by self-interest but were working solely for the upbuilding of an institution which I can say without fear of being challenged has accomplished good work in our midst.” There were some polite protestations not to resign, but a new board quickly took shape. A number of board seats would remain vacant but James A. Geary, Joseph A. Marven, and F.W.S. Colpitts were elected as directors, and the new executive, chosen immediately, consisted of A. Cavour Chapman as president, John H. Harris as vice-president, Reid McManus as treasurer, and F.W.S. Colpitts as secretary.46 It would take two further annual meetings in 1918 and 1919 before the new board was completely operative as outlined in the new legislation, but despite the further changes the executive chosen in 1917 remained the same, except that L.F. Wallace replaced Colpitts as secretary in 1919. Frederick Sumner was among the six retiring directors in 1918,47 ending his long and dedicated service on the board. No one realized that a year earlier A. Cavour Chapman had embarked upon an even longer period of service: he would remain president of the hospital for over a quarter of a century. Within a short time the changed board ended the medical staffing logjam caused by the old board’s restriction of the visiting staff to six doctors annually, although subtle changes were already well underway before the much acclaimed “standardization” of staff was achieved in 1918.48 Veteran physicians James Ross and Oscar McCully had passed away in 191149 and new recruits, such as doctors Paul McL. Atkinson and A. Raymond Landry, gradually appeared on the hospital roster.

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Their accommodation, as well as the consistent re-appointment of board favourites Louis Bourque, William Ferguson, Fred White, and Leveritt Price, limited the visiting positions available. Offsetting this was the appearance of specialized positions, as well as an expansion in the ranks of the consulting physicians, ornaments or not, which provided some room for growth. Already in 1910–11, the six acting, or visiting, physicians were buttressed by four consultants (L.C. Harris, Henry Coleman, Robert Botsford, and Clinton Purdy), along with three physicians described as “Oculists and Aurists” (Gaius Smith, Sherman Burgess, and Oscar McCully).50 In 1912 the six elected visiting staff were backed up by eye, ear, nose, and throat specialists Smith and Burgess, a new x-ray specialist, Dr George O. Taylor, a new dental surgeon, Dr Charles A. Murray, along with Coleman and Dr Fred Richard as consultants.51 A request from the county doctors in 1913 to add two of their number as consultants was accepted, and Merville A. Oulton of Shediac and J.D. Calkin of Sackville were included with the two local consultants, six visitors, and three of the above-named specialists, since Dr B.F. Reade was now dental surgeon.52 The biggest change, however, came in 1918, with what the press described as the “standardization of staff”: its division “into two classes, medical and surgical, as is the system in other hospitals.”53 There would now be a three-surgeon staff (Ferguson, Myers, and White), six medical staff (MacNaughton, Bourque, Coleman, Landry and McL. Atkinson from Moncton, and Howe Alonzo Jones from Salisbury), eye specialist Sherman Burgess and radiologist Fred Richard, as well as four consultants (A. Henry Chandler and Leveritt Price from Moncton, with Wallace G. King from Petitcodiac and Edward T. Gaudet from Memramcook). The staff had been considerably enlarged, and the county links strengthened, but, consistent with past staffing choices, the Moncton additions revealed a continued McGill dominance in academic training. New staff doctors George Taylor, Paul Atkinson, and A. Raymond Landry were all McGill trained. County physician additions enjoyed the same academic background, with Edward Gaudet, George W. Fleming from Petitcodiac in 1916, Howe Alonzo Jones, and Merville A. Oulton from Shediac in 1913 all McGill educated. The only exceptions were J.D. Calkin from Sackville in 1913, a medical graduate from the University of Vermont, and Wallace G. King, who was trained at the Cincinnati College of Medicine and Surgery.54 A number of other shifts occurred in the hospital’s second decade that the institution had to come to terms with now or in the near future. The pressure of patient numbers led to the creation in 1916 of an out-patient service, although this may only have caused further problems since apparently “treatments were given in the operating room

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due to lack of space.”55 Another revealing shift among patient numbers was demonstrated in the gender breakdown for 1917–18, when for the first time in the hospital’s history women outnumbered men patients (438 females to 393 males).56 And yet, despite much discussion of improving maternity services, as of 1918 the Moncton Hospital had no obstetrical service. As early as 1911 the Ladies’ Aid Society, responding to a request from the hospital board, committed itself to raising $1,000 for the “proposed erection of a maternity ward.”57 As at the national level, however, giving birth in a hospital would not become widely accepted until the 1920s and 1930s. In Ontario, for example, “as late as 1939 more births occurred at home than in hospitals.”58 Faced with this reality, and the inevitable lack of space for such a ward, the $1,000, which was raised by May 1912, was placed “in reserve” for the day when such a project could be brought to fruition.59 Other projects were equally enthusiastically endorsed and funds were raised through tag days, balls, picnics, and door-to-door canvasses of the entire community. Such efforts produced over $1,000 to help renovate and enlarge the nurses’ home, the supplying of linens and ice cream on a regular basis, and, as the decade closed, over $4,000 for a motor ambulance and close to $1,300 as the “nucleus of a building fund for a new hospital.”60 At times these fund-raising ventures were in alliance with specific individuals – Mrs (W.F.) Emma Humphrey’s picnics were huge successes – or with other organizations, such as the Moncton branch of the Canadian Red Cross Society in the case of the new ambulance. The Ladies’ Aid Society’s executive and membership continued to be dominated by wives or other relatives of doctors, board members, city councillors, or other prominent Monctonians, and executive representation for the churches of Moncton also continued. This vital church link was preserved if not enhanced. Likewise expanded were connections with county women, as donations from Kent, Albert, and Westmorland counties were a feature of almost all campaigns launched.61 By 1915 there were apprehensions that too “many calls upon the public, owing to the deplorable war,” as one woman supporter feared, would divert funds, or as a board member put it, “cut off” our “help” from the Ladies’ Aid.62 But even during the darkest days of the conflict, the women’s organizations successfully met both their “patriotic work” and their hospital commitments. Consequently the appointment of the president and secretary-treasurer of the Ladies’ Aid Society to the hospital board in 1916, which remained a feature of the restructured board in 1917, was an overdue acknowledgment of the organization’s vital contribution. The Toronto General Hospital would not have a female trustee on its board until 1938 – although, admittedly, a small

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hospital in Owen Sound, Ontario, “granted representation (by nomination)” to women in 1909.63 With pride, and yet understatement in view of the active role they soon would play in one of the hospital’s most important management decisions, the president and secretary of the Ladies’ Aid Society reported in May 1919 their faithful attendance at all board meetings, placement upon “several committees,” and active engagement “in hospital affairs.”64 One of the causes closest to the hearts of women supporters was the nursing school and residence, with the result that any attempt to improve living conditions for the nurses was strongly endorsed. In the nursing school, although details are lacking and the only study available is a biography of Alena J. MacMaster, whose stewardship of school and hospital began in 1919,65 the curriculum, training, and working conditions largely paralleled the national situation. Nursing remained one of the few occupations open to young women, although the demanding nature of the apprenticeship and eventual career work was widely known. The occupation acquired new respectability and public recognition as a result of the challenge of the war years and crises at home, such as the Halifax explosion in 1917 and the influenza epidemic shortly after.66 At institutions such as the Toronto General Hospital, the rising interest in nursing studies and the desire to serve were reflected in a substantial increase in applications that peaked in 1915 and declined as the war wore on.67 There were thirty applicants to the Moncton nursing school in 1913, only seventeen by June 1914, but a rise again to thirty in 1916 and an apparent decline by 1918, when zero probationers were admitted. The number of nurses in training increased steadily from nine in 1913 to nineteen in 1918 but during the same period the difficulties of a student nurse’s life, or the opportunities emerging in other work force sectors, meant that the graduating classes only numbered three or four each year.68 The program required long hours in the wards (likely the standard twelve-hour shift for six and a half days a week) followed by lectures by the hospital doctors or senior nurses. A comparison between the lectures offered in 1913 and 1918 reveals little change in the topics covered. In both years the subjects taught – Bandaging/Surgical and Operating Room Technique, Surgical Emergencies and Gynecology, Anatomy and Physiology, Materia Medica, Medical Diseases, Anaesthetics and Minalysis, Bacteriology/ Sterilization and Disinfection, Obstetrics, and Special Senses – and the doctor/lecturers – doctors Ferguson, Myers, White, Purdy, Price, Richard, McNaughton, Bourque, and Burgess respectively – remained almost the same. Atkinson replaced Purdy teaching Materia Medica, while Price’s Medical Diseases and McNaughton’s Bacteriology/Sterilization and Disinfection were dropped, but otherwise this part of the curriculum

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remained the same. On the other hand, senior nurses who lectured in the program had changed, a testimony to the turmoil at the top level in this area, as Lottie E. Corbett and E. Blanche MacDonald were listed as head operating nurse and superintendent respectively in 1913 but replaced in both positions by Edythe B. Damery in 1918.69 The nurses’ training school followed what was now the standard length and steps of other Canadian nursing programs. After admission, there was a three-month probationary period, followed by acceptance as a “junior” nurse in training, then “intermediate,” and finally “senior” nurse status with progressively heavier duties in the three-year program.70 One innovation introduced in 1916 was to co-ordinate, or supplement, Dr Bourque’s obstetrics lectures with the practical wisdom offered by a woman employed at one of Moncton’s several maternity hospitals. In the third year of their training Moncton student nurses were to have a two-month obstetrics course “at the maternity hospital under Miss Doherty.” Also during Bourque’s lectures the same “Miss Doherty” came to the hospital “one hour each week for class, thus assisting the nurses with the lectures and preparing them for practical work.”71 By 1918 this training arrangement was transformed into “a three month training period in obstetrics and infant feeding” that was arranged at Saint Luke’s Hospital in New Bedford, Massachusetts. Although caesarean section operations within the hospital increased to six in 1916,72 without a maternity ward there might seem little demand for such training. But since the majority of graduate nurses would seek private practice employment and be involved in home birthings, and student nurses might assist doctors in such activities, it was an excellent addition to the Moncton curriculum. Rewards within and after the program looked attractive when compared with the lot of women in other activities. The satisfaction and praise expressed by patients was, of course, welcome and gratifying. One typical comment offered by a 1916 patient underlined the virtues of Moncton’s nurses and the respect they earned. Nurses, he wrote after his “experience of life” in the hospital, were “the best and sweetest of women, untiring in their attentions to the sick, always amiable and ready to do anything they are asked to do, performing what must be most disagreeable duties without the slightest sign of distaste, always smiling, cheerful and obliging.”73 More tangibly, student nurses usually were paid “monthly stipends of $8, $10, or $12” depending on the level they were at,74 although in Moncton the scale might have slightly differed, since in May 1918 the board approved a motion that student nurses “receive the sum of $8 [monthly] for their first year, $12 for their second and $15 for the third and last year.”75 Sensitivity to the needs of graduate nurses was demonstrated by Dr Coleman a year later

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when he moved that the “much overworked” operating room nurse, Miss Florence Snell, should be “given an increase in salary up to $80 per month.”76 Head ward nurses in Vancouver earned $50 per month in 1914, so Moncton might have been lagging a bit. It has been estimated that at the national level by the end of World War I, graduate nurses in private practice had real earnings as high as $1,000 annually but between $400 to $750 on average, which, while not a pot of gold, placed them ahead of other working women in industrial or whitecollar employment.77 The nation-wide expansion of the number of student and graduate nurses from less than 300 at the turn of the century to over 20,000 by 1918 led to considerable occupational flexibility and mobility for women willing to move to better opportunities available across Canada and in the United States.78 Higher salaries, better working environments, and the urge to wander west or south to newly expanded facilities were probably major reasons for the Moncton Hospital’s difficulty in securing a long-lasting superintendent, a difficulty that reached crisis proportions in 1918–19. Sophie MacDonald had taken the reins as superintendent in 1909 and was frequently praised for her “very able” management of the hospital. Thus the board expressed “regret” and yet “appreciation” for her fine services when in late 1911 she submitted her resignation to take effect in January 1912. Blanche MacDonald, originally from Saint John, had served as head nurse at the Moncton Hospital for two years and was promoted to acting superintendent, followed by a permanent appointment as superintendent on 23 February 1912. At the same time the board was pleased to report that a former Moncton resident had come home to work at the hospital. Lottie Corbett, after working in the United States for several years, returned to Moncton because of her father’s serious illness and accepted appointment as head nurse. Although taking a brief leave from June to December of 1915 to serve with a Harvard unit of doctors and nurses in the overseas war zone, Corbett continued at the hospital and was appointed to succeed MacDonald when she resigned as superintendent in January 1916. Two years later, however, Corbett was lured back to the United States for what was described as “an important position on the staff of Brooks Hospital, Boston.” Kind speeches, a gold wristwatch from the medical staff, and a “purse of $40 in gold” from the hospital board marked her departure, as well as a press tribute to a woman who had “devoted unsparingly of her time and energy towards the successful operation of our City Hospital.”79 Lottie Corbett, as the board now discovered, was going to be extremely difficult to replace. In the period from January 1918 to August 1919 three different superintendents were tried before Corbett’s match

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was found in Alena MacMaster.80 After Corbett’s resignation, a graduate of the hospital’s own nursing school, who had served as head of the operating room, Edythe Damery, was appointed acting superintendent, but in March 1918 the board was again reviewing applications. When the chosen candidate, a “Miss MacDonnell of Montreal,” could not be won over, a special committee was struck “to engage a superintendent at the earliest possible moment.” Triumph came when Adele M. MacDonald arrived in June 1918 to assume her duties as superintendent. Originally from Montreal, she was recruited in New York at a salary of $100 per month,81 but her stay in Moncton was brief: in January 1919 another graduate of the Moncton nursing program, Grace Myles, had to be appointed acting superintendent.82 By May of the same year Myles in turn served notice she would be resigning on the 1st of June 1919. Board members were by now freely commenting on the chaos caused by this constant change, since “as soon as one superintendent gets well trained there is another change.” Various suggestions were made to rectify the problem. To board member George J. McClure, arrangements should be made to select and train a superintendent from among the existing nursing staff “and thus stop the practice of going abroad for a superintendent.” Other board members urged an increase in the salary offered. But the most substantial and possibly most attractive change to the position occurred with the passage of new hospital bylaws in May 1918 that clarified the authority of whoever served in the position. “The duties of all in connection with the hospital staff are fully defined and the enforcement of the same [are] left entirely in the hands of the new superintendent.”83 While George McClure continued to press for an internal candidate, it was the women members of the board who seized the initiative and eventually backed the candidacy of a woman who at least partially met McClure’s specifications. In mid-May of 1919 board member Mrs (R.P.) Cora Dickson pushed through a motion “that advertisements be placed in Montreal, Boston, Halifax, St. John and American papers for a superintendent for the Moncton hospital.”84 This produced six applications, which were brought before the board in July by McClure, as chair of the applications committee. One of the six was recruited privately by Cora Dickson, who had already informed her that “we all want you and feel sure we can at once come to satisfactory agreement.”85 As a result, seconded by Mrs (F.L.) Harriet Doyle, Dickson quickly moved “that the board accept the application of Alena Jean MacMaster, of New York, who graduated from Moncton hospital in 1909.” Other board members were not as immediately ready to accept MacMaster. Dr Coleman expressed concern that “the selection ought to be made by ballot” and that the committee “had failed in its duty.”

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McClure said selection should be made by “the full board” (only eleven board members were present) and that “the committee did not wish to be responsible for the appointment.” Finally it was decided to refer the matter back to the committee, composed of McClure, Allie E. McSweeney, Coleman, L.F. Wallace, Mrs Dickson, and Mrs Doyle. The decision was a squeaker: after further deliberation the report came back “that a majority of the committee had decided upon Miss MacMaster.” The board then unanimously approved this recommendation, although it was “understood that for the first three months Miss MacMaster was on trial at $125 per month, permanent arrangements to be made at the expiration of that period.”86 While not an internal candidate by McClure’s definition, MacMaster, born in New Brunswick’s Northumberland county, was one of the two graduates in the Moncton nursing school’s first class; she had worked at the hospital until 1912 and would have been well known to other medical staff as well as to some board members. Her career involved further studies and work as superintendent in several hospitals in Oklahoma and New York. In September 1919 the press reported that she had arrived from New York City and “assumed charge of the institution.”87 Alena J. MacMaster would remain very much in charge for twenty-eight years. The inauguration of MacMaster’s superintendency was significant not only for the determination of the two women board members that she should be appointed. At roughly the same time, at least one other hospital in the Atlantic region, in St John’s, Newfoundland, was the scene of a bitterly contested battle over female responsibility for nursing and the overall direction of a hospital, and when control “was taken from the nurses and given to male administrators and doctors,” the outcome was a severe setback to women administrators.88 In Moncton, however, no such opposition emerged. Instead, the hospital appointed a female hospital superintendent and director of the nursing school with few, if any, reservations expressed about the candidate, although the process was questioned. Given the constant turnover of personnel endured over several years, acceptance of, and support for, MacMaster was understandable. As well, despite the Newfoundland example, choosing a woman superintendent was not all that unusual, since it was very much “the period of the women hospital administrator.” By 1933, nurses ran 41 per cent of all hospitals in the United States and this window of opportunity for women only closed in the late 1940s,89 at the same time that MacMaster’s own tenure would come to an abrupt halt. What was unusual about MacMaster’s appointment was the clear mandate from the board, precisely stated in the May 1918 bylaws, concerning the superintendent’s responsibility for, and supervision of, all

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hospital staff. Apparently the hospital board had learned that its hands-on approach of the past had provoked reaction against what was perceived as its own heavy-handed administration and unnecessary intervention. It was now content to let an administrator run the hospital. With the strong-willed and experienced MacMaster, and a supportive hospital board and president, the stage was set for an authority balance that somewhat differed from that of other hospitals. Generally authority is seen during this period as passing from trustees to physicians and then to administrators, with the challenge to physicians by administrators coming in the 1930s and 1940s.90 In Moncton, power was devolving from the board to the hospital superintendent at a much more rapid pace, while the medical staff, still deferred to and very much a voice to be heard, could come into its own only with the cooperation and support of a sympathetic superintendent sensitive to their goals and needs. If women board members and an incoming woman administrator were now assuming more active roles, George J. McClure, active on behalf of the labour unionists of Moncton, revealed another new element on the board. McClure, representing the Trades and Labour Council, and Norman Sinclair, representing the railroad brotherhoods, had first been elected to the hospital board in June 1918.91 The city’s labour union ranks had grown considerably, helped by the substantial number of unionized workers employed by the railway. This industry had become by far the largest employer in Moncton, growing from 650 men and women employees of the Intercolonial in 1896 to 2,310 in 1911 and 2,502 people in 1920 working for what now had become the Canadian National Railways system.92 Representatives of the labour unions were becoming increasingly assertive of their rights and were willing to speak out on hospital issues, at times offering generous support, and on other occasions expressing the need for an accommodation of labour’s hospital needs or changes in the basic structure and funding of the institution. The “X-Ray Apparatus,” installed in 1912, was largely the result of a $750 donation raised “from the labour organizations” of the Intercolonial.93 It came with a price, however, in that the board agreed that “only one-half the fee charged in ordinary cases” would be charged whenever any member of the contributing unions required x-ray services. Union sensitivities about the rates were no doubt sparked by the special ambulance fee of $2 charged for any call to the Intercolonial shops, when calls to other parts of Moncton only cost $1. After union protests in May 1911, this charge was lowered to $1 for Intercolonial shop workers as well. Labour unionists were particularly incensed, however, as were theatre owners, when the hospital board requested Moncton city council approval for a spe-

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cial one-cent tax on every theatre ticket with the funds to be used in support of the hospital.94 At a stormy session of city council in May 1917, labour union representatives voiced their strong opposition to such a measure. They made clear that “they objected primarily to the principle of taxing the workingman’s amusements for the benefit of an institution like the hospital which,” they argued, “is not under responsible government, that is, the people do not elect or select the management.” Appearing in the press at the same time as the county council’s and Frank Murphy’s criticisms of the hospital board, these negative comments contributed to the demise of the old board. William G. Atkinson spoke on behalf of the labour unionists concerning their opposition to any aid of this sort while the hospital was “under its present management and the present system.” While calling for change within the institution, and citing alleged board abuses such as purchases without public tenders, Atkinson clarified that unionists did not oppose supporting a properly managed hospital. But if “the hospital is in need of more funds, donate same,” he advised city council, “if you deem it advisable out of the city funds and then every man in the city will be paying his proportionate share.”95 Some of labour’s complaints were met when the hospital board was restructured in 1917 and, of the two labour union representatives elected in 1918, McClure was active in asserting labour union support for the hospital, even to the point of assuring all concerned that labour endorsed a $60,000 assessment on the city of Moncton for the hospital’s building needs without any need for a plebiscite on the question.96 McClure’s rhetoric sometimes exaggerated rank and file support, or interest, which was embarrassingly demonstrated at the 1919 selection of hospital board members. Six vacancies existed on the board and, while McClure and Sinclair had another year each on their two-year terms, the Amalgamated Labour Unions wrote to the hospital board that labour “was not sufficiently represented.” Consequently four more labour union representatives were nominated, supported by McClure. When Dr Alphonse Sormany, now a board member representing Westmorland county, looked at the turnout for the meeting, however, he noted that only board members were in attendance. If groups like labour unions wanted more representation, he commented, then “they should have men at the meeting to vote for their nominees.” McClure rather sheepishly admitted that perhaps the labour men had not “understood that they could come to the meeting and vote.” Apparently a majority of those present and eligible to vote agreed with Sormany since, although it took four more separate ballots after five vacancies were filled by majority vote in the first ballot, not one of the four labour nominees was elected.97

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Despite this labour union disappointment, by 1918–19 the operations of the hospital, along with its staff, structure, and board had been profoundly altered by the presence of new players and participants. Even temporarily disenchanted labour unionists, perhaps with less enthusiasm than George McClure, moved towards accepting the new image of the institution as belonging “entirely to the people” and quite legitimate “in coming before the people to ask them for assistance.”98 Public solicitation was not new, although at this critical time it was optimistically hoped that it would bring an even more generous response than in the past. However, it was the people’s elected representatives who, more than the ordinary citizens themselves, were now going to be directly targeted for the funding support that was needed. Two major players, the provincial government and the Moncton city council, had to be brought on side if adequate funding was to be achieved for basic hospital operations and badly needed expansion. After the harmonious relationship with the Westmorland county council was restored, A. Cavour Chapman did not press them for additional immediate support. He explained to the county council in January 1919 that “all that the Hospital was asking at this session was the usual yearly grant of $2,250,” which passed quickly with supportive comments. At the same time, Chapman pointed out that the hospital board was seeking a special substantial assessment, spread over a fouryear period, from the city of Moncton to partially fund an addition to the hospital. Assistance from the county “for this purpose would not be asked for until plans for the proposed extension were fully prepared.”99 At the provincial and city council governmental levels, solicitation for substantial funding increases was already underway and, in both cases, it seemed that the timing was particularly appropriate. The new Liberal provincial government of February 1917 placed Moncton hospital supporters at the cabinet table. In the Walter Foster government, Clifford Robinson was appointed minister without portfolio while Peter J. Veniot was minister of public works. Robinson, as a former Liberal leader and premier, was a respected voice, while Veniot carried considerable weight as a major architect of the Liberal victory because of his delivery of Acadian constituencies to the Liberal cause.100 In April 1918 A. Cavour Chapman and Dr Sormany were able to report on a very positive meeting with the premier, which had also been attended by Robinson, along with several Liberal members of the legislature from Kent and Westmorland counties. Veniot could not attend but Sormany assured the board that he had corresponded with the “Hon. Mr. Veniot” who “would do all he could for them.” The hospital’s case rested on the size of grants received by hospitals in other communities, such as Saint John, which was receiving $4,300 annually.

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Sormany and Chapman came away from the provincial government meeting convinced “that the grant would be increased,”101 although no action had been taken as yet. As it turned out, even a new Liberal government, with friends of the hospital in cabinet positions, failed to change the small hospital grants awarded. Dr William F. Roberts had been appointed as the “first Minister of Health in the Empire” in 1917 and, in the New Brunswick Health Act passed a year later, this new department, among other activities, was to supervise and provide monetary support for “the Tuberculosis Sanatoria and public hospitals.”102 Nevertheless, New Brunswick’s financial contribution to its general public hospitals remained the same small annual lump-sum grants, which were to help cover the cost of indigent, non-paying, public ward patients. It also seemed the appropriate time to mount a case for expanded hospital aid to the Moncton city council, but the campaign proved equally disappointing. While A. Cavour Chapman was not an alderman in 1919, Moncton’s mayor, Hanford Price, and two of its eight aldermen, John Stewart and C.A. Melanson, were on the hospital board as the city’s representatives. In addition, Dr Bourque, member of the hospital staff, and Dr B.F. Reade, former dental surgeon on the hospital staff, sat as aldermen on city council.103 As well, the now constant newspaper scrutiny of hospital activities, whether it was airing dirty linen or applauding positive changes, was continuously reminding the Moncton public of the hospital’s needs and the city’s responsibilities. By means of Ladies’ Aid fund-raising events, statistics about Moncton’s increased use of the hospital facilities, the growth in the number of Moncton physicians on staff, and even reports of county resentment that the hospital was becoming a Moncton-dominated institution without sufficient city support, all contributed to widespread references to “our City Hospital” and “our hospital” among Monctonians. As in other communities in the aftermath of World War I, this growing pride in the institution dovetailed with a desire to honour those who had given their lives in the Great War. Proposals emerged for solid monuments such as a possible “Soldiers’ Memorial Wing” as an addition to the Moncton Hospital,104 and this was the goal of the hospital board as it entered upon negotiations with the vital partner in this process, the Moncton city council. In January 1919 the board unanimously approved a motion asking the city council “to assess the sum of $60,000 in four annual assessments each, for the purpose of erecting and equipping extra accommodation to the present Moncton City Hospital.”105 Accompanied by headlines about “The Urgent Need For Additional Hospital Accommodation” and doctors’ stories about patients turned away or inadequately handled because of lack of space, the request

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produced Mayor Hanford Price’s agreement to call a special city council meeting in mid-March to hear the hospital’s case.106 At this session several Moncton councillors, ironically those on the hospital board itself, revealed for the first time their serious concerns about this proposed major expenditure. To a certain extent the presentation by the hospital delegation was a bit too honest for some of the city councillors, although the enthusiasm and commitment of the hospital supporters shone through. Mrs (F.L.) Harriet Doyle epitomized the commitment by promising a Ladies’ Aid donation of $1,000 to equip and furnish “a maternity ward in the new wing.” Dr Coleman and Allie McSweeney detailed the urgent need for hospital expansion, but their new cost figures alarmed some councillors. Coleman confessed $60,000 might be “far too little money” and set a $100,000 figure as more realistic for total cost, while McSweeney echoed the need for “at least $100,000 or more” for the proposed wing. Alderman John Stewart quibbled about the size of the city funding already extended to the hospital, while his colleague C.A. Melanson had a steady stream of questions. Did the board not have a definite idea of the cost? Did the grants from Westmorland and Kent counties really cover the cost of their non-paying patients? Did the hospital take a portion of the fees charged to patients by doctors or surgeons? What would the counties contribute to the cost of the new wing? The board delegation, which also included L.F. Wallace, F.E. Whelpley, and John H. Harris but not A. Cavour Chapman, did its best to respond but, clearly, while the council was courteous there were major concerns. All that the hospital case received on this day was the mayor’s promise of careful consideration. After the hospital delegation departed and all the other agenda items were dealt with, alderman and doctor Louis Bourque brought the hospital matter up again to urge action. Other aldermen, specifically Stewart, James Blackwood, and Melanson, felt popular support was lacking, more time was needed, and perhaps a plebiscite was required. As a result, council adjourned “without taking any action.”107 Hospital expansion had hit a major roadblock. Over the next year, board meetings, public meetings, and newspaper coverage, emphasizing both the major changes that had occurred within the hospital and its urgent needs, only seemed to reinforce the inertia of city council. In addition, some board members further alienated potential city council supporters by harsh comments about council’s response, or lack of a response, to their presentation. Dr Coleman reported to the hospital board that it was his perception that the council had not been “in any way spellbound by the oratory of the delegation, or that their words fell on very good soil.” McSweeney admitted they had received “a patient hearing” but since then council’s inaction

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revealed how “discourteous” that body was to the hospital board. Moreover, he was particularly upset to see Alderman John Stewart quoted in the press about an alleged lack of public support for such a hospital expenditure. Since Stewart was present as a hospital board member, along with the mayor, Hanford Price, they both plunged into the debate. Stewart focused on the leap in the estimated cost, which had started at $60,000 but “grew suddenly until it was twice the original figure.” In his own ward he had met only one “rather listless” supporter of the project, while the majority response was: “We don’t want more taxes.” Mayor Price now weighed in with his comments. He reminded some board members that “it was not at all wise” for them “to throw out slurs and insults in the presence of the City Council members of the Hospital Board, because they would not take them.” Furthermore, he had problems with a hospital board that was now too open and representative. He pointed out that Moncton city council had only three positions on the hospital board and yet was “asked to vote $60,000, when the sum of $200 would buy 100 votes and place enough members to take charge.” Instead of a city assessment, the mayor urged the launch of a private subscription campaign as the first step; he himself would donate “$500 towards the new wing,” and once the “monied men” had given, and if the people agreed in a plebiscite, then city council would act. The words of both alderman and mayor were forceful reminders to other hospital board members that a more conciliatory and educative approach was required. Board members Whelpley, Sormany, and Chapman now much more cautiously explained the hospital position, while emphasizing the need for a frank “exchange of ideas” and their own appreciation of council’s position, but nonetheless the need for local government action and support. Only McClure went a bit overboard with rhetorical reassurance the mayor probably did not want to hear, that labour totally supported hospital expansion and “Mayor Price … could go right ahead as the labor men would back him up” on the $60,000 commitment. What emerged at the end of the day was a motion supported by all, including city council representatives on the board, that a joint committee of the hospital board and city council should be created in order to achieve the “education of the citizens to the urgent need of the hospital.”108 The hospital board added further embellishments as the new decade dawned, such as a building fund, in which the board placed $1,000 to get it started, and capitulated almost completely to Mayor Hanford Price’s suggestions. A broadly based committee, with representatives from the Board of Trade, the labour organizations, city council, and women’s organizations was to “devise ways and means” of raising the necessary hospital funds. Private

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solicitation would be attempted through this community committee, which A. Cavour Chapman hoped might raise “from $50,000 to $75,000 in the city of Moncton by subscription.” Only then, Chapman suggested, should the matter go back before city council.109 Without the necessary additional funding and support, the Moncton Hospital began and ended its second decade as a fifty-bed institution, although much else about it had been transformed. Fundamental changes in the staff, management, hospital policies, and number of patients served, along with a more representative system of government, had not resolved what had been a major problem in 1910 and remained a major problem in 1920: the need to fund a substantial expansion if the hospital was to continue to serve its various and growing constituencies. Interwoven with this funding problem was the reality that the new Hospital Act left unresolved the basic question of whether any one party bore a special and heavier responsibility for hospital costs. Whether the institution was in reality the Moncton City Hospital, meeting primarily Moncton’s needs, rather than a Moncton Hospital meeting the regional needs of surrounding counties and the city, remained unclear. The metropolitan-hinterland relationship in the delivery of health care services had become a major source of contention. Moreover, although harmony with Westmorland county council had been restored, Moncton city council now appeared uneasy about any extension of hospital support and even questioned the existing grant. As the twenties opened, expansion plans had to be placed on hold until community-wide support could be re-awakened.

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4 At the Crossroads

In January 1941, Moncton Hospital superintendent Alena J. MacMaster informed her board that hospitals were “at a cross-roads never before reached in history” as an “entirely new philosophy of hospital financing” had come of age. It now seemed widely accepted that “private and voluntary philanthropy as a source of revenue” would be supplanted by “government or alternative forms of support.”1 In reality, at her own institution this shift of responsibility was not a sudden epiphany but had been underway, as MacMaster was well aware, throughout the interwar years, and the transformation of public attitude and policy was far from complete. Yet her remarks revealed the crisp insight and sharp focus that MacMaster had exerted in her management of the hospital and the hospital board throughout the 1920s and 1930s. Under her guidance, the services offered by the Moncton Hospital had been brought to a level of maturity and accomplishment that belied the deindustrialization and then depression that blighted the Maritime provinces and the Moncton region in these two successive difficult decades. In the years after World War I the city of Moncton continued its expansionist trajectory. Although the nature of its basic economic activities changed significantly, in its adjustment the city fared considerably better than other comparably sized communities in the region.2 Moncton grew in population from 17,488 in 1921 to 22,763 in 1941, or from 20.4 per cent to 23 per cent of the total regional population served by the Moncton Hospital. In the same period Westmorland

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county, excluding Moncton, expanded from 35,899 to 41,723, which represented a limited increase from 41.8 to 42.3 per cent of the hospital’s potential clientele. Kent county increased in population from 23,916 to 25,817 but declined from 27.8 to 26.2 per cent in this southeastern corner of New Brunswick. From 1921 to 1941 Albert county declined both in population and in percentage served from 8,607 (10.0 per cent) to 8,421 (8.5 per cent).3 The high hopes of Moncton boosters, and hospital backers, that the city’s growth would be so spectacular as to necessitate separate city and county institutions were not yet realized, but the growth was substantial enough to put severe pressures on the hospital. Behind Moncton’s own twenty-year population increase of 30.2 per cent lay fundamental changes in its economic and ethnic complexion. Economically it underwent a transformation from a primarily industrial community, largely controlled by an indigenous elite, to a branch plant manufacturing centre increasingly dependent on a transportation/warehousing/service sector.4 The major employer remained the Canadian National Railways but the number of its Moncton employees steadily declined from 2,502 in 1920 to 1,960 in 1930, and to 1,387 by 1938. At the same time, other industrial enterprises peaked in 1920, when ninety other establishments employing 3,061 people, declined to forty such enterprises in 1927, and leveled off at forty-six in 1938 with 1,801 workers, “the lowest employment level in this sector since 1923.”5 Gains in the service sector, such as the T. Eaton Company opening a mail-order house employing over 750 in 1920, followed by a retail store in 1927, compensated considerably, although Eaton’s presence, along with the onset of the Depression, contributed to the 1931 closure of the longestablished and locally owned McSweeney department store.6 Adjustment and transition were the order of the day. Change also prevailed in the ethnic composition of the city and Westmorland county, as the Acadian presence reached new levels of visibility and necessitated an overdue accommodation. In Westmorland as a whole, the French ethnic proportion of the population increased from 39.1 per cent in 1921 to 41.8 per cent in 1941, while in the same time period the Acadian presence grew from 31.1 to 33.6 per cent within the city of Moncton. Province wide, New Brunswick’s French-speaking residents soared from 21.8 per cent of the population in 1911 to 35.8 per cent in 1941.7 As the major urban centre, which served both the overwhelmingly Acadian Kent county and an increasingly assertive French-speaking community in Westmorland county and within the city’s own boundaries, Moncton had to adjust

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to this reality. In the area of health services, Acadian leaders pushed for a separate French-language, Roman Catholic hospital. As a result, in 1922, the first Hôtel-Dieu de l’Assomption welcomed patients in a renovated house, and by 1928 a new building on the north side of Union Street was opened as the Hôtel-Dieu, which eventually evolved into the Georges L. Dumont Hospital.8 Even with two hospitals to serve the city and counties, the Moncton Hospital’s patient numbers continued to mount. Despite a temporary fall in use of the hospital in the early Depression years, from 1919 to 1939 both the number of patients admitted and the total number of hospital treatment days more than doubled: patients admitted rose from 1,197 in 1919–20 to 2,619 in 1939, while the annual total hospital treatment days increased from 13,657 to 30,085.9 During the 1920s private paying patients remained well above 80 per cent of the hospital’s clientele, peaking at 83.7 per cent in 1929–30, while the percentage of indigent public patient numbers reached a low of 16.3 per cent in the same year. The Depression changed this with what were now described as private and semi-private patients dropping into the low 70 per cent range. Public non-paying patients, now categorized as ward patients, peaked at 28.8 per cent of the hospital clientele in 1933 and had only dipped to 26.7 per cent as Canada emerged in 1939 from its economic hard times. The hospital board’s apprehension in the 1910s about the growing number of public patients from the counties, and their appreciation of Moncton patients’ willingness to pay, weren’t as necessary in the 1920s. Figures 3 and 4 examine where private and semi-private patients resided compared to public/ward patients. On the positive side, from the vantage point of hospital board members, the city of Moncton contributed handsomely to hospital revenue by consistently providing the largest number of private and semi-private patients. On the negative side, during the economically troubled thirties, the city delivered by far the largest number of public/ward patients. The ratios of private versus public/ward patients of the two largest hospital users, Moncton and Westmorland county, roughly tracked each other in the twenties. The Depression considerably altered this patient balance as increased use of the public wards, especially by Moncton residents, caused concern among hospital administrators. Moncton dropped sharply to a 65.5:34.5 per cent paying/non-paying ratio in 1933 and only recovered to a 70:30 per cent ratio in 1939. Westmorland experienced a far less severe decline, moving from a 77.9:22.1 per cent ratio in 1933 to 75.9:24.1 per cent in 1939.

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NUMBER OF PATIENTS

Figure 3 Residence of private and semi-private patients, 1913–1953 2,500 2,500

Moncton

2,000 2,000

Westmorland

1,500 1,500

Kent

1,000 1,000 Albert

500 500

Others 1953

1950

1945

1939

1935

1933

1929–30

1924–25

1919–1920

1913–1914

00

sources: Daily Times (Moncton), 11 June 1914; armh 1920, 12; armh 1925, 18; armh 1930, 24–5; rmh 1933, 28–30; rmh 1935, 28–9; rmh 1939, 32; rmh 1945, 32, 34–5, 37; rmh 1950, 21, 23; rmh 1953, 22–3, 31, all mha.

NUMBER OF PATIENTS

Figure 4 Residence of public/ward patients, 1913–1953 600 Moncton 500 Westmorland

400 300

Kent

200

Albert

100 1953

1950

1945

1939

1935

1933

1929–30

1924–25

1919–1920

1913–1914

0

Others

sources: Daily Times (Moncton), 11 June 1914; armh 1920, 12; armh 1925, 18, armh 1930, 24–5; rmh 1933, 28–30; rmh 1935, 28–9, rmh 1939, 32; rmh 1945, 32, 34–5, 37; rmh 1950, 21, 23; rmh 1953, 22–3, 31, all mha.

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Figure 5 Per diem patient cost, 1898–1953 20

DOLLARS

15 10 5 0 1898–99 1917–18 1929–30 1935 1945 1953 1910–11 1924–25 1932 1940 1950

Years

sources: “The Moncton Hospital Annual Report, 1965,” 4, Moncton Municipal Records, rs 418, g2s1, armh 1925, TimesHospital 1930, RS (Moncton), 15 June 1911, 1965”, 13 Junep. 1918; 20; armh Source:panb; “TheDaily Moncton Annual Report, 4; Moncton Municipal Records, rmh 1935, rmh 1940,(Moncton), 1953, of 24–5;G2S1, 28–9; 27; rmh 1945, 32, 34–5, 23; rmhReport Daily Times 418, PANB; 15 June 1911,37; 13rmh June1950, 1918;21, “Annual mha. 22–3, 31, all Moncton Hospital Moncton, N.B. [ARMH] for the Year Ending May 31st, 1925”, p. 20; ARM

1930, pp. 24-5; “Report of the Moncton Hospital [RMH] for the Fiscal Year Ending Decemb 31 1935” 28 9 RMH 1940 27 RMH 1945 32 34 5 37 RMH 1950 21 23

In the difficult thirties use of public ward facilities increased as patients were unable or unwilling to pay the rates charged by hospitals for private and semi-private rooms.10 Among potential patients, a willingness to avoid hospital treatment if at all possible also took its toll. Across Canada, hospital bed occupancy declined, while Prince Edward Island, Ontario, Manitoba, and New Brunswick were especially hard hit by the increase in public ward patronage and a corresponding fall in private and semi-private usage. Hospitals adjusted by transforming private rooms into semi-privates and semi-privates into public to secure more ward units.11 These changes in the use of hospital facilities resulted in part from the Depression, but there also was a growing public reaction against rising hospital charges. Rates were tied to costs and at the Moncton Hospital, as figure 5 indicates, per diem costs per patient increased steadily, decreasing only slightly for brief periods in the late twenties and mid-thirties before resuming a steady rise upward. The Moncton Hospital’s per diem patient cost and the rates it charged patients went through two distinct phases between 1899 and 1932. In the first, paying patients bore the brunt of the increased rates. In the second phase, the burden was shared, although the largest increases were directed at public ward occupants or their patrons – various levels of government or the hospital itself. From 1899 to 1918, when the per diem patient cost went from 99 cents to $3.20, the public

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ward patients who paid, admittedly few in number, faced a charge that remained unchanged at $3 per week or 43 cents per day. Private patients initially paid $6 to $10 per week, or 86 cents to $1.43 per day.12 In 1914 the charge for a private room had increased to $12 per week or $1.71 per day. In April 1918 a sliding scale for semi-private and private rooms was introduced that brought their cost up to the $2 to $3.71 range.13 Compared to the 1917–18 per diem patient cost of $3.20 (a 223 per cent increase from the hospital’s first year of operation), most of the rates were not keeping pace, although the roughly 133 per cent to 159 per cent increase in private and semi-private rates made clear on whose funds the hospital depended. Moreover, rising costs for anaesthetics, operations, and drugs, along with surgery fees, x-ray charges, and laboratory expenses might add considerably to the private and semi-private patient’s bill. During the next phase, from 1918 to 1932, the per diem patient cost went from $3.20 to $5.21, an increase of 62.8 per cent. In 1923–24 the Moncton Hospital’s public ward rate increased to $5 per week or 71 cents per day, which patients were now urged to pay if at all possible.14 Better ward accommodation arrived when a new hospital addition opened in 1930 with four-bed wards replacing the large public wards.15 In the early thirties, rates reached the levels where they would remain for over a decade. The cost for public ward patients from adjoining counties was set at $2 per day, paid by the patient or the county, while Moncton public ward patients were “expected to pay $1.50 per day for their treatment.” Public ward patients from any other counties or municipalities were charged at approximately the prevailing per diem cost.16 Semi-private patients, by 1931, paid $2.50 per day, while private patients were offered a range of options from $3.50 to $6.48 per day.17 As a result of these changes, public ward rates had doubled or tripled in the 1918–32 period while semi-private charges grew by 25 per cent. Some private room rates were up as much as 74.1 per cent, while those at the low end of the scale had actually been reduced by 5.6 per cent Both per diem patient cost and the hospital rates charged had increased substantially, but the Moncton Hospital situation was comparable to hospitals in the rest of Canada. A report on 1929 Canadian hospital rate changes pointed out that “the greatest increases in rates [in that year] were for public wards.” Semi-private rates had moved “upward very slightly” while private charges were a “little lower for the first time since 1913.” This fit the Moncton Hospital pattern. Furthermore, it was estimated that per patient maintenance cost increased 110 per cent from 1913 to 1929. Moncton’s per diem patient cost had increased 109 per cent from 1910–11 to 1929–30. Finally, across

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Canada the average ward charge in 1929 was $2.03 per day (Moncton’s rate rose to $1.50 and $2 in 1932), the average semi-private rate across Canada was $2.87 (Moncton’s 1931 rate was $2.50), while private room charges across the country averaged $5.2318 (Moncton’s rate varied from $3.50 to $6.48 in 1931). The Moncton Hospital was very much in step with its sister Canadian institutions. The hospital’s provincial government support, and the funding provided at the local level, however, lagged behind what was available in some other parts of Canada. In Ontario a more enlightened, if not all that more generous, system of hospital aid had developed. In 1897 Ontario’s Hospitals and Charitable Institutions Act provided per diem grants to public hospitals for the maintenance of indigent patients while an amendment in 1912 outlined the municipal responsibility for an indigent patient per diem as well.19 Although there were constant complaints about the skimpiness of these grants, by 1928 the provincial grant was 60 cents per day while the municipalities contributed $1.75 per day, with some hospitals accepting a lump-sum grant from the municipality rather than the per diem.20 Any suggestion that the province and municipalities should lower these rates, a rumour in 1932, provoked a horrified outcry.21 In New Brunswick by 1927 the provincial government was funding fourteen hospitals with annual lump-sum grants totaling $11,700, ranging from $250 for a twelve-bed institution to $3,800 for the 200bed Saint John General hospital.22 The Moncton Hospital received $700 that year, and $2,000 in 1930 when its bed capacity went from 86 to 125.23 All provincial hospital grants were reduced by 25 per cent in 1932, so Moncton’s grant fell to $1,500 and remained at that level until after World War II. In the early thirties it was made clear that these lump sums for the care of the indigent were “not based upon per diem consideration” and would continue in this form, despite hospital agitation for a switch to the per diem basis.24 The provincial government did legislate in 1923 that the “Cities, Towns, Incorporated Villages or Counties” would have to pay for indigents’ hospital services at the “average cost per diem per patient” in the current year or the year preceding admission.25 The Moncton Hospital opted instead to continue to receive annual grants from its surrounding counties, sporadically in the case of Albert and Kent, regularly from Westmorland, until the hospital switched to per diem requests in the thirties. Extracting county payments for indigent patients was made even more difficult because of problems establishing the residence of patients. Consequently, the provincial government introduced new legislation in 1931 “to more closely designate the legal entitlement [settlement] of an indigent patient, to make possible the collection of fees.”26

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If provincial and county government support was limited and slow to increase, at least the city of Moncton’s grant to the hospital rose more rapidly and substantially. It moved steadily upward, reaching $8,250 in 1923–24 and $9,000 in 1929–30. When the total provincial, county, and municipal grants in 1929–30 (amounting to $14,700) are compared with the 1926 provincial and municipal grants to similarsized Ontario institutions, the Moncton Hospital’s government support lagged considerably behind. In 1926, when comparable figures are available, the ninety-six-bed Kitchener hospital received $23,287 in municipal support and $3,319 from the provincial government, for a total of $26,606; the one hundred-bed St Thomas hospital received $12,000 and $5,728, for a total of $17,728; while the 125-bed Stratford hospital received $15,751 and $2,818, for a total of $18,569.27 The gap between these figures and the 125-bed Moncton Hospital’s $14,700 in 1929–30 government support may have widened further as the Ontario hospitals ended the prosperous twenties. Not only was government support less than that available at comparable Ontario hospitals but the decline in that support, as a percentage of the hospital’s total revenue, was far more severe at the Moncton institution. A comparison with the Owen Sound General and Marine Hospital, based in a small town and founded only a few years before the Moncton Hospital, reveals that its provincial and municipal income was 30.7 per cent of its total income in 1910, 23.6 per cent in 1920, and 23.1 per cent in 1930.28 At the Moncton Hospital 31.6 per cent of its total income came from provincial, municipal, and county grants in 1908–09, 20.3 per cent in 1918–19, and 12 per cent in 1929–30. Despite these financial limitations, bringing the Moncton Hospital in line with other modern hospitals was the major goal, and eventual achievement, of Alena MacMaster. This required a considerable and costly expansion of services and space. In attracting MacMaster back to Moncton, optimistic descriptions of a fifty-bed enlargement, establishment of maternity facilities, and enhanced x-ray services had been offered.29 At first, these promises rang rather hollow, since assumptions about increased provincial funding and vastly improved municipal support remained unfulfilled. Determined to deliver on their commitments, board members and the ever supportive Ladies’ Aid continued to press the hospital’s case at every opportunity. It was not the best time to do so: even a usually strong backer of the hospital, the Moncton Daily Times, wondered whether too much was being expected of Moncton taxpayers. In an editorial just prior to MacMaster’s appointment, the newspaper endorsed a “general assessment” as the “best means” of raising hospital funds, rather than “relying upon subscriptions, enter-

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tainments and other means of like nature.” Yet it also argued that the adjoining counties and provincial government must share the cost. There must be “an equal distribution of the burden of cost of construction and maintenance as well as a considerable grant from the government.”30 It became clear that substantial help from these various quarters would not be available immediately, but if the $60,000 assessment idea had to be shelved quietly, at least an increased city grant could be sought. Hospital board president A. Cavour Chapman improved prospects in this area by opposing, and winning the mayoralty from, Hanford Price in 1920. Re-elected in 1921,31 there was a strong connection between Chapman’s re-entry into municipal politics and the steady increase in the city’s hospital grant. At public hospital functions reported in the press, when he wore both hats as city mayor and hospital president, “His Worship Mayor Chapman” was quite willing to deplore the low level of Moncton’s annual hospital grant as “unworthy of the City of Moncton,” while asserting that “the amount available … should be nearer $150,000.”32 More realistically, the Ladies’ Aid, while not losing sight of a “new hospital,” now called for “immediate steps” towards “temporary extensions to accommodate patients.”33 Abandoning for the moment the dream of a new wing for the hospital, in the spring after MacMaster’s arrival the hospital board approved the purchase of four lots and two houses next door to the hospital for a limited expansion. The purchase cost was $19,000, to be paid off with a $4,000 down payment and a three-year mortgage with interest at 6 per cent.34 By the time one of the houses had been renovated and formally opened in March 1921 as “the new Annex,” a further $14,000 had been expended and the hospital’s debt was rising towards “the vicinity of $35,000.”35 The Annex added twenty beds to the hospital’s capacity, with the first floor containing kitchen facilities, a children’s ward, accommodation for private patients, and potential new x-ray quarters. On the second floor were a nurses’ dormitory and other facilities, as well as further private rooms, one of which was furnished by the Imperial Order of the Daughters of the Empire, while others were equipped as memorials to family members killed in World War I. Three wards, each equipped with two beds, and a “dormitory for the assistant to the superintendent” were on the third floor. Renovation work was also underway on the house between the Annex and the main hospital building, which was intended to accommodate patients with contagious diseases and which would provide sixteen more beds. To round out the complex, the board soon approved Alena MacMaster’s suggestion that a connecting passageway was “absolutely necessary” to link together all hospital buildings. The hope remained for even more

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substantial expansion, as Chapman reminded the crowd assembled for the Annex opening that “a brand new building” was still needed, since the facility opened that day was “only sufficient to relieve the needs temporarily.”36 Several times in that day’s speech-making, gratitude was expressed to the Ladies’ Aid for its contribution to the equipment, furnishings, and other needs of the new facilities. This expansion, and the Ladies’ Aid’s active role, marked the last hurrah for the traditional fund-raising approach of relying almost totally upon volunteer solicitation of private donations. It was discovered that even this relatively successful appeal was insufficient to meet all the expansion expenditures. Individuals and groups, including the Ladies’ Aid, learned from the experience and soon proposed major changes in hospital funding strategies. Nonetheless, to achieve properly outfitted annexes, the Ladies’ Aid rallied to solicit donations throughout Moncton and the surrounding counties once more. Led by Mrs (R.P.) Cora Dickson, Mrs (F.L.) Harriet Doyle, Mrs (O.B.) Clara Price and Mrs (F.J.) Ella White, the city and the smaller county communities were visited by door-to-door canvassers, who produced over $4,200 in donations.37 In May 1921 the Ladies’ Aid reported over $10,000 raised for the hospital cause that fiscal year, and had committed itself to funding new x-ray equipment costing $1,200, which eventually escalated in price to over $2,600.38 The latter donation was contingent upon, as Cora Dickson explained to the hospital board and to the perturbed labour representative George McClure, no further rebates or discounts for donors. Dickson argued that the Ladies’ Aid was not setting this condition to antagonize “the labor organizations,” but over the years labour unions had received “considerable in return in rebates” for their original contribution to the cost of the “old machine.” It was time to recognize that “[h]ospital work is a community work in which everyone should engage … not for their own benefit but for the most good for others.”39 This gospel of giving was soon to undergo further refinement in terms of community responsibility. Within a month’s time the Ladies’ Aid undertook yet another chore, agreeing to supervise a car raffle to meet part of the cost of the connecting passageway, linking the old and newly renovated hospital buildings,40 but even this most committed of organizations now wondered whether new solutions were needed to meet vastly expanded hospital expenses. While advising the hospital board that the Ladies’ Aid “would continue to give assistance,” a resolution had been passed by the membership that the hospital “[b]oard and the [Ladies’] Aid [should] jointly meet the City Council to discuss the advisability of the city financing the Moncton Hospital.”41 Creeping municipalization of hospital services was thus openly proposed and debated by the hospital

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supporters who had been most successful in meeting the institution’s needs through voluntary donation campaigns. Another community service organization was also demonstrating a new sensitivity to hospital needs and probing for more effective longrange solutions to the hospital funding question. In August 1920, doffing his hospital and mayoralty hats in favour of his Moncton Rotary Club apparel, A. Cavour Chapman presided at a Rotary Club meeting where the plight of the hospital was addressed. Dr A. Raymond Landry reported on its “over-crowded condition” and urged his fellow Rotarians to join in a campaign to convince Monctonians of the need for “more hospital accommodation.” Chapman promised to bring about much more support from city council, while hospital board member George O. Spencer stated that “the hospital should be made a civic institution, and supported by assessment.” The result was approval of a motion moved by Landry, and seconded by hospital board member H.C. Charters, that the Rotary’s public affairs and educational committee should “look into the hospital situation and report at [the] next meeting.”42 Chaired by future Moncton alderman and four-time mayor of the city in the early thirties, C. Hanford Blakeny, that committee reported at length a month later at a Rotary Club meeting called as a “Hospital Field Day.” This session was chaired by yet another hospital board member, Allie E. McSweeney, and heard a devastating description of the “startling facts” behind the “evil conditions” at the hospital. While the dedication and resourcefulness of doctors, nurses, and management were praised, hospital conditions were “deplorable”: it was chronically “over-crowded”; the “ill and dying are suffering”; the hospital was “20 years behind the times” with “no waiting room for patients,” “no class-room for student nurses,” “no up-to-date laboratory or in fact any laboratory,” “no out-door department,” “no up-todate laundry,” and “no contagious ward”; on and on the list of needs went. McSweeney hastened to point out that renovation work presently underway would improve the situation, “but much better facilities were needed to meet the demands of our growing city and territory.” The Rotarians’ committee was of the opinion that “a brand new building is necessary” and the “present institution could be entirely used as a maternity home.” To finance the hospital, the city of Moncton was required to play a much greater role, and it was suggested that “the city might float a bond issue, the same as financing any other civic enterprise.” This basic funding should be complemented by a fund-raising drive throughout the “city and neighbouring counties” along with increased and substantial assistance from “the provincial government and nearby county councils.” Immediately, however, Rotarians must pressure city council to tackle “this serious menace to the

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public health and welfare of the community, and that this body should convey to the council their desire to assist in any way possible to remedy this dark blotch on the escutcheon of this fair city of Moncton.”43 These stirring words were matched by the less than stirring action of appointing yet another ten-person committee – admittedly stacked with hospital board members, prominent citizens who also were hospital supporters, the mayor/hospital president, one alderman, and one doctor – “to further consider the matter.” Despite this limited step, the meeting had mobilized support among some of Moncton’s most prominent male citizens, provided page-one visibility for hospital needs, and outlined a funding approach that might be acceptable to the provincial and municipal governments as well as to the hospital board. The board, however, was preoccupied with the renovation work underway, and was waiting for the final bills to come in, as well as the final results of private solicitations and subscriptions. It was only in December 1921 that it received confirmation of a substantial debt. Despite the funds achieved by the Ladies’ Aid, other donations, and special grants of $1,000 each from Westmorland county council and Moncton city council, as had been predicted the board still faced a $35,000 debt and annual interest on it of around $2,000. Looking to the future, the board approved further examination of a “hospital insurance scheme for protection for the working man,” but board member F.E. Whelpley was more concerned with the immediate reality of a hospital overdraft, mortgages, and interest payments. He suggested that “the whole hospital debt should be wiped off by means of a bond issue, guaranteed by the city.”44 This combined the debenture approach suggested by Rotarians with the greater municipal role proposed by the Ladies’ Aid and was to be the solution embraced by the board. With the approval and co-operation of the Moncton city council and the New Brunswick government, two acts were passed by the provincial legislature in April 1923. “An Act to enable the Trustees of the Moncton Hospital to issue Debentures” allowed the board to issue $20,000 in debentures that would pay up to 5 per cent annual interest, and which were to be paid off over a twenty-year period. A sinking fund, amounting to at least 3 per cent annually of the total debentures, had to be established from the hospital revenues to pay off the principal, and the hospital would also have to meet the annual interest payments. Funds raised in this way were to eliminate the mortgages and other indebtedness of the hospital. Passage of a second legislative measure allowed the city of Moncton to “guarantee the payment of the principal monies and interest” of the hospital’s debentures should the Moncton Hospital ever have to default on the payment of the principal or interest.45 In May 1924, with the paying patient revenues it gener-

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ated, along with funds raised from the sale of 400 bonds valued at $500 each, and a generous $11,500 donation from the Harvey Horseman estate, the Moncton Hospital was able to report that it had retired $20,000 in mortgages, paid off a $15,000 bank note, paid the interest on its bonds, and set aside $650 for its sinking fund.46 The state of hospital finances, on the surface at least, had vastly improved. In reality, while renovation and re-equipment expenses had been met, the need for a new hospital wing would re-surface quickly and the temporary financial equilibrium had been achieved by more than a debenture approach and a fortuitous donation. Revenues from patients remained of critical importance and, within the hospital, a concerted attempt was made to increase that revenue by increasing charges for all patients, private and public. To cost-conscious superintendent Alena MacMaster, both non-paying and paying patients must realize the real cost for delivery of the services their proper health care required. First to be educated were Moncton Hospital board members, who were presented in September 1920 with MacMaster’s proposals for room charge increases. Graduate nurses who boarded at the hospital were to pay increased board fees, and the hospital board also approved selected private and semi-private room charge increases for patients to a range between $22 to $30 per week. In one case, the rate was not pushed as high as was proposed and the increase was not accepted in the case of the public wards.47 Nevertheless, three years later the board agreed that patients in the public wards who were “unable to pay,” who were residents of Moncton or the adjoining counties, and who were recommended by their physicians were subject to “investigation … and if their circumstances justify it, they are required to pay Five Dollars per week,”48 or 71 cents per day. Each year MacMaster carefully reported the expensive burden placed on the hospital by this “free” care and the willingness of only a very small number of public ward occupants to make even a token payment towards their total expenses. Early in 1926 she explained to A. Cavour Chapman that, in the calendar year just past, Moncton’s 145 public patients had received 2,821 days of treatment at a cost of $8,406.58 and had paid in return the grand total of $304.16.49 By May 1928 MacMaster was willing to re-define what “free” treatment meant, particularly in the case of county public patients. The superintendent contended that the “average public ward patient [was] unwilling to pay the public ward rate of $5.00 per week, on the basis that he has been informed by his Parish Councillor or other authority that Grants made [to] the hospital free him from personal obligation to pay $5.00 a week toward his hospitalization, which he is expected to pay, if able to do so.” As far as MacMaster was concerned, the authorities recommending patients for

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admission (by this time it required a physician’s recommendation as well as one from a parish councillor or overseer of the poor) were unaware that their recommendations merely allowed public ward patients “to participate in the practically free service of the public ward, for example: free medical and surgical attendance provided by doctors on public ward service, free X-Ray, operating room, laboratory, anaesthetics, drugs, dressings, etc. at the very moderate cost of $5.00 per week charged to those able to pay.” To explain the situation concerning this “practically free service,” MacMaster urged a letter from “the Hospital Board to the various County Councils [which] might to a great extent correct this situation.”50 The problem of non-paying patients persisted, but where the board hesitated, MacMaster had no compunction. When a pathology laboratory was opened at the hospital in November 1921, MacMaster quickly suggested asking the city for an annual $1,000 grant in return for lab work such as water and milk testing, along with other public health services. To her disappointment, this work had to be done free for the city, and she complained that in 1925 it required $517 of annual work “in our laboratory without charge.”51 Several years’ operation of the isolation unit for patients with contagious diseases sparked a long explanation from MacMaster concerning the additional burden and expense, as well as long quotes from the relevant hospital administration literature, making clear that whenever and wherever such units were established special grants were required to “relieve the hospital of any financial burdens concerned therewith.”52 More successful was her campaign to raise revenue from private and semi-private patients. With a pathology lab available, all patients admitted were to have blood and urine examinations for which flat rates of $5 for private patients and $2.50 for semi-private were charged.53 The establishment of obstetrics services and the 1923 conversion of the Annex into a maternity department likewise helped hospital revenues. Alena MacMaster had stressed the need for maternity services since her arrival and in June 1925 she reported with pride, spiced with her own payment philosophy, progress in this area. Nurses’ accommodation had now been converted into a six-bed semi-private maternity ward, bringing the “maternity capacity to twenty beds” in the Annex. This additional semi-private service, she argued, was particularly attractive to families with a “modest income” since “the low rate of $2.50 per day for mother and infant inclusive will appeal to the expectant mother of limited means.” It offered the attraction of “supervised nursing care and attention without the usual anxiety and worry over domestic adjustments which she usually experiences in her home.” After this glowing endorsement of hospital birthing as the proper course

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for all women, MacMaster emphasized that the poor were not turned away, although they would be better persons if they paid: “As in the past (in cases of extreme need) the expectant mother without home nor funds may find shelter within our walls. We strongly urge, however,” she continued, “the payment of a nominal fee when funds are at all available, because personal responsibility should at all times be encouraged.”54 The maternity service created a steady climb in the number of hospital births, from sixty-six in 1923–24 to 222 in 1939, and the hospital’s male/female patient percentage ratio also reflected this new service, moving from 45.7:54.3 per cent to 42.1:57.9 per cent in the same years. The reluctance to encourage “charity” maternity cases waned only gradually, however, since in 1929–30 only four of 156 births were to ward patients, while by 1939 this had risen to thirty-seven of 222 births.55 Patient charges and services were being scrutinized carefully and adjusted, but, while additional services were appreciated, there was danger of a reaction to the increased costs. Offsetting this possibility was a growing emphasis on community service and outreach, which enhanced the hospital’s position and reputation. In 1923– 24 a free school clinic “for poor children of the city for the removal of tonsils and adenoids” was launched. An insulin service for diabetics was established in 1924. A clinic for the prevention of tuberculosis, directed by Dr George J. Wherrett, was introduced, with the Moncton Gyro Club meeting the cost of patients unable to pay for x-ray examinations of their lungs; although, MacMaster confessed, the club was allowed a “50% discount on this service as [a] tribute to this more than worthy cause.” Dr George Lyons was allowed to establish a venereal disease clinic for the New Brunswick Department of Health, and it treated 349 patients in 1927–28. By this date, even the free lab work for the city of Moncton was accepted and now underlined as benefitting the community’s battle against diphtheria and typhoid.56 The fuller range of services advocated and implemented by MacMaster was complementary to her more basic goal, established in her early years at the hospital, of achieving standardization and certification for the Moncton Hospital. To win ranking as a “standard hospital,” and accreditation under the program established in 1921 by the American College of Surgeons, required that the hospital reach a certain level of efficiency and respectability. Some requirements were already met, such as an anaesthetist, a radiology department, and a resident radiologist. Others, such as a laboratory and qualified pathologist, were the result of MacMaster’s willingness to take a Red Cross donation intended to purchase equipment for the operating room and redirect it to the pathology lab. As she reported to the hospital board, “the more pressing requirement of a pathological department was

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presented to officials of [the] Society, and with their sanction” the necessary equipment was purchased and a technician hired.57 Additional requirements such as written pre-operative diagnoses, post-operative reviews for each surgical procedure, clinical records for every patient, and “a formally structured medical staff required to hold monthly meetings and to review collectively all hospital deaths”58 would be met only gradually through her first decade. One by one they were achieved and at each step full justification was provided to the hospital board. MacMaster’s professional experience and willingness to keep up in her field, by a mastery of the literature and by regular conference attendance, made her a very effective teacher and administrator. In June 1921, for example, she explained that, despite obvious deficiencies that had to be rectified, “we are trying to standardize our Hospital in accordance with the reprints I mailed each member of the board.” The goal, she continued, was to “comply explicitly with the minimum requirements of the American College of Surgeons.” She had brought in “two experts” for guidance concerning the requirements and was about to interview a third. A visit during the summer months had been arranged for the Canadian representative of the American College of Surgeons, and she confidently expected that the hospital would “make as good a showing as possible.”59 True to her optimistic expectation, the Moncton Hospital qualified as a standardized institution in 1922.60 Alena MacMaster’s confidence, her expertise, and her administrative abilities were rewarded by national recognition for the Moncton Hospital in the years ahead and by accreditation and active membership in the American Hospital Association in 1926. Neither MacMaster nor other hospital supporters had forgotten, however, that even with expanded services and temporary renovated quarters, the hospital’s service to its several communities still required a new wing. In 1925 MacMaster reminded the board of this need for “More Room.” Three years later, she produced figures showing that at times the hospital “operated at more than 100% of its rated capacity,” as on occasions there were ninety-eight patients but a “normal capacity of eighty-six beds.” While the daily average number of patients was sixty-five, the realities of overcrowding at times and inadequate services in some areas had to be addressed. In an ominous tone, she concluded her 1927–28 report: “It is not without reason that your Superintendent predicts that the next few months in the life of the hospital will determine, in a large measure, its future destiny and the hope is expressed that during this critical period those who shall be responsible for its guidance, may be endowed with foresight, integrity, and prudence.”61 The tone of her remarks was occasioned by the disturbing reality that, in the year just passed, the Moncton Hospital had

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launched the most ambitious fund-raising campaign in its history and returns by the spring of 1928 were well short of the goal set. The campaign aimed at the construction of a new wing for the hospital, on the site occupied by the annexes, as well as a new powerhouse and laundry. The Moncton city council was first to be approached, for debenture guarantees, and, in April 1927, the New Brunswick legislature passed legislation that revealed city council’s qualified support. The legislature authorized hospital issuance of up to $150,000 in twenty-year, 5 per cent annual interest debentures, with the usual sinking fund arrangements and with the bond funds earmarked “for the general repair, improvement and equipment” of the Moncton Hospital. But written into the legislation were three qualifications requested by Moncton city council: the council would guarantee only $75,000 of the debentures; council had to approve “the plans and specifications of the proposed building”; and council must have the right to appoint at least three of its members “to the Hospital Building Committee.”62 Municipal control and guidance took another step forward. It was a qualified step, but the Moncton city council’s uneasiness with its growing responsibility might be overcome, the board felt, by a successful fundraising drive. Shortly after this legislation passed, the hospital board convened a meeting of churches’, women’s, and other fraternal organizations that resulted in a commitment to raise $125,000 during the month of September in 1927.63 Chaired by former long-time hospital board member, and now senator, Clifford W. Robinson, who personally secured a $5,000 donation from the estate of the late A.R. McClelan, the drive was extremely well publicized and well organized. In August 1927 a special issue of The Atlantic News was devoted to the history and needs of the Moncton Hospital and was obviously intended for wide distribution. The need for “The Moncton Hospital Campaign!” was proclaimed at great length with elaborate articles and pictures capturing the institution’s past history, achievements, staff, strengths, and needs. Supplemented, and probably paid for, by advertisements from a wide variety of Moncton enterprises, including hospital board member Ambrose Wheeler’s construction company, which eventually would be awarded the contract to build the new wing, it was a sophisticated appeal. To give just one example of this well-crafted campaign document, several pages dealt with “Questions And Answers?” the public might have about the hospital and the drive. On the number of hospital beds, it was pointed out that the “district” served had a population of 65,000 to 75,000 (probably an underestimate). With the proposed addition Moncton Hospital would rise to a 125-bed capacity, which, with the 125-bed Hôtel-Dieu also under construction, would leave the region

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with “approximately 250 beds or slightly less than the minimum safety” requirement of “at least five hospital beds for every one thousand residents.” The necessity of expanded operating rooms, x-ray facilities, laboratory, heating plant, and other facilities was explained. Doctors cry out for hospital expansion, it was reported. Demand had vastly increased – 464 per cent in the “last twenty years,” it was claimed! Concerning maternity services, they were available and were necessary: “The United States Government after an exhaustive survey states that of the 16,000 mothers who lose their lives in childbirth and the 75,000 babies who die before the end of their first month of life every year, more than half could be saved by the use of proper hospital care.” To those who thought faithfully paying for services when they were patients was sufficient contribution, there was the reminder that this did not meet the total costs, since “even if we pay all our expenses” we were still “recipients of charity.” A modern hospital would attract and keep new doctors. And “Who owns the hospital? We do. It is our hospital.” “Who controls it?” was answered: “You. Your neighbours and fellow citizens. The members of the hospital board are accountable to you for the satisfactory accomplishment of the duties imposed upon them.”64 After this impressive broadside, coverage in the local press was mobilized for the cause. Full-page ads ran for several days headlined “$125,000.00 To Raise. Can We Do It? YES!,” accompanied by personal testimonials, with the words of different individuals each day, confirming Monctonians’ support for the drive and awareness of the urgency of hospital needs.65 A drawing of the hospital as it would appear when enlarged to its new 125-bed capacity was followed by a clear statement as to what the goal was, who should be giving, and what had already been committed. The new wing, powerhouse, and laundry would cost $275,000 to $300,000. To achieve this, it was explained, “the people of this section of New Brunswick” were being asked “to supply $125,000 of the cost during the intensive campaign which is just starting.” The balance would be produced by the sale of bonds “of which the city has already guaranteed in the amount of $75,000.” Alongside this fanfare, an army of 200 campaign workers, divided into twenty-four teams of women and men, was unleashed to reap the harvest of donations and subscriptions.66 It was intended to be an intensive campaign, ending by early October, with both volunteer workers and the general public spurred on to the $125,000 goal by daily press reports on the soaring level of donations. The first contribution from outside the city was acclaimed in headlines; a “Good Start” was proclaimed as $5,200 was subscribed on the first day; by the 28th of September $43,000 had been achieved; but by 1 October 1927 the

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total stalled at $48,007. It was reported that the drive’s team captains had “voted to carry on the campaign indefinitely in conjunction with the executive committee and will meet with that committee at some date in the near future and lay plans for a continuation of the work.”67 While donations considerably augmenting the October figure would continue to come in, the $125,000 target would never be achieved. In all probability, the target was unrealistic in a community of Moncton’s size. In 1903, with a little less than half as large a population, the city, helped by the counties, had been able to raise a little over $20,000 for the hospital, and this was regarded as a heroic achievement. To set the goal six times higher in 1927 was likely overly optimistic even in the relatively buoyant economy, for Moncton at least, of the 1920s. As well, with the French-speaking residents, a good portion of the targeted audience, facing solicitation for the new Hôtel-Dieu, a substantial sector of the community had another hospital cause requiring support. Nevertheless, when the final returns were in several years later, after the new wing opened, the total raised stood at $74,000, with a further $7,000 in unpaid pledges,68 a respectable achievement. Regardless of this eventual outcome, in the spring of 1928 after the September fundraising campaign, Alena MacMaster had reason to wonder how the obvious shortfall in funding would be met. With the co-operation of Moncton city council, further debentures were the answer. With the same twenty-year, 5 per cent interest per annum, and sinking fund arrangements, authorization for up to another $150,000 was sought and received in 1929, another $90,000 in 1930, and a final $40,000 in March 1931, the latter issued to pay off “the balance due on the construction of the new hospital and to furnish certain furnishings and equipment for the same.”69 Not all debentures authorized were issued since donations or ordinary revenues could be used instead and the hospital was reluctant to float too many bonds unguaranteed by the city. Only an approximation is available for the final total cost of the hospital addition, furnishings, and equipment, with $400,000 the usual figure cited. In 1931, however, as a result of its expansion, the bonded indebtedness of the hospital had increased by $300,000, of which $280,000 had been guaranteed by the city of Moncton and $20,000 was hospital guaranteed.70 In addition, the original 1923 debenture issue of $20,000 had not yet been paid off. With funding in place, work on the addition was soon underway and was quickly pushed to completion. The nationally renowned architectural firm of Stevens and Lee was hired and construction by Ambrose Wheeler Limited commenced in the spring of 1929. The citizens of Moncton were invited to view “The New and Enlarged Moncton City Hospital” at opening ceremonies scheduled for 28 October 1930. The

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day before, to whet the appetite of opening-day viewers, the Moncton Daily Times provided a twelve-page description of the grand enterprise. The hospital project was endorsed in an editorial accompanying the supplement: “Those first to take part in the movement would be very proud could they see the development that has taken place, the Moncton hospital being one of the most modern and well equipped in the province and rated in the first class by the American College of Surgeons.”71 The paper then took its readers on a tour of the “modern fireproof” three-storey “new hospital building – for the new structure is more than a wing, it being the main hospital.” The new addition could accommodate seventy-five patients and contained on its first floor, among other features, an ambulance entrance, admitting room, out-patient department, waiting room, surgical dressing room, various clinics, pharmacy, laundry, kitchen and dining facilities, x-ray department, physiotherapy department, laboratory, general office, doctors’ lounge, board room, superintendent’s office and apartment, and uniquely designed accommodation for public ward patients. The public wards were “broken up into seven wards, containing four beds each but capable of accommodating an extra bed.” A corridor ran from the building to the powerhouse, built “a safe distance from the hospital.” The second floor accommodated the private and semi-private patients with approximately five single rooms, seven double rooms, eleven other rooms, a two-room suite, a nurses’ room and “an attractive solarium and balcony directly over the ones provided for the public and patients.” Three operating rooms were located on the third floor: one for eye, ear, nose, and throat cases and the other two “for major operations” with all equipped “modernly and scientifically.” Semi-private wards were also housed on this level. The reporter’s exhaustively detailed tour probed every nook and cranny of the new building with constant emphasis on the lack of extravagance and yet thoroughly modern nature of everything: plumbing, heating, lighting, communications systems, nurses’ stations, elevators, and an “electrically illuminated call board.” The latter system, marveled the writer, was “so constructed that once a patient summons a nurse by pushing a small button at his bedside, the nurse can only extinguish the light by returning to the point where the summons was made”; such a system was “the latest in hospital construction” and was “in use in all the modern and up-to-date institutions.”72 Viewing this latest addition to the wonders of the world the next day was an impressive turnout of dignitaries and ordinary citizens. The official opening ceremonies were scheduled for the main foyer of the building but it proved “entirely inadequate” as visitors overflowed its limited space: “The adjoining halls and every point of vantage within

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earshot of the speakers was utilized, while many others, who failed utterly to find standing room in the vicinity of the foyer, visited the various rooms of the building.” Visitors streamed through from noon to the late evening, “and after a visit to all the rooms and the various departments of the new hospital, only words of praise were heard for those who have made possible this modern institution which will take its place among the foremost hospitals on the continent.” New Brunswick’s lieutenant governor, Hugh H. McLean, officially opened the building and was joined in his speech-making by “Ex-Mayor” and hospital president A. Cavour Chapman, New Brunswick premier J.B.M. Baxter, provincial health minister Dr Henry I. Taylor, Westmorland’s member of parliament O.B. Price, Senator Clifford Robinson, and the clerk of the city of Moncton, Colonel S. Boyd Anderson, representing the mayor, Clarence W. Redmond, who was out of town and thus unable to attend. All speakers, of course, extolled the virtues of the new building and everyone connected with its construction, but some comments were particularly appropriate, ironic, and even, unwittingly at times, prophetic. Clifford W. Robinson was the strongest link with the past and accordingly he paid tribute “to those who had been pioneers in hospital work in Moncton, mentioning the names of George B. Willett, A.H. Jones and Hugh Hamilton, as well as those who had been active in the work today.” A. Cavour Chapman was proud of the “modernly equipped and up-to-date building” but could not resist a reminder that “[w]e will ask you in the near future to complete and furnish it.” For a $475 donation a room could be furnished, while $1,000 would “ensure a room bearing your name for all time.” Requests from Chapman for hospital support were something Moncton city council had heard many times, according to S. Boyd Anderson, and Chapman’s “determination and devotion” were key factors in “building the new hospital.” Anderson believed that there was not “another man who had so many no’s, don’t knows, and don’t cares thrown at him as had been thrown at Mr. Chapman, but the President of the Hospital Board went along and accomplished what many people said was impossible.” City clerk Anderson then moved on to talk with pride about Moncton’s “sound business administration and prosperity,” which was demonstrated in revenue-producing new projects such as the police station, airport, exhibition building, and rink, all of which would pay their own way and “not cost the citizens a cent,” while the city’s sinking fund, he reported proudly, had just passed the million-dollar mark. Little did he know what the Depression would do to this prosperous picture; nor could he be aware of the burden of interest on the hospital’s substantial debentures that would soon be deposited on the city’s doorstep. It was the premier of the province, however, who took the prize

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for combining blunt words with ambiguously enigmatic pronouncements. J.B.M. Baxter wanted the citizens present “to think about the problem of the hospital.” What was the problem? To the premier, hospitals “cannot be operated without money,” some of which came “from the patients, and some from public sources.” But hospitals had to accommodate all “classes of people who come to your doors,” some of whom were wealthy or “white collar” workers who could afford or were responsible enough to pay. What of those who lived a “precarious existence” but who must receive “the same treatment” as their “well off brother[s]”? Those who could not or would not pay would indeed soon test the resourcefulness of the hospital. Expansion of services must continue, Baxter asserted, as “we are broadening out in public health.” Where would it end? “This is an age of diagnosis and specialization,” he declared. “The totality of industries ought to bear the total of loss by sickness of people employed in those industries … which after all is the basis of workmen’s compensation. Are we not coming to a point where we will see a change in the whole system of hospitalization.”73 Of all the speeches delivered that day, perhaps Baxter’s, although without a precise solution and certainly raising a funding issue that was not new, captured the uncertain future of hospitals and medical services in general. The Depression soon worsened and it brought a “precarious existence” for many more individuals and institutions than anyone dreamed. On opening day in October 1930, optimism and confidence had not yet been eroded by the Depression. Alena MacMaster was probably typical of many when, a few months earlier, she had outlined the eagerly awaited expansion of services that the new seventy-five-bed wing (which brought the total capacity to 125 beds) would bring to the Moncton Hospital. We hope, she wrote, “to immediately develop a regulation Out-patient Department,” a physiotherapy department, an eye, ear, nose, and throat clinic, as well as expanding and shifting other departments into the new quarters. The changes, she honestly admitted, required additional staff, which meant “additional operating expenses” and “a noticeable advance in our per diem cost.”74 How right she was: the per diem cost, which had actually moved downward in the late 1920s from $3.78 in 1924–25 to $3.09 in 1929–30, would soon rise to $5.21 in 1932 and be at $4.72 in 1940.75 The general deflation of the thirties apparently had only a limited impact on hospital expenses. Faced with rising costs, the traditional answer had been increased charges. But by 1932 both private and public charges were at levels where further increases would be difficult if not impossible. Patient charges were laid out in a special July 1931 issue of The Busy East, which focused on the Moncton Hospital as “A Great Community

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Asset.” At times, the magazine was on the defensive about the rates charged, a response to the widening consumer reaction against further hospital rate increases that was being demonstrated most forcibly in a decline in hospital usage. The Busy East emphasized that there were “no extra charges” to public ward fees, that additional charges paid by private and semi-private patients were “slightly below the fee[s] usually assessed” at other institutions, and that the hospital rates were actually quite “moderate.” Moreover, given the real per diem operating costs of the hospital, compared with what municipality, county, or part-pay public ward patients contributed, the hospital was being forced to subsidize patients “from its own resources or earnings.” By 1931 as well, reported The Busy East, the “problem of collecting the money due the hospital for the care of patients is a constant one, especially in these days of depression and unemployment.”76 By 1933, as the Depression deepened, the hospital’s financial situation deteriorated to the point where the ratio of patient fees versus government support underwent a substantial readjustment and the city of Moncton emerged with significantly increased responsibility for the hospital. The total revenues of the hospital fell from $122,018.97 in 1929–30 to $86,596.98 in the 1933 fiscal year, partly because of a decline in the number of patients admitted from 2,087 to 1,955, and, more importantly, because of the surge in the number of public ward patients. The decline in paying patient revenues from 1929–30, when they amounted to $72,333.72, to 1933, when they bottomed out at $62,823.37, was particularly noticeable. Declining revenues, the increased number of public ward patients, the inability of the adjoining counties to meet their financial responsibilities for several years (a temporary phenomenon rectified in 1935), and the obvious incapacity of the hospital’s straitened resources to meet its debenture obligations all combined to create a financial crisis that was deeper than the $10,113.12 shortfall in revenues compared to expenditures reported in 1933.77 Even with total revenues well over the $100,000 mark, it would have been extremely difficult for the hospital to meet on its own the annual debenture interest payments on $320,000 worth of bonds plus its sinking fund obligations, and also to cope with its other increased expenditures. The Moncton city council, although faced with the need to pare expenditures, a reduced tax base, uncollectible revenues, and a growing relief burden,78 responded to the challenge. Moncton’s annual grant to the hospital increased drastically, taking different forms, in response to the hospital’s Depression woes. At a city council meeting in late February 1931, with the brief explanation that hospital bonds had been guaranteed by the city, approval was given to the regular $9,000 grant as

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well as $12,000 for interest on hospital debentures and $3,679 for its sinking fund.79 In 1932 the city’s formal grant dropped to $8,100 but it was supplemented by a grant of $14,000 towards the hospital’s debenture interest and a $4,757.61 sinking fund contribution, for a total of $26,857.61. By 1935 the Moncton contribution took the form of a $5,000 grant for indigent patients, $14,000 for interest on the hospital bonds, and $4,292.40 as a sinking fund grant, for a total of $23,292.40.80 City support had become a vital factor in the fiscal stability of the hospital as never before. In addition, over a ten-year period, the balance between private patient revenues and total government grants had significantly changed. In 1924–25 paying patient revenues of $45,204.65 represented 67.6 per cent of the hospital’s total $66,861.58 in revenue, while government grants amounting to $12,000, made up 17.9 per cent of the total. In 1935 patients paid $74,932.84, or 63.9 per cent of the hospital’s total $123,156.67 in revenue, while government grants/payments were $31,908.86 or 27.2 per cent of total revenue. More prosperous times did not alter substantially this new ratio since in 1939, on total revenues of $133,937.98, patient fees represented 62.2 per cent ($83,283.77) while government grants/payments were 26.3 per cent ($35,174.41) of total revenue. And the major government supporter was the city of Moncton, providing 73 per cent of government funds available in 1935 and 66.2 per cent in 1939.81 Municipalities had emerged in other Canadian communities as the major government support for local hospitals, but with uneven results. Some hospitals were forced to close because of deficit situations and, in some cases, municipal financing was badly disrupted by the experience as hospital costs proved too much of a burden.82 In New Brunswick, and Moncton more specifically, the perils of municipal over-reliance, or over-commitment, were recognized, so alternative sources of funding were sought. Obviously the provincial government was one possibility. By 1934, New Brunswick and Prince Edward Island were the only provinces still offering lump-sum payments to hospitals instead of per diem grant schemes for indigent patients. Three of the western provinces went even further in their support, with per diem grants covering all patients.83 Per diems were assessed as delivering more funds than lump-sum grants and per diems for all patients would be even more of an improvement. But a 1935 recommendation by the New Brunswick Hospital Association that the provincial government “increase its subsidies to hospitals by making a per diem allowance per patient” available84 produced no change in provincial policy. As World War II broke out, New Brunswick provided $19,162.50 in grants for seventeen institutions, lump sums varying from $187.50 to $3,750 depending upon the bed capacity of each hospital.85

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The Moncton Hospital’s ability to respond to Depression financial problems was further complicated by apprehension about antagonizing the paying public with increased charges and thereby lowering paying patient revenues, and by concern about biting the hand that was now feeding it by demanding more from a city council that was playing a more active funding role than ever before. Consequently, the board tread carefully. On the other hand, Alena MacMaster underlined the need to press for more funding where it was warranted and theorized about funding arrangements that would allow patients to meet the increased cost of health services. The squeeze for minuscule additional revenue was demonstrated in the hospital’s handling of out-patient treatment, which was now well accommodated in the new wing and which offered an expanded range of clinics and services. Users were warned that it was a service “for the benefit of the poor only,” and even the poor were encouraged to meet “a flat charge” of 25 cents per visit. Other potential out-patients “who are able to pay ordinary fees for medical attendance” were told to see their own doctors since they were “not entitled to treatment and will be refused.”86 MacMaster continued her careful scrutiny of services offered, and she remained ever alert to, and quite unapologetic about proposing, new sources of revenue. An arrangement with Henry’s pharmacy was cancelled and the hospital opened its own service, staffed by Marjorie Rodd. In 1935 MacMaster was pleased to report “an actual profit” of $239.95. Repair and replacement expenses were kept to a minimum. Services such as the venereal disease clinic were re-examined, with MacMaster suggesting that “the hospital should receive some subsidy from the Province of New Brunswick for supplying space and overhead maintenance.” An adequate conveyance vehicle for contagious disease cases was badly needed but MacMaster firmly stated that “I do not believe that it is the responsibility of the hospital but rather of the [provincial] Department of Health or the Municipality to supply a suitable vehicle.”87 Even if successful, however, all these measures would not solve the basic problem that Depression-era patients were increasingly unable or unwilling to pay for hospital services. The amount of bad debts grew every year and, in 1932, MacMaster described the situation as “most discouraging.” While there were patients who acted in “good Faith” to meet, or arrange to meet by a payment plan, their fees, and the poor were quite legitimately unable to pay, to MacMaster’s horror there was an increasing number “quite able to pay who neglect or refuse to recognize their obligation to the hospital,” and who “resent all attempts on the part of the hospital to collect.”88 As a long-term solution, MacMaster, within the year, was proposing schemes that had been tried in

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Great Britain and the United States, experiments with what she termed “the Periodic Payment Plan for the Purchase of Hospital Care.” Since both municipalities and individual patients lacked the funds to meet hospital needs, a “system of hospital insurance” should be worked out whereby certain hospital services would be provided to the participant in return for “payment of an annual premium.”89 By the mid-thirties MacMaster’s suggestion had progressed to the point where hospital secretary Ruth Wilson had prepared “a study on Group Hospitalization” for distribution to board members. MacMaster was optimistic that “it is the intention of our President when the time is opportune to inaugurate this service if at all possible.”90 In 1937 a Moncton experiment with such a scheme was launched.91 A Group Hospitalization Service Commission sponsored by the Moncton Hospital board and Hôtel-Dieu was organized that year and formally incorporated in April 1939.92 Urging an emphasis on group subscription rather than what MacMaster felt to be the “actuarially unsound” individual enrollment in plans, the Moncton Hospital superintendent was pleased to report the success of the new plan. In 1940 between 4 to 5 per cent of the patients admitted were under this hospital care scheme, receiving “1,382 hospital days service at a charge to the Plan of $7,586.50.”93 The full impact on hospital revenues of such private hospital insurance schemes would only be felt in the war and post-war years. In the interval, as MacMaster analysed the growing burden of unpaying, or underpaying, patients, she was quite willing to point to Monctonians as the major problem. In 1935, as county councils resumed their per diem payments for their public patients, and were sending an increasingly healthy ratio of private versus public patients to the hospital, Moncton’s ratio dipped to an unhealthy low. MacMaster pinpointed this reality for the benefit of board members in her report for that year, explaining that “35% of all patients admitted from the city of Moncton were public ward patients.” Of the total 27,266 hospital days for that year, moreover, 40 per cent were taken up by public ward patients and it was Moncton patients in turn who took up “70% of the public ward hospital days.”94 Thus when the city council offered suggestions about how Moncton usage of the hospital might be reduced, along with the hint of tightened financial support, it received a very prickly response from the hospital. The response took the form of a letter that listed the various services the hospital offered to Moncton’s “indigent poor,” along with the clinics and other public health services from which the city profited, as well as the reduced pressure on other agencies, such as the almshouse, the Children’s Home, and the Victorian Order of Nurses, all provided willingly by an over-burdened hospital.95

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The letter concluded with the hospital’s desire for continuing “mutual understanding and co-operation” but sought clarification of the cityhospital relationship. It was emphasized that the “interest of the city cannot cease with the cold mathematical [de?]termination of so many days’ treatment” under a grant formula. The “formal agreement[s]” between hospital and city, as well as the expanded municipal support, continued despite such periodic abrasive exchanges. The letter was interesting because, although signed by A. Cavour Chapman, it was on the stationery of A.J. MacMaster and recited points she frequently made; thus, she probably wrote it with Chapman willingly signing. As such, it told a great deal about the changing role of the board, its president, and their relationship with Alena J. MacMaster. From her earliest moments as superintendent, MacMaster had taken the lead in shaping the hospital and its policies, while board members, some of whom were very aware of the 1917 public complaints about an overinvolved and heavy-handed board, were quite willing to play a supportive role. At times the board did reject or soften MacMaster’s proposals, but, for the most part, she was allowed to run the hospital. The superintendent’s actions were invariably endorsed by A. Cavour Chapman, who served as hospital president through the entire interwar period up until a year before his death in 1943, and he and MacMaster worked extremely well together. Given such latitude, the language used by MacMaster in reporting various decisions subtly changed in the early 1920s. “With the approval of our President,” and a hiring choice “accepted by herself and President Chapman to fill the vacancy,” were soon balanced and eventually replaced by MacMaster announcements that “I have been fortunate in securing the services of …”96 Facilitating this evolving transfer of day-to-day operational responsibility, and policy recommendations including matters such as fee structures, from the board to the superintendent was the growth of a carefully selected hospital bureaucracy. In 1925, the administrative staff numbered seven; by 1930 the “executive staff” had grown to eleven plus the hospital auditor. By this date MacMaster had filled almost all the key positions with graduates like herself of the Moncton Hospital nursing program or with women she had personally selected and with whom she worked well. Moncton graduates Marion G. MacLaren as head nurse, Bertie M. Wells as surgical supervisor, Dorothy F.R. Oliver as night supervisor, along with Alice Newcomb and Florence Breau as ward supervisors now served on the staff. Helen Ryder remained as matron while Ruth Wilson continued as a valuable and trusted secretary to MacMaster and the hospital. As the superintendent had predicted, and despite the Depression, additional staff had to be added with the expanded services opened in 1930, and

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by the end of the decade the executive staff numbered eighteen,97 many of whom were carry-overs from the 1920s and all of whom met the standards set by MacMaster. Longevity of service marked the board of trustees as well as the hospital staff. Indeed it was rather ironic that, after 1917, the need for “new blood” on the board gradually swept in newcomers who would now repeat the practice of old board members by serving again and again. The difference was that no public challenge was offered to this continuity of membership. In the interwar period and beyond, a number of individuals would give the hospital at least a decade of service or more.98 And yet, with this continuity, there were still some noteworthy changes to representation on the board. Mrs (F.L.) Harriet Doyle was the first woman to be elected to the executive of the board, serving as secretary for several years in the early twenties, while Mrs (W.A.) Janet Ferguson’s appointment to the board in 1936 as a New Brunswick government representative increased the number of women members to three (two Ladies’ Aid representatives still served). The physicians increased their board representation to two members in 1936 as well, with Dr Henry Coleman representing the Moncton Medical Society and Dr James MacNaughton representing the “Moncton Hospital Attending Staff.”99 Reflecting the growing municipal control, Moncton’s mayor and three aldermen were on, and remained on, the board from 1927 onward, while representation from the adjoining counties disappeared from 1933 onward. All these changes occurred without any change to the 1917 legislation and, in the case of Moncton’s representation, the addition was more than what was required under the Hospital Act. If board membership for 1929–30 is taken as a sample and examined in terms of occupation, or occupation of spouses in the case of women members, continued domination by the better-off, middle- to uppermiddle-class, socio-economic elite of the community is quite clear. In that year, information is available for twenty of the twenty-three board members listed in the hospital’s annual report. Hospital president A. Cavour Chapman was secretary-treasurer and manager of the New Brunswick Wire Fence Company and a director of the Central Trust Company; vice-president Allie McSweeney was a partner in the Peter McSweeney Limited department store; secretary George A. Robertson was a retired merchant, president of the Hotel American Limited, and director of a number of companies including the New Brunswick Wire Fence Company; treasurer Bliss A. Bourgeois was Atlantic region treasurer of Canadian National Railways. Non-executive board members included the manager of the T. Eaton Company store; a representative of the railway workers; a contractor and director of Central Trust

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Company; the city clerk and treasurer of the city of Moncton; a marine engineer and chair of the New Brunswick board of examiners for stationary engineers as well as honorary member of the Brotherhood of Locomotive Engineers, which he represented on the hospital board; the president of Spencers’ Limited, which owned and operated two drug stores; the owner of the “largest custom tailoring company in Moncton”; a Moncton alderman and biscuit company owner; a lawyer and magistrate; the Westmorland county warden who owned a garage and service station as well as several funeral parlours; a veteran Moncton doctor; a wholesale merchant; a locomotive engineer; an auditor for cnr; the wife of the Pierce-Arrow, Cadillac, and McLaughlin-Buick dealer; and the widow of a doctor.100 Excluding the women members and labour representatives, these individuals frequently sat on the same company boards, joined the same service clubs (particularly the Rotary Club), had active municipal and provincial political connections and, in general, were prominent leaders in the city of Moncton. Meetings of companies such as Central Trust, which handled one of the hospital’s sinking funds, must have been particularly cosy as shareholders A. Cavour Chapman and Reid McManus met with other prominent shareholders and hospital supporters Clifford Robinson, E. Albert Reilly, Joseph A. Marven, W.F. Fergusson, and Frederick R. Sumner.101 Although the hospital board might have allowed and encouraged a considerable devolution of authority upon Alena MacMaster and her administrative staff, the board retained its power of final approval and remained an important conduit that had access to the ears and pocketbooks of those who made the political decisions or provided the economic support necessary for the effective operation of the Moncton Hospital. The hospital’s effective and efficient operation, as it underwent renovation and expansion, shifts in administrative and economic responsibility, along with the trauma of the Depression, required the support and co-operation of its physicians. In general, Alena MacMaster revealed a deferential sensitivity to doctors’ desires, but on some occasions she gently guided or pointedly prodded the staff physicians to achieve and maintain the standardization and certification requirements. She was helped in this professionalization of the institution by the doctors’ basic endorsement and commitment to the same goals set by MacMaster. Any laggardly performance on their part was caused at least partly by the lack of specialists and by what remained, despite expansion, a sometimes overburdened medical roster. To be sure, the increase in the number of patients served in the interwar years was roughly matched by a substantial growth in the specialization and number of physicians. For 1920–21, the hospital listed twelve doctors

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on staff plus three consultants, if Dr Henry Coleman is excluded from the consultant list, being also listed among the “medical” staff. The physicians were broken into three “surgical” staff: William Ferguson, Fred White, and Ambrose Myers; six “medical” staff: Louis Bourque, A. Raymond Landry, Paul McL. Atkinson, Howe Alonzo Jones, James MacNaughton, and Henry Coleman; an eye, ear, nose, and throat specialist, Sherman Burgess; a roentgenologist, Fred Richard; and a dentist, Fred E. Burden. George Taylor, Leveritt Price, and J.D. Calkin were listed as consultants.. Each of the surgeon-physicians and medical-physicians were assigned four-month duties, in two-month stints, of public ward attendance at the hospital.102 By 1940, this staff had been significantly expanded in numbers and specializations available. The hospital now had twenty-five doctors on staff along with eight consultants. However, three of the regular staff and one consultant were already on leave for military duties, which meant that, in reality, patients, whose numbers had more than doubled, were served by physicians whose numbers had not increased at the same pace. The official list contained five senior surgeons: Harry E. Britton, Paul McL. Atkinson, George A. Lyons, Joseph W. Dobson, and Charles R. Baxter; five junior surgeons: John Stewart, Hugh M. MacLean, H. Paul Melanson, K.W. MacKenzie, and Ralph P. Myers; and three senior physicians: James MacNaughton, Robert G. Girvan, and Robert D. Roach. The senior physicians were designated for other duties as well, with Roach appearing as senior pediatrician and electro-cardiologist while Girvan and MacNaughton also served as anaesthetists. There were two junior physicians: Harry L. McKeen and Robert Cox, while E.W. Ewart handled orthopedics, exclusive of fractures. Sherman Burgess and Francis E. Boudreau were the eye, ear, nose, and throat specialists while the junior specialists in the same area were Vincent P. Doucet and Arthur W. Ross, with L.A. Goodridge listed as ear, nose, and throat specialist. By 1940 William A. Pullin was opthalmologist, W.S. Fitzpatrick was urologist, and Fred A. Richard continued to serve as roentgenologist. John A. Folkins was dental surgeon. Finally, there was an eight-person consulting staff consisting of Ambrose Myers, A. Raymond Landry, Alphonse Sormany, Robert J. Caldwell, Andy R. Richardson, Charles A. Gass, P.L. Oxley, and R. D. MacDonald. In terms of duty periods in the public wards of the hospital, listed for full-time availability were Ewart in orthopedics, Roach as pediatrician, Fitzpatrick as urologist, and Richard as roentgenologist. The two anaesthetists, Girvan and MacNaughton, alternated on a monthly basis while their six months of service, arranged slightly differently, was matched by all the eye, ear, nose, and throat specialists, except Francis E. Boudreau, who was on call for emergency only. Ophthalmologist

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Pullin also was listed for six months of duty. Senior surgeons were each assigned three months of public ward responsibility while their junior counterparts had four-month stints. Senior physicians had four months scheduled while their junior colleagues did six months of public ward service.103 While staff names and services had considerably changed, the medical training of the staff continued to make meetings seem like gatherings of the local McGill University alumni chapter,104 although Dalhousie University was now making its presence felt. A comparison of hospital physicians, excluding consultants, in 1929–30 and 1940, reveals McGill as the dominant medical school, but Dalhousie was closing the gap by 1940, while the number of American-trained physicians had declined considerably. In 1929–30, twenty-one “attending staff” were listed and information is available for twenty of these physicians. Eleven were McGill trained, four were from Dalhousie, two were graduates of New York’s Bellevue Medical College, while one each were drawn from Queen’s, City University of New York, and Baltimore Medical College. In 1940, information is available for twenty-four of the twenty-five doctors listed, again excluding consultants, and McGill’s medical school remained the leader with twelve graduates. But Dalhousie University now accounted for eight of the hospital staff members, followed by one physician from each of Laval, Edinburgh, the University of Toronto, and Bellevue.105 The staff had been almost totally Canadianized in training by 1940, and the sole provider of medical education in the Maritimes, Dalhousie University, seemed on the verge of challenging McGill as the major supplier of medical graduates, at least in the Moncton area. The medical staff, like the hospital board and the administrative staff, was supportive of Alena MacMaster’s policies, although the doctors differed in that their views consistently received a special and deferential consideration. It was only rarely that MacMaster seemed to feel firmer direction was needed but, on those occasions, her views prevailed. In April 1921, the untimely death of Dr Fred White caused the physicians to re-think their surgical and medical structure and it was their suggestions that the board implemented. Instead of moving immediately to replace White, the board delayed any decision and accepted Dr Fred Richard’s suggestion that the “medical fraternity of the city” should meet to discuss changes. What was on the minds of several doctors, as Dr Henry Coleman articulated at the board level, apparently supported by senior surgeon William Ferguson and others, was an approach whereby a senior physician should be assisted by a junior doctor, who could thus gain valuable experience. In surgery, as Coleman explained, no assistants were present, “only a nurse.” As a result, “there were no

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younger practitioners getting experience.” It was now proposed that “the work should be divided and several assistants appointed so that the latter could place themselves in a position to handle any emergency in the future.” Shortly thereafter the system of senior and junior surgeons and physicians was implemented and by the thirties it was found in almost all the specializations. On equipment needs as well, the doctors’ views were heard at board level. For example, Alena MacMaster raised x-ray machine problems and suggested that “Dr. Richard will in all probability be present at the Board meeting and personally state his requirements.” Richard did indeed appear before the board to report the “worn out” nature of his equipment which the board, with considerable Ladies’ Aid help, rectified almost immediately.106 Meeting standardization and certification requirements involved the occasional bump on the road, causing MacMaster to hint sometimes that greater co-operation would be appreciated. To busy doctors, upto-date record-keeping and incomplete charts were always problems. To improve this situation, MacMaster was elated to report in June 1930 the hiring of Neva King as a “half-time worker” to help in the development “of a case record system.” As far as the American College of Surgeons was concerned, MacMaster emphasized, “the constant attention to case history keeping by both attending doctor and the hospital” was all-important. MacMaster’s message was probably intended for her doctors as well as her board members. In the same report to the board, there was a hint that the regular medical staff meetings had not quite received standing ovations from hospital physicians. Carefully choosing her words, MacMaster wrote that staff meetings were now regular events and were “on an average fairly well attended.” With the move into the new wing, however, the situation would improve as “present conditions do not provide the proper stimulus.” “I believe,” she stated, “when the staff room is at the disposal of the attending staff, the doctors will feel more free to meet and discuss their cases with a reasonable assurance of comfort and privacy, and [the move] will result in a better attendance.”107 Regular meetings were achieved and the hospital physicians developed the usual committee structure. By the early forties these responsibilities were not yet burdensome, as the medical staff was able to get by with only five committees: the executive committee, records committee, program committee, credentials committee, and an intern committee. Staffing considerations were extremely important to the physicians and, while MacMaster sympathetically conveyed their views, she could also over-rule the medical staff. Usually staff recommendations were presented to the board with a straightforward endorsement from MacMaster, such as in 1933 when she simply stated: “Herewith attached is

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a recommendation from the attending staff concerning certain staff appointments.” But in January 1936, when the physicians proposed the option of having six senior and six junior surgeons on staff, Alena MacMaster believed the existing four and four arrangement was more efficient, “and her option prevailed.” In the same year, after a generally positive inspection by the American College of Surgeons, some of the critical comments of the inspectors brought quick action from MacMaster and the medical staff. It was suggested that hospital recordkeeping badly needed improvement and the staff bylaws required immediate revision. MacMaster’s assistant administrator, Ruth Wilson, was assigned to work with Dr Charles Baxter on the bylaws, while MacMaster announced that in future, except for emergency cases, all case histories had to be written up before acceptance in the operating room.108 Despite this chastisement, the medical staff gained support and approval for a number of changes that improved the quality of medical services. By 1936, exclusive of those already on the medical staff, a retirement age of sixty-five was agreed upon with automatic appointment as consultants in their specialities granted to the retirees. Any member of the attending ward staff could extend “the courtesy of the hospital” to any visiting doctor of specialist standing if the legal requirements of the New Brunswick medical society were met. In May 1937 new staff bylaws were approved, modeled on a set endorsed by the American College of Surgeons, with tightened rules about attendance at staff meetings. November of the same year brought a medical staff proposal for a change in surgical procedures, except in eye, ear, nose, and throat cases, that necessitated establishment of an intern system. It was argued that every surgeon should “provide himself with an assistant for all major surgical procedures.” Since surgery fees would increase if this proposal was implemented, it was recommended to the board that the “immediate engagement of two medical graduates as interns would lessen the financial burden incurred by the public.” The result was the appointment of one intern in June 1938, McGill graduate Dr Everett Crutchlow, but securing interns proved difficult. Crutchlow finished his term and departed in the summer of 1939 but his successor left shortly after his appointment. Consequently the hospital applied to Dalhousie University to be placed on its medical school’s “list of hospitals for rotating service of student interns.”109 Recruitment and replacement of staff was not easy, and at the close of the 1930s only Dr Ambrose Myers remained from the hospital’s founding medical staff. As the more prominent physicians passed on, the community’s sense of loss was usually expressed in the local press, along with, in several cases, comments on the widespread recognition

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of the medical skills available at the Moncton Hospital. In May 1919, upon the death of Dr Edward Botsford Chandler, it was reported that “his fame as a diagnostician extended over a considerable part of this province and Nova Scotia, where his services were largely sought in a consulting capacity.”110 Two years later, when the “Widely Known And Highly Esteemed Medical Practitioner” Fred White passed away, his many non-medical contributions as one of Moncton’s “leading citizens” were praised at length. As well as his impressive community and national service, it was underlined that White “was widely known as one of the most skillful physicians and surgeons in eastern New Brunswick.”111 When Dr William Ferguson died in 1935, the tone of affection and respect for this “Brilliant Surgeon” was especially apparent. His entire medical career, beginning with studies under “that famous Canadian, Sir William Osler” at McGill, his post-graduate training, his early work in western Canada, and his long service to the Moncton Hospital were all recounted. He was, reported the Moncton Transcript, a “plain man” who had “done infinite good in the community.” Always he was “the genial doctor, who unobtrusively gave his best attention and forgot the bill. He will be missed among the poorest of the community.” Yet, the reader was reminded, this humble and approachable doctor’s skills were appreciated well beyond Moncton’s boundaries. “Leaders in surgery in Montreal, one of the centres of surgical skills in the world, respected his views and patients have been known to have been asked: ‘Why come to me when you have such a man as Dr. Ferguson in your own city?’ He became a Fellow of the American College of Surgeons in 1920 and refused all other honors.”112 It had been the much-esteemed Dr Ferguson who turned the first sod for the construction of Hôtel-Dieu in June 1927,113 and the emergence of this sister institution led to one further loss for the Moncton Hospital. While some francophone physicians remained on staff, others decided that their major responsibilities were at the Hôtel-Dieu and, while remaining on the courtesy staff of the Moncton Hospital, A. Raymond Landry, J.E. Leger, Leo Doiron, and J. Alfred Gaudet took positions on the new hospital’s active staff.114 The management of the hospital’s at times “brilliant” physicians, and the guidance of, and co-operation elicited from, the hospital board revealed the sometimes brilliant administrative skills of Alena J. MacMaster. In these areas, the superintendent relied upon a mix of careful education and timely leadership interventions. The hospital thus functioned, for the most part, as a collegial and consultative enterprise, but there was one sector of vital importance, near and dear to MacMaster’s heart, which she regarded as of necessity a fiefdom and ran it accordingly. “Owing to our increase of work,” she reported to the board in

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June 1921, “I found it necessary to enlarge our class [of student nurses] from 21 of last year to 27 at the present time. With the autumn work, more will be needed.” To handle increased patient numbers and a wider range of hospital services, as at other hospitals in the 1920s and 1930s, the student nurses attending the Moncton Hospital’s training school were of vital importance. Particularly in view of a general administrative reluctance to add too many graduate nurses to staff, because of their expense, apprenticed student labour provided the exploited female drones who kept the hospital humming. Once again drawing upon her own experience and mastery of developments in the nursing field, MacMaster’s hands-on approach to the nursing school allowed her to gradually develop the standards of admission, the curriculum, and the exchange programs, where necessary, that would produce a well-housed, welldisciplined, and well-trained nursing graduate. By 1931 MacMaster could speak with pride of a Moncton Hospital Training School for Nurses that had acquired, and had to protect, a reputation for the quality of its nurses. By this point, the school’s “every activity is planned to bring out the very best in every young student under its care, both as woman and nurse, and the results can best be gauged by a survey of the efficiency and reputation of its graduates.”115 When MacMaster arrived in 1919 the hospital’s nursing needs were met by two or three graduate nurses along with twenty student nurses, including five probationers as well as fifteen other students at the junior, intermediate, and senior levels. The graduating class of 1919 numbered five. Nineteen applicants had been accepted into the program during the 1919–20 year but selectivity on MacMaster’s part, combined with the difficulties of the program, winnowed the new crop considerably. By May 1920, five of the nineteen probationers had been accepted into the school, five were still on probation, and the remaining nine “had not been retained, owing to their not demonstrating an adaptability, or an inclination for the work.”116 Graduation ceremonies, which had fallen by the wayside as well-attended public events, were restored by MacMaster in 1921 in order, she reported, “to call attention to our training school” and to ensure a “proper recognition” of the graduates’ “services and training.”117 The attention paid to the nursing program, along with a renovated and expanded nurses’ home available in early 1925,118 was rewarded by a steady increase in the number of students and graduates. In May 1930, of forty-six student nurses, fifteen graduated from the program, and by 1940 student nurses numbered fifty-seven, with sixteen students graduating during the year.119 This expansion of student nurses, and of registered nurses, had an ironic dimension because it contributed at least partly to what has been aptly described as a “crisis” for the “third generation of

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graduate nurses” who emerged in the 1920-42 period.120 On the positive side, an expanded supply of nurses, from 21,162 in 1921 to 38,709 in 1941, improved the ratio of nurses and nurses in training to population from 1 for every 410 people Canada-wide in 1921 (1 for every 405 New Brunswick residents in the same year) to 1 nurse or student nurse per 295 persons Canada-wide (1 for every 293 New Brunswick residents) in 1941.121 MacMaster noted in 1930 that a recent survey of 1,196 hospitals reported a student nurse/patient average ratio of .62, while Moncton Hospital had a .64 ratio, “approximately twothirds of a nurse per patient.”122 On the negative side were the shrinking employment opportunities for the nurses graduating from the expanded training schools. Hospitals wanted to meet their nursing needs with growing numbers of student nurses and so most graduate nurses had to look to private nursing opportunities, which they initially did quite willingly as an escape from hospital regimentation. But in the 1920s hospitals were attracting many more patients and so the private care opportunities were shrinking. Somewhat offsetting this loss were hospital staff positions or private care opportunities within the hospitals, which doctors might recommend and patients might desire, but this growth did not match the increased number of registered women nurses available. The Depression compounded the problem as the money available for private care by nurses, whether in the hospital or at home, was reduced, while some cost-conscious hospitals relied even more heavily on student nurses and attempted reductions in the staff of their graduate nurses.123 The employment problems faced by graduate nurses were left unaddressed by many institutions but Alena MacMaster was sensitive to the profession’s difficulties and attempted solutions on several levels. She was active in graduate nurses’ organizations locally and provincially, and whether within the Moncton chapter of the New Brunswick Association of Registered Nurses or the provincial executive of that organization, her leadership and suggestions sometimes bore fruit.124 In the mid-1920s, while not maintaining a paid registry, the Moncton Hospital did undertake to assist in the placement of “private duty” nurses “both inside and outside the Hospital,” and by 1930 this had evolved into a register “kept in the Office of the Superintendent” that provided names of graduate nurses available for work.125 At the same time MacMaster willingly served as registrar and in other executive positions for the nbarn to assess credentials and to guarantee that nurses met the required standards before registration. Of particular concern to her was the low level of training in some nursing schools, which led her to recommend closure of schools where “nursing education facilities were inadequate.”126 More direct than merely facilitating the employment of

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graduates, and possibly restricting the number of graduates, was MacMaster’s arrival at what would to a great extent eventually resolve the employment problems of fully trained nurses: graduate nurse staffing of hospital wards. This “rise of general duty-nursing” would gradually transform nursing services,127 and MacMaster was guiding her own institution in that direction in the 1930s. Although the Moncton Hospital continued to rely heavily on student nurses, the number of graduate nurses employed increased steadily until in 1940 the fifty-seven student nurses were working alongside a “Graduate Nurse Staff” of fourteen.128 In the exodus decade of the 1920s, however, many graduate nurses resolved their employment problems by migrating to other parts of Canada; in the case of nurses trained in the Maritimes, “migration to the New England states” apparently proved especially attractive.129 Graduates of the Moncton Hospital Training School for Nurses were not immune to the temptations of migration, although a large number remained in New Brunswick. In the period from the graduation of its first class, in 1909, to 1930, the school produced 130 graduates, compared to the 309 trained by the larger Victoria General Hospital in Halifax from 1900 to 1925, and the 148 graduates of the longer established Victoria Public Hospital school in Fredericton from 1894 to 1930.130 Home addresses as of 1930 were available for 123 of the Moncton Hospital graduates, and of this group sixty-five (52.9 per cent) remained in New Brunswick, thirty-six of them in Moncton, of whom six were employed on the Moncton Hospital staff. Of the remaining fifty-eight nursing graduates, twenty-five (20.3 per cent) were residents of other Canadian provinces or Newfoundland while thirtythree (26.8 per cent) were in the United States. Within Canada, Nova Scotia claimed nine Moncton Hospital graduates, followed by Quebec with six and Ontario with four, while one each were found in Prince Edward Island, Manitoba, Saskatchewan, Alberta, and British Columbia, with one graduate in Newfoundland. Nursing graduates resident in the United States primarily chose New York, with eleven graduates, or Massachusetts, also with eleven, followed by Rhode Island and Florida with two each, and one each scattered to Colorado, Maine, Michigan, Connecticut, Idaho, New Hampshire, and Arizona. If nurses were hired by hospitals, however, marriage usually cut short their employment and career. MacMaster repeatedly reported the resignation or departure of nursing staff because of marriage. Comparative figures available on graduates of the Winnipeg General Hospital from 1920 to 1928 reveal that 31 per cent never married, while the 1930 list of all 130 Moncton nursing graduates contained forty-five (34.6 per cent) married and eighty-five (65.4 per cent) unmarried.131 Even allowing for

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the possibility of out-of-date information available to the Moncton Hospital, its 65.4 per cent unmarried figure was an extraordinary reversal of the Winnipeg figure. Possibly it revealed how successful MacMaster and the Moncton nursing program were in instilling a career commitment within their student nurses. The program of training and education in the Moncton nursing school, MacMaster emphasized, was under constant assessment and adjustment. It had considerably changed over the years, she argued, since “[u]nlike former days (when student nurses were exploited for the profit of the hospital, their lectures and practical instruction given the most casual attention, and their living conditions anything but an example of practical hygiene), those enrolled in the training school are a carefully selected group of young women chosen for their education and personality.” Basic requirements “of health, moral character, and education” must be met for admission, she emphasized, and “[a]fter they are enrolled they must cover a curriculum of studies and practical work that would surprise an average college student.” It was a rigorous and demanding program, the superintendent admitted, as “very little dross can survive the crucible of their vigorous training.” But they emerge, MacMaster proudly claimed, fitted “for one of the most blessed careers a young woman is privileged to embrace!”132 In the early 1920s applicants had to be between twenty-one and thirty-five years of age, “of superior education and refinement,” and have completed at least one year of high school.133 Gradually the student age dropped and then rose slightly, while the admissions requirements substantially increased. The 1920s students had an average age on admission of 18.6 and by the 1930s averaged 18.9 years.134 In 1930 two years of high school were required for admission and by 1932 this had been raised to high school graduation: “only graduates of a recognized High School or Matriculants are considered.” Hospital staff doctors shared with MacMaster the teaching responsibilities, although MacMaster’s heavy burden was reduced somewhat with the addition of nurses such as Maisie Miller as assistant instructor in 1931 and Dorothy Oliver in 1932, the latter taking on instruction duties instead of her staff nurse position.135 Keenly interested in nursing school curriculums, MacMaster served on the committee devising “a standard curriculum for the province” and was quick to adapt the courses and training available at the Moncton Hospital to meet the needs of the changing world of hospital medical care. Service on the province-wide curriculum committee convinced her that much of what was being proposed was already in place in the Moncton program. Nonetheless, regular curriculum revision and the creation of new courses marked the interwar years.136 When the 1932

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Survey of Nursing Education in Canada, the Weir Report, appeared, a good number of its major recommendations were immediately implemented by MacMaster. By 1935, the curriculum required 132 hours of instruction in the probationary period or preliminary term, followed by 132 hours, 234 hours, and 222 hours respectively in the first, second, and third years.137 When clinical training could not be provided because of Moncton’s limited facilities, arrangements were made elsewhere to meet these training needs. Although the old hospital building was largely devoted to maternity cases after the opening of the new wing, clinical opportunities were still restricted in this area, and clinical training in tuberculosis treatment was even more restricted. Both needs were met by affiliation arrangements with other hospitals. The maternity training linkage with Saint Luke’s Hospital in New Bedford, Massachusetts, was replaced in 1927 by an affiliation with the Montreal Maternity Pavilion of the Royal Victoria Hospital in Montreal, which provided Moncton student nurses with a three-month course in “Obstetrics and Infant Feeding.” From 1925 to 1939, there was also an arrangement with the tuberculosis hospital in Saint John for a threemonth course in “Tuberculosis Nursing and Public Health.”138 MacMaster firmly believed that discipline was crucial in the shaping of a properly trained nurse as well as a reassurance required by parents committing their daughters to the care of the Moncton nursing school. “The discipline is such,” MacMaster wrote, “as to free the mind of anxious parents from all worry, and designed to develop as refined and well-bred a group of girls as can be found anywhere in a similar environment.”139 Curfews, a restricted number of late leaves, roll call, lights out, and a long list of written and unwritten rules were fondly, and not so fondly, recalled by nursing graduates. Violators were quickly, and severely at times, punished, with an entire class suffering on one occasion – a 1936 graduate recalled that when one nurse was caught smoking, the “formal graduation exercises [were] cancelled for the whole class of that year.” Classes in the late afternoon, early evening, or Saturday afternoon, the latter encroaching on the student nurses’ limited time off, were also less than fondly recalled as some students, coming directly from ward duty, dragged themselves in to listen and learn.140 Such disciplined training, education, and clinical experience created a nurses’ training school whose graduates led the class province-wide for three consecutive years when provincial registered nurses’ examinations were written, Alena MacMaster reported proudly in 1935.141 Probably the greatest reform in the nursing school came as the thirties ended. The long hours of work required of student nurses in wards and in classrooms, and the exhausting hours required of graduate

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nurses, were long regarded as a horrible abuse. At the Toronto General Hospital, Jean Gunn campaigned for over two decades to lower the hours required, with strong opposition from government and her own hospital board members. In 1937 Gunn finally achieved an eight-hour day for private-duty nurses, but when she died in 1941 the same reform had not yet been achieved for her student nurses.142 In 1940 at the Moncton Hospital, where MacMaster had been an outspoken opponent of student nurse exploitation, she reported with measured words what ranked as a major achievement: “In line with the movement toward a shorter hospital day, it is of extreme satisfaction, particularly to the Principal of the school, to record the hours of duty distributed over the school year as at eight hours and thirty-two minutes per day or approximately fifty-eight hours per week, not including class hours.” She further explained: “A ten month year shows, with classes included, a nine hour day, the hours for night duty being unavoidably longer.”143 It remained a long day but the long overdue reform of nursing hours was underway at the Moncton Hospital. Also underway was a rethinking of the hospital’s role in the community. As the Depression eased in 1937, MacMaster reminded the hospital board that it was time to take stock and to “consider the future in light of changed and changing conditions.” The superintendent predicted an expanded and quite “legitimate” public education role for the hospital, to facilitate a “more healthful, abundant and happy” lifestyle for all, along with an expansion of the hospital’s public health role in areas such as “environmental sanitation,” “communicable disease, pneumonia, diabetes, the degenerative diseases,” and “mental health.” Furthermore, she suggested, it was not the hospital’s sole responsibility to meet future health problems. It required “better coordination of effort among the health agencies” available to the general public. As she set this ambitious and forward-looking agenda, however, MacMaster emphasized that always, amid past and future changes, the hospital must keep firmly in mind “its essential function – the professional care of the patients.” Thus, in analysing annual reports that sometimes offered “a barren outline of statistics,” the hospital’s board and the patients it served should recognize that these were only “an index of ever growing service to a community which, judging from the facts presented, is paying greater heed to the essential benefits which may be obtained whenever needed in the standardized approved modern hospital of today.”144 It was an eloquent mission statement revealing a hospital attuned to the changing needs of the communities it served. What the war and post-war years would do to these noble aspirations remained unknown but the interwar years clearly brought many

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important crossroads decisions and changes to the Moncton Hospital. With the guidance and direction of Alena J. MacMaster, a supportive board under A. Cavour Chapman, an increasingly specialized and skilled medical, nursing, and support staff, and the approval and appreciation of the surrounding communities, especially the city of Moncton, the hospital was successfully handling the many challenges it faced. Nevertheless, its success in offering an ever widening range of services to an ever growing clientele only led to pressures for more space and staff. These in turn raised the inevitable questions about government and patient funding responsibilities that prosperous times and policies, rather than Depression responses, still had to address.

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A postcard view of the Moncton Hospital in 1903. The Moncton Museum

Proposed late 1920s extension to the Moncton Hospital along with the already existing building. Moncton Hospital Archives, armh 1928

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The “connected” Moncton Hospital in 1924. Moncton Hospital Archives, armh 1924

View of the Moncton Hospital after the completion of the 1930 addition. The Busy East 21 (July 1931): 18–19, and Moncton Hospital Archives, rmh 1950

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The nurses’ home in 1925 and a public ward in 1928. Moncton Hospital Archives, armh 1925 and armh 1928

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A private room and the operating room in 1928. Moncton Hospital Archives, armh 1928

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The pathology laboratory in 1927. The Atlantic News 1 (August 1927): 7

The 1950 view of the proposed new hospital. Moncton Hospital Archives, rmh 1950

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The children’s ward and a private room in 1931. The Busy East 21 (July 1931): 8, 5

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Alena MacMaster at various stages of her professional career. Gautreau and Winans-Orr, The Life and Times of Miss Alena Jean MacMaster, R.N., cover, 2, 94

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Medical staff of Moncton Hospital in 1929. Front row: Dr H.E. Britton, Dr F.A. Richard, Dr J.A. McNaughton, Dr W.A. Ferguson, and Dr W.P. Kirby; second row: Dr G. Lyons, Dr Euclide Leger, Dr Ambrose Myers, and Dr R.G. Girvan; third row: Dr L.H. Price, Dr J.A. Dobson, Dr C.R. Baxter; back row: Dr A.E. Forbes, Dr L.E. Goodridge, and Dr S.W. Burgess. MacLellan, History of the Moncton Hospital, 40.

Dr L.N. Bourque, one of the original medical staff and the first Acadian doctor at Moncton Hospital. The Atlantic News 1 (August 1927): 43

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A. Cavour Chapman, president of the Moncton Hospital Board from 1917 to 1943. The Busy East 21 (July 1931): 25

Ambrose Wheeler, chair of the Moncton Hospital Board from 1943 to 1947. The Atlantic News 1 (August 1927): 3

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Alena MacMaster and the graduating class of nurses in 1923, and MacMaster in 1927. Moncton Hospital Archives, armh 1924, and The Atlantic News 1 (August 1927): 11

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Katherine Richardson, 1948 nursing graduate and within five years director of nursing, and Pauline Alward, 1947 nursing graduate who was appointed operating room supervisor in 1948. Both led the province in their grades in the provincial registration exams in their respective years. Moncton Hospital Archives, rmh 1948

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5 An End and a Beginning

In the summer of 1953, the Moncton Transcript praised the completion of “A Great Building Achievement” as a new 225-bed, $3-million Moncton Hospital was about to be opened. The “people of Moncton and Westmorland County,” the editorial proudly announced, were to be blessed with “a new, modern hospital adequately equipped for the care of the ill and the injured in the whole southeastern section of New Brunswick.” The “dream” was realized, the seemingly “endless planning” had been successfully executed, and the “crowded and difficult conditions” of the past were no more, while provision had been made for any necessary future expansion. Opening ceremonies, the Transcript continued, brought to an end “one chapter in the history of that part of Moncton’s life that deals with the community’s responsibility to the sick and the injured, and opens a new one.”1 It was both an end and a beginning. Located in the largely undeveloped northwest end of the city, the new Moncton Hospital had not been easily achieved. Hospital overcrowding caused expansion proposals to burst forth as the Second World War ended, but disagreement whether this should involve additions to the existing King Street facility or a new building on a new site, difficulties in arranging the necessary funding, board and medical staff confrontations, as well as the inevitable questions concerning city versus county responsibility, delayed and at times threatened to scuttle the project. In this struggle were numerous casualties: the medical staff emerged considerably changed; the structure of the hospital board was profoundly altered, with none of the old board members re-appointed; municipalization was completed, although

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service to surrounding counties was re-emphasized as a regional clientele re-emerged. Above all, it was no longer Alena MacMaster’s hospital. Nonetheless, her predictions about the sources of funding for the modern hospital had become reality and her leading role in the hospital’s development continued until her abrupt resignation in 1947. Through the war and post-war years the city and counties served by the hospital underwent considerable growth, although past census patterns changed somewhat while the clientele served was markedly altered. On the surface, Moncton experienced an “unprecedented period of growth” during World War II as, at times, as many as 15,000 airmen were stationed, however briefly, at five major bases scattered in and around the city.2 In reality, in the decade from 1941 to 1951 Moncton’s growth rate was more than matched by that of surrounding Westmorland county and, in terms of the potential clientele served by the hospital, it was the county that experienced the greatest percentage increase. The hospital continued to meet the needs of the city of Moncton as well as Westmorland, Albert, and Kent counties, although the fall-off in Kent county patient numbers, their needs now met by l’Hôtel-Dieu de l’Assomption as well as by a small hospital established in Rexton in 1946,3 was so substantial that by 1945 their numbers were no longer listed separately in Moncton Hospital reports. Moncton grew from a population of 22,763 in 1941 to 27,334 in 1951, a 20.1 per cent increase, while Westmorland county, excluding Moncton, increased from 41,723 to 52,678 in the same period, a 26.3 per cent increase. In percentage terms Albert county grew considerably as well, with a 17.7 per cent increase from 8,421 in 1941 to 9,910 in 1951. In the same decade largely French-speaking Kent county’s growth was more restrained, as it moved from 25,817 to 26,767 residents (up 3.7 per cent). The percentage of residents claiming French as their mother tongue declined slightly both in Westmorland county as a whole, from 41.8 per cent in 1941 to 41.1 per cent in 1951, and in Moncton, where francophones went from 33.6 per cent to 30 per cent of the city’s population.4 In the period from 1941 to 1953 the number of patients admitted to the Moncton Hospital increased by 77.2 per cent (from 3,648 to 6,466) while the annual number of hospital days required to treat these patients grew by 44.5 per cent (from 39,611 to 57,241).5 This compared with an even more explosive growth pattern at Hôtel-Dieu, where, over a slightly longer period, the number of patients admitted had expanded from 1,762 in 1938 to 6,611 in 1953 (a 275.2 per cent increase) and the annual total of hospital days had jumped from 19,349 to 53,652 (a 177.3 per cent increase).6 This sister institution’s growth diminished the pressure on the Moncton Hospital as did, to a much lesser extent, the August 1946 opening of the twenty-five bed

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Sackville Hospital in the eastern end of Westmorland county, and its expansion to thirty beds in 1948.7 Nevertheless, increased patient numbers in the early 1940s forced constant adjustments to meet overcrowded conditions and encouraged the widely shared assumption that hospital facilities must be expanded considerably once the war ended. Moncton Hospital Superintendent Alena MacMaster reported 100 per cent occupancy of its rated capacity of 125 beds in 1943 despite measures she had taken a year earlier to discharge maternity patients at the end of a week’s stay and to discourage admission of chronic and “restcure” types who might be handled at home. In 1944, as a temporary solution, the Moncton Hospital raised its bed capacity to 150 by converting three front and two rear sun porches into wards, but the space inadequacies remained.8 This constant growth was marked by a shift in the constituency served as the hospital no longer drew a majority of its patients from the city of Moncton. At different times in the past the percentage of Moncton patients had sometimes exceeded 60 per cent, but it declined steadily from 53.6 per cent of those admitted in 1941 to 42.2 per cent in 1953. Meanwhile the Westmorland county contingent rose from 26.9 to 36.7 per cent, and Albert county’s patient numbers also increased, from 7.3 per cent in 1941 to 12.9 per cent in 1953.9 An even more subtle alteration occurred in the early fifties: the Depression trend of a huge jump in public ward patients was reversed in the 1940s as the percentage of private and semi-private patients soared as high as 97.2 per cent of all patients and was at 95.4 per cent in 1950, while ward patients dipped to 2.8 per cent and 4.6 per cent respectively. But by 1953 private and semi-private patients fell to 82.2 per cent of the patients admitted while ward patients rose to 17.8 per cent.10 As at other hospitals, Moncton’s public wards were no longer largely receptacles for the indigent but had been transformed and bore “little resemblance to the public wards of but a generation ago.” Indeed, The Canadian Hospital argued, the very name itself should be changed from “public” to “standard” wards since most patients using these facilities now were paid for through various forms of pre-payment plans, either private or government.11 Among the private hospital insurance plans enthusiastically embraced by Maritimers in the mid-1940s and onward was Blue Cross.12 MacMaster’s valued assistant, Ruth C. Wilson, resigned in 1943 to play a leading role when the Maritime Hospital Association formed the Maritime Hospital Service Association, which became part of the Blue Cross organization.13 Two years later MacMaster commented that both the Group Hospital Service Association, formed in 1937, and the Blue Cross “have served the Hospital well” and were “expanding State

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and province wide.” Acknowledging the hospital’s space problems, she expressed “regret” that “we cannot always provide the desired accommodation” for patients covered by such plans.14 By 1953, Blue Cross had become the dominant player in this sector. It absorbed the Moncton Group Hospitalization scheme in 1949, which brought in the Canadian National Railways employees who had been covered by the older and more expensive “preferred service” plan ($2.20 per month for family coverage). Railway workers, and other Monctonians who had used the Group Hospitalization plan, now secured semi-private coverage for $1.50 per month, and ward accessibility, previously not part of their plan, at an even lower monthly premium.15 This was a major factor in the surge of ward patient numbers at the Moncton Hospital from 1950 onward.16 By 1948 hospital insurance in New Brunswick was estimated to cover just more than 24 per cent of the province’s total population, and at least 3,000 Moncton area residents were added to the Blue Cross subscriber lists under its 1949 expansion.17 Across Canada, by 1952, approximately 5.5 million out of 12.5 million Canadians (excluding British Columbia and Saskatchewan since they had compulsory provincial government hospital care plans) had voluntary hospital insurance coverage.18 Hospitals clearly benefitted from hospital insurance plans, but a large number of potential patients remained uncovered. A national health insurance scheme could provide the universal coverage to make hospital care accessible to all. The Second World War and post-war years witnessed not only the expansion of private health insurance but the growth of expectations and support for an always imminent but never quite implemented national health insurance program. All political parties were reported in 1942 “on record as approving health insurance” in general, although when it would happen was not clear.19 A Gallup poll the same year revealed that 75 per cent of Canadians polled were willing to pay “a small part” of their monthly income for medical and hospital care.20 Further polls in 1944 and 1949 demonstrated even more support, at the 80 per cent level in both instances, for a national health plan whereby a flat rate payable each month would provide “complete medical and hospital care by the Dominion Government.”21 The federal government had emerged as a potential major player in the field of hospital care, but its intervention required provincial cooperation that was not easily secured. The Heagerty Committee report, presented to Parliament in the spring of 1943, was welcomed as “the most comprehensive report on health insurance ever compiled in this or any other country,” and “of vital concern to every doctor, nurse and hospital trustee in the country.” It was assumed that “this or similar legislation” was “inevitable.”22 Expectations for immediate federal

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legislation were dashed at the post-war dominion-provincial conference on reconstruction several years later, when the federal government’s health insurance measures were presented as a part of its “Green Book Proposals.” Once that conference collapsed in disagreement, “the health insurance proposals were, if not dead, at least in limbo.”23 Resurrection came in May 1948, when Prime Minister Mackenzie King announced to the House of Commons a national health grants program. Thirty million dollars annually for an initial five-year period were committed to the health care area. The largest item was a $13-million annual grant for hospital construction. For a province to access the construction funds it had to match the federal funds, and local support, municipal or voluntary, was required. Hospitals could also profit, if their provinces participated, from allotments available for tuberculosis and venereal disease control, and from funds for professional training and money for cancer research and control. In addition, federal funds were to be granted for health surveys, general public health, mental health, and the care of crippled children. Although the hospital construction grants were on a matching cost basis, along with the venereal disease and cancer control programs, the other grants were non-matching. Except for the health survey funds, all involved recurring funding and several were to be increased.24 A complete national hospital insurance scheme had not yet been achieved, but the new federal program was a major contribution to health care in Canada and to hospital development. Provincial governments, even those in the poorer provinces, would find it difficult to resist what was offered. The New Brunswick government welcomed and soon shared in these federal health care programs. Prior to the federal initiative, New Brunswick’s post-war tax-rental arrangement with Ottawa and an increase in the province’s normal revenues combined to create “a tremendous revenue increase.”25 Stung at the same time by criticisms from the New Brunswick Medical Society about the total inadequacy of medical services in the province, including “a gross shortage” of “hospital accommodations of all types,”26 the traditional policy of limited aid to hospitals underwent considerable change. At the 1947 session of the legislature, provincial grants to hospitals were raised from just over $20,000 annually to approximately $125,000 in 1948, when the increase took effect. Hospital grants were now to be 30 cents per patient day for all hospital patients for the first 5,000 patient days ($1,500) and then 20 cents per day for each additional patient day.27 In 1951, the grant was increased to 50 cents per patient day.28 As its own grants were revised upward, the provincial government also put pressure on the municipal and county governments to increase their hospital

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contributions.29 There were still severe criticisms from the provincial director of hospital services about “inadequate funds” available to his department, delays and uncertainties in the allocation of hospital construction funds, and the lack of careful planning and study to achieve an integrated hospital system,30 but despite such serious deficiencies in provincial health policy, the New Brunswick government’s investment and involvement in the hospital system had increased substantially, to the point where health spending was no longer the “minor budgetary item” of the past.31 Government had also now assumed responsibility for construction costs of hospitals, as well as new equipment, with the municipal and county levels sharing a heavier burden than their provincial and federal counterparts. As per diem operating costs escalated wildly after World War II,32 governments moved to increase their support. The increased per diem patient grants of the New Brunswick provincial government were more than matched in January 1949 by a $1 per day grant from Westmorland county and Moncton city councils for each of their residents admitted as patients to the Moncton Hospital.33 For the most part, patient rate charge increases were delayed by the war, but the post-war years brought substantial increases. The per diem payment required from Westmorland and Albert county patients at the ward level increased from $2 to $3 in 1940, while Moncton patients were still expected to pay $1.50 per day.34 Other increases were postponed. But from 1945 to 1953, for patients at all levels, there were three increases of 50 cents per day as well as one of $1 per day.35 Charges for other services, for example, operating room, outpatient, and ambulance fees, also increased. Budgets somehow were balanced – except for a few exceptional years such as during the 1953 move to a new hospital site – as the Moncton Hospital’s annual operating expenses grew from $151,419.29 in 1940 to $818,695.64 in 1953.36 As per diem patient costs soared from $4.74 in 1945 to $16 in 1953, the increased costs and charges were rationalized in the same way at the national and local levels. Leonard Lockhart, the hospital board chairman, argued that the Moncton rates were “equally as high” as rates at other New Brunswick hospitals37 while, speaking for the New Brunswick section of the Maritime Hospital Association, Donald F.W. Porter explained that the “dramatic increase” in per diem cost, for the most part, was because of factors at work across Canada. As he outlined the situation, “The increases in our costs are caused chiefly by improvement in existing services, addition of new services, higher wages, increase in total staff, the Provincial Social Service and Educational Tax and, in certain hospitals, increase in Bond interest and depreciation.”38 Hospitals congratulated themselves on the increased revenue extracted

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from patients, which was ascribed to the “increasing general level of prosperity” and, more importantly, “the phenomenal growth of plans for the prepayment of hospital expense of which Blue Cross is a notable example.”39 Because of accounting changes over the years to the Moncton Hospital year end reports, it is impossible to decipher the precise amounts that hospital and medical insurance schemes, as well as increased government support, contributed to the hospital’s increased revenue. While certain government grants, and Blue Cross payments on occasion, were specifically listed, other government program support and voluntary insurance payments were more frequently simply rolled into the revenues from private, semi-private, or ward patients. It was estimated, however, that by 1954 New Brunswick hospitals were receiving “revenues up to 65% of their total income from voluntary insurance schemes, the outstanding example of course being our Maritime Blue Cross.”40 If the paying uninsured are added to this, patient payments were probably contributing 75 to 85 per cent of the total hospital revenue, an increase from the 62.2 per cent in 1939, when the figures were clearly presented in the hospital’s annual report.41 What can be more readily, although only roughly, tracked, and compared with the Ontario situation, are the basic government grants (provincial, municipal, and county) as a percentage of the hospital’s total revenue. In Ontario, from 1940 to 1950, it was estimated that while patient payments (including insurance payments) increased from 66 to 76.1 per cent of total hospital revenue, payments from municipalities and the provincial government actually decreased from 26.1 to 21.2 per cent.42 The Ontario provincial and municipal contribution continued to decline, reaching 18.7 per cent in 1954.43 At the Moncton Hospital, while the years after 1945 brought a substantial increase in government funding for the hospital’s operating expenses, the percentage government contribution to total hospital income declined even more substantially than in Ontario. Whereas in 1939, grants from all levels of government amounted to 26.3 per cent of total hospital income, by 1945 this had declined to 13 per cent and by 1953 to 12.2 per cent.44 A substantial gap remained between government support of hospitals in Ontario and government support in New Brunswick, even at a time of allegedly buoyant government revenues.45 The increased government responsiveness to hospital needs was emerging at the same time as, and in response to, the general public’s growing appreciation of and support for broadening hospital accessibility and facilities. Even as the war drew to a close, the much more favourable public attitude to expanded medical and hospital services was the subject of considerable discussion. In 1944 A.J. Swanson,

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superintendent of the Toronto Western Hospital,46 was appointed to assess and to chart the future course of the Moncton Hospital and, while his basic recommendation eventually would not be accepted, his description of public expectations concerning hospitals was perceptive and prophetic. He argued that the war-time prosperity and high levels of employment drew people out of their homes for services previously taken care of in the home. It is “now rare,” he pointed out, “to have maternity cases handled at home if there is a hospital available.” Doctors and the public, in other matters as well, now had a clear preference for patients “to be in hospital rather than be taken care of at home when necessity arises.” Prosperous times provided the funding to pay for hospitalization, but Swanson also emphasized the growth of private hospitalization insurance plans, such as “Blue Cross … [and] your own Maritime Plan” as examples of “steady and consistent growth” that would work to “place an ever increasing demand on your hospital facilities.” In addition, he predicted, federal and provincial health insurance schemes were on the horizon, regardless of what political party was in power. After all, he explained, “almost a million young men and women will be returning to civil[ian] life in the not too distant future.” Their medical and hospital needs had been met during their military service and “they will know that it is a good thing for the State to take care of that highly important welfare measure.”47 He might have added that the post-war population growth about to occur, as well as the public esteem in which hospitals basked as a result of their dispensing wonder drugs such as penicillin, would further fuel the need for hospital expansion.48 These powerful arguments and realities sparked post-war hospital expansion in many other Canadian communities. But in the spring of 1945, when Swanson’s report was unveiled in Moncton, action on its recommendations almost immediately bogged down. The report concluded that “while a complete new plant is admirable and much to be preferred to adding wings to an older structure, there are many drawbacks to such a proposal in this instance.” The hospital’s latest wing, it was pointed out, was only fifteen years old, “well laid out and equipped with most of the essential services,” so that it would be much less expensive to bring it up to standard than to “build a complete new hospital.” Hence Swanson believed that “we should devote our thoughts to the extension of the present plant in the way that will provide the greatest amount of new accommodation and adequate basic facilities to service not only the added extension but any future extension of not too elaborate extent.”49 Swanson’s recommendation initially seemed in line with what Moncton city council and the Moncton hospital board had in mind, since, in

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the same month as his report, the provincial legislature approved a new debenture issue for the hospital that was guaranteed by the city of Moncton. The two parties sought and received provincial approval for $400,000 in debentures to resolve the “insufficient accommodation” issue at the Moncton Hospital by adding “a new wing … to the present structure and other additions made thereto.”50 This consensus of opinion was soon shattered by an imbroglio of legendary proportions as board members split on the hospital expansion issue, city council and hospital board parted company, hospital staff went public in support of expansion but opposing board expansion plans, and Moncton taxpayers and the provincial government all entered the fray. In the earlier hospital donnybrook in 1917, a Murphy had been involved, and in this post-World War II battle Francis P. Murphy’s son, J. Edward, upheld the family tradition as a key participant. The first cracks in the consensus emerged in May 1945, when a hospital board subcommittee, chaired by Harry J. Crudge, reported its analysis and recommendations concerning the Swanson report.51 The subcommittee pointed out that the “increasing demand for hospital accommodation” meant that the “desirable ultimate objective for the Moncton Hospital” might be a 260-bed facility. This hint of the expansion that was really necessary rather undermined the limited project eventually endorsed by Crudge and his colleagues. But when various schemes were toyed with that would achieve such an ultimate objective (which included a new main building, new maternity building and new nurses’ residence) costs escalated over $1 million. Pressing on with its analysis, in view of the reality that “a limit of funds has been indicated in the amount of $400,000,” the subcommittee turned its attention to much reduced proposals. Finally it settled on a new main building of seven storeys and a basement, which it was estimated could handle 208 patients and would cost $492,950, not including the cost of furnishings, extra surgical equipment, and extra staff living quarters. All the schemes considered involved additions on the existing hospital site and all clearly required more funding, although an attempt was made in the recommended expansion proposal to adhere a little more closely to the funds that were available. Crudge and others on the hospital board felt that funding realities dictated a limited on-site addition, proposed by Swanson and now echoed by the subcommittee. At the same time other board members were increasingly infatuated with a much grander expansion, and these dreamers proposed expansion if necessary on an entirely new site. Nine months after the subcommittee report, the split became apparent when a meeting of the “Special Building Committee of Moncton Hospital” was called to appoint an architect and to decide on the “advisability or

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inadvisability of building an extension to the present Hospital plant, or, constructing a new Hospital on an entirely different site.”52 Board member George O. Spencer chaired the committee and the meeting. He opened discussions by explaining that there seemed to be a general acceptance of Swanson’s proposal for an on-site expansion, but that he had been approached by provincial cabinet minister and former Moncton mayor C. Hanford Blakeny, who wished to outline a quite different proposal. Blakeny proceeded to speak “at some length.” His was a plea for “beauty,” “artistry,” and “surroundings appropriate to the community it serves” if hospital facilities were to be modernized. On the King Street site, parking was inadequate, attractive surroundings were lacking, there would be no future space for further expansion, and the existing structure, Blakeny believed, could never be converted into “a modern-looking one” even if an extension was added. Instead he suggested a new hospital on a new site: “the Humphrey farm at the end of Highfield Street Extension which he understood could be purchased for $20,000.” The majority response was that this was a nice idea but such a move would require much more funding than was available. Hospital board chairman Ambrose Wheeler53 “questioned if the amount needed [for such a project] could be raised.” Board member Ruth Wilson commented that such a move might be “desirable” if “it could be financed.” Alena MacMaster joined this chorus, agreeing “that if considering a million dollar hospital it would be well to think in terms of a new site,” but all of this was “providing of course the necessary funds were guaranteed.” Where the funds would come from concerned Alderman Arthur E. Stone since, although he felt the Humphrey farm “would be an excellent location,” there was no way the city of Moncton could fund it alone and, without commitments “from Federal or Provincial Governments or the County of Westmorland,” Stone “did not think it would be advisable to consider moving from the present location.” Two other speakers, one a long-time board member and the other a young alderman about to become Moncton’s youngest mayor in a year’s time, were more supportive of the Blakeny proposal. Thirtyone-year-old Alderman J. Edward Murphy argued that Moncton’s future growth would be away from the eastern end of the city, the present King Street location of the hospital, and “he personally would be very much in favour of moving from that part of the city” in the future growth direction proposed by Blakeny, “if such a plan were practical.” Reid McManus, a board veteran, also agreed with Blakeny’s suggestion “and considered the site mentioned an ideal one that would command the attention of the County as well as the City as it was actually located in the County.” This division of opinion led the meeting to adjourn

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rather inconclusively after suggestions for further committee study, consultation with city council, and the recommended appointment of architects Govan, Ferguson and Lindsay of Toronto, regardless of “whether an extension is built to the present plant or an entirely new plant is constructed.”54 Funding was clearly a major stumbling block but if the major funders – Moncton city council and the city taxpayers – proved supportive of the grander scheme, board caution and on-site expansion proposals would be brushed aside. Funding was re-addressed by Moncton city council in the summer of 1946 when it increased considerably its financial commitment to hospital expansion. Council also proposed what would in effect be total municipal control over the hospital by a major revamping of the 1917 Moncton Hospital Act. City council proposals were presented at a hospital board meeting on 14 August 1946. Moncton council agreed to guarantee a further $400,000 in hospital debentures, which was shortly thereafter raised to an $800,000 increase for a total city-guaranteed debenture commitment of $1,200,000. The price of this support was that the hospital board must agree to amendment of the Hospital Act so that the board could be reduced in size from twenty-five to eleven members, “9 of whom shall be appointed by the City Council,” including the chairman of the hospital board. At this meeting only eleven board members were present, among whom were the mayor G.F.G. Bridges, and three aldermen, Fred M. Brown, Arthur Stone, and J. Edward Murphy. Alena MacMaster was not in attendance. Not a single voice was raised against the city proposals. Although Chairman Ambrose Wheeler was silent, George Spencer, who moved a motion accepting the city’s proposals, conceded that restructuring the board was necessary since the “general opinion of the citizens has been that the set-up has been too cumbersome, [and] that the number of members of the Board should be reduced.” B.A. Taylor seconded the motion, which promptly carried, after he added that “this action should have been taken some time ago.” A fundamental change in the size and composition of the board, guaranteeing its control by the city of Moncton, had thus been quietly endorsed by the hospital trustees in attendance. Major municipal responsibility for hospital finances was about to be matched by municipal control over the institution. The existing board had become a lame duck in view of this agreement, and already it showed. At the same meeting, when possible hospital rate increases were raised, it was decided that such action was now inappropriate since decisions like this should be “deferred pending the appointment of a new Board.”55 Despite the board’s hesitancy about making major decisions, and its acquiescence in the face of Moncton city council’s move to municipalization of the hospital, some members of the board blissfully assumed

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that it was still full-speed ahead for the on-site expansion. A rude shock awaited them. C. Hanford Blakeny was Moncton’s representative in the provincial legislature and a respected senior statesman. J. Edward Murphy, allegedly out to break up “the old line ‘establishment’ which for years had controlled the affairs of the Moncton Hospital,” and committed to a “new site and the construction of an entirely new and modernly equipped building,”56 was about to be elected mayor of Moncton. These were formidable champions of hospital expansion on a new site. They were soon to be joined in the lists by other supporters alienated by hospital board actions. Some board members remained oblivious to these unfolding realities as they commissioned architectural plans concerning several different proposals for on-site additions to the Moncton Hospital.57 By January 1947 the architects’ proposal outlined a five-storey additional wing and four-storey maternity wing that together would accommodate 185 patients; costs had escalated to $1,350,000, although Harry Crudge hoped that it could be done for $1 million.58 The determination of some hospital board members to push through this on-site expansion provoked an angry reaction from the medical staff, other board members, and the taxpayers of Moncton. At a midFebruary board meeting, when George Spencer announced plans for the erection of the new wings proposed by the architects, one of the hospital’s senior physicians, Dr Robert D. Roach, openly attacked the plan. Lack of consultation with the medical staff was his major complaint: the “doctors had tried to outline what they wanted, yet at the end have no show or say.” Furthermore, Roach stated, “No foresight is shown,” and no provision was made for a nurses’ residence. Board member Mrs (W.A.) Janet Ferguson supported Roach, commenting that plans to use the old maternity building as a nurses’ home were totally unacceptable. Roach resumed his criticism by announcing that the medical staff had decided “to present their view publicly through a publicity campaign if the board and city council did not support their views.” While Chairman Ambrose Wheeler was concerned only about “why the medical profession left the voicing of this disapproval until so late a date,” two other hospital board members, who were also Moncton city aldermen, openly supported Roach’s criticism of the plans. Alderman E.B. Gaskin bluntly predicted that $1 million was not enough for proper facilities, and the proper facilities he had in mind were “a new site and new building.” Alderman J. Edward Murphy more diplomatically recommended delay on any final decision. Instead he suggested “that the problem be turned over to the incoming board when the medical profession could again make their representations.” This

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brought no answer from the hard-core board members unwilling to surrender their expansion plans.59 As this dissension made headlines so did the Moncton city council’s vastly increased financial commitment to the hospital and the concern of taxpayers about selecting municipal politicians in the approaching April elections who would spend tax money carefully.60 A newly formed Taxpayers’ Association, which numbered among its active members Leonard Lockhart, a prominent businessman and head of a woodworking firm, called a public meeting for the evening of 18 February to discuss the hospital situation. Attended by “approximately three hundred citizens,” the meeting heard another scathing attack, this time led by senior hospital surgeon Joseph W. Dobson, on the hospital board’s proposed on-site expansion plan. Dobson emphasized that “in the opinion of the medical staff the plans are inadequate and, despite the proposed expenditure of $1,200,000 for renovations to the old building and additions to the new, only fifty beds would be added.” He proposed that “a new hospital is needed but that citizens must back the doctors in their request to city council for better accommodations and the expenditure of more money.”61 While a further meeting was to be held on the subject, it was clear that the doctors’ opposition had carried the day, contributing to a growing public perception that the proposed plan of the hospital board was “a waste of money.” The taxpayers, as represented by the Taxpayers’ Association at least, were on side. So were municipal politicians like J. Edward Murphy, who shortly thereafter announced his candidacy for the mayoralty on a platform of “reform” and “sound business management” of taxpayers’ money.62 Board chairman Ambrose Wheeler and his supporters were outraged at this public attack on their plan and, indirectly, on their capability as a hospital board. In one of the most acrimonious sessions of the hospital board, with both an “independent stenographer” and the board’s own secretary present to take notes, board members gathered on 24 February 1947. Wheeler hoped that all the facts behind the expansion plan would be clarified, and the “one-sided” press reports and doctors’ accusations would be corrected. Attempting to present a balanced review of events, his comments nonetheless revealed how annoyed he was, particularly at members of the medical staff who had gone public with their criticisms. Thus, while he claimed “I am not going to criticize any person who made the statement at the taxpayers’ meeting; you know him, he is a member of the Building Committee and the Hospital Board,” Dr Joseph Dobson knew, as did everyone else, at whom Wheeler’s wrath was directed. But in presenting information

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about the “new site” case Wheeler inadvertently strengthened it by the admission that in March 1946 the hospital board had been offered, by Donald A. MacBeath, “as an outright gift to the hospital ten acres situate[d] north of Mountain Road and within the City limits; no strings attached to that.” A new site for a new hospital, in the part of the city suggested by Blakeny, Murphy, and McManus, was apparently already available.63 Crudge followed this with long rehashes of hospital board actions, with help from Allie McSweeney and interventions from Wheeler, which repeated the convoluted funding and architectural studies conducted, and emphasized the need to guard against any increased tax rate. As Wheeler expressed it: “There is a need for a hospital and we have to try to use our good judgment and commonsense to build as near what we want with the least outlay.” Moreover, “the majority, if not unanimous, thought we had better stick to the present location.” Instead of bothering to address the possibility of additional funding support and the gift of a new site, board discussion degenerated into a long argument about the number of new beds mentioned in the press by Dobson, the number Crudge claimed really would be available, and insinuations about the inaccuracy of both sets of figures. While Dobson claimed his position had been misunderstood and would be corrected, he and Roach did not yield on their basic point that the board’s expansion plan was inadequate and a disservice to the Moncton community. Dr Roach provided detailed figures about the wholly inadequate capacity of the hospital, both now and in the future if on-site development was followed, as well as a list of other medical staff objections to the way the physical plant was laid out in the architects’ plans. He concluded: “As far as the Medical Staff is concerned, we are certainly not out to make a fuss about this; it is because we thought we were not getting what the community needs that we took this stand.” He pointed out that “[w]e sent in a letter to the Board at their last meeting stating those facts and our reasons for stating them and we suggested that we thought the whole thing should be aired and the facts brought before the public by a combination of the Board and the Staff; this suggestion was apparently not acceptable and our only recourse in view of this was to make the facts known in the best way we knew how.” Dr Joseph Dobson was more precise about what the medical staff wanted in order to meet Moncton’s medical needs. After explaining his desire to correct any misquotation or misunderstanding, he pointed out that the growth of Moncton required considerably more than an extension to an inadequate existing facility. “When this hospital was built it was built in good faith, good for 20 or 30 years, and now in 10 years is overcrowded.” The “medical men” believed that the board plan would create a hospital that would be “obsolete” within a

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decade. “We have lots of money here. I believe that if you gentlemen will agree with us and put this before the public, that you will get a two million dollar hospital or more.” It was a devastating one-two punch to the plans of Ambrose Wheeler and his supporters. By the end of the evening even Wheeler acknowledged, “We had better tell the Architects to stop until such time as we know what we are going to do.”64 Alderman J. Edward Murphy was in attendance at the meeting but he did not speak, so it was left to his fellow alderman, E.B. Gaskin, to clarify which side, doctors or board, the council was on. Gaskin reminded the board that when a “new Hospital Board is appointed, the City Council will be the people to say whether we build a new hospital.” Moreover, now that all the information was available, “if the people bring pressure to bear on the Council and say a $3,000,000 hospital” was necessary, then the municipal politicians “will do it.” The doctors had prevailed. Gaskin then urged immediate cancellation of any further architectural arrangements until a definite course of action had been decided upon.65 If further indications of the taxpayers’ position were required, a meeting two evenings later of the Taxpayers’ Association did the job. An audience of 800 attended as a motion passed urging a plebiscite on the question of whether the board’s plans should be followed or “a new hospital be built on a new site.” While Ambrose Wheeler was present to urge “that economy was necessary,” doctors Dobson, Roach, and Paul Melanson countered with “the need for greater accommodation for the public.” Blakeny captured the sentiments of the audience when he “urged that a new hospital be built in such a way that an expansion program could be carried out with little difficulty when the time comes.”66 Dobson and Roach made sure that the question of hospital extension “flared up” at future board meetings, with the result that two weeks later Ambrose Wheeler announced that “plans for the extension of the Moncton Hospital” had “been set aside.” The architects were to delay any further work.67 The hospital board had surrendered but Ambrose Wheeler and his associates did not yet grasp how complete their defeat was. The early April election of J. Edward Murphy as Moncton’s new mayor was quickly followed by the provincial legislature’s amendment of the Hospital Act and its approval of the increase in the city of Moncton-guaranteed debentures to $1.2 million.68 Murphy then moved swiftly to secure city council’s appointment of a new hospital board of eleven members. The mayor and E.B. Gaskin were approved as council’s members on the board, Leonard Lockhart was appointed as board chairman, and eight other new board members were appointed. Not a single old board member was re-appointed. The news of their replacement became public knowledge through radio and press announcements before they were officially

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informed. Wheeler was appalled that they had not been “given a dignified opportunity to make way for the newly appointed [members]” but had been dismissed “abruptly.” At its May meeting, as a result, the old board members resigned en masse immediately. They were joined by Alena MacMaster, who tendered her resignation as superintendent at the same meeting to be effective 10 June 1947. MacMaster explained that since “my entire Board was replaced, I felt I had to go too.”69 Other outgoing board members were more outspoken, with Ruth Wilson proclaiming that city council’s actions smelled of “dirty trickery and petty politics.” Mayor Murphy merely responded by expressing appreciation of the old board’s efforts while explaining that it would have been difficult to squeeze the twenty-five former members into the much reduced board without excluding some. Consequently, it was “thought better to start with a new board.”70 He might have added that appointing new board members such as Leonard Lockhart and others revealed the taxpayers’ desire for, and the city council’s commitment to, a more substantial new hospital building on a new site. Alena MacMaster’s reign was over but, now in her sixties, her career was not. When the new hospital board wished her “a well-merited retirement after her arduous and strenuous life,” she pointedly made clear that she “expected to have many more years of nursing service.”71 True to her word, her career continued in Clifton Springs, New York, in Campbellton, New Brunswick, and eventually back in the new Moncton Hospital. Indeed, although long since retired, she attended the ceremony in 1974 marking the renaming of her beloved school to the Miss A.J. MacMaster School of Nursing. Nonetheless, her last year as superintendent was far from happy. Torn between her loyalty to a medical staff determined to achieve what she herself dreamed of, a modern new facility, and her loyalty to board members who had supported her faithfully through so many difficult times, she remained largely silent in the final confrontation over the proper course of expansion. Given her commitment to the best in modern hospital facilities, if her board colleagues had been treated more graciously even she might have conceded that her doctor colleagues’ courageous and determined stance had won the community the far better facilities it deserved. If the MacMaster era had ended, the Leonard Lockhart era had begun. Destined to preside over the hospital board for a decade and a half, Lockhart’s management of hospital affairs often bordered on a full-time occupation, particularly in these early years. As the new board chairman discovered, the war may have been won but many more battles had to be fought. It was Lockhart’s opinion that the views of “a large group of citizens” had been heard in that it “was false economy

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and a very poor investment for the future to spend any money on adding a piece to the present hospital.”72 But many pieces now had to be fitted into place. Advice and a reassessment were needed concerning Moncton’s hospital requirements, the hospital staff had to be reorganized, and, above all, the commitment to a more expensive hospital project had to be matched by even more financial support. As a first step, the board asked Montreal hospital consultant Dr John C. MacKenzie to do a report on the Moncton Hospital. He arrived early in June 1947, and after six weeks of study his report was received on 28 July. It presented an unqualified endorsement of a new hospital on a new site. MacKenzie recommended abandoning “the present site insofar as a permanent site is concerned” and procuring of “a new site … which will comfortably accommodate the projected new hospital with its nurses’ residence and training school” and provide “ample future expansion space.”73 Lockhart and the new board quickly refined the report into a request to Moncton city council for “immediate action.” The goal of “a new 250-bed hospital … constructed on a new site” could be achieved for $3 million, according to Lockhart, who argued that construction should be “started in the early summer of 1948 at the latest.”74 In Moncton, quick action on hospital matters rarely occurred and Lockhart’s request for a quick start was not achieved. Financing from Westmorland county was now required along with increased funding from Moncton city council, while federal and provincial contributions also had to be arranged. To Lockhart’s continuing exasperation, the wheels ground slowly as funding painstakingly fell into place. Using the argument that Westmorland county patients were roughly onethird of the hospital’s patrons while Albert county residents numbered about one-tenth, Lockhart plunged into lobbying the neighbouring county councils to win their support for the new hospital project. It was an eye-opening and at times disappointing experience. Negotiations would drag out over a year, with Albert county approached on two different occasions and responding each time by “politely and promptly” refusing to provide the 10 per cent of the funding support requested.75 Westmorland county council proved equally difficult, causing Lockhart to comment privately that “I was up to my ears in the rottenest and the dirtiest kind of politics that anyone could ever get mixed up into.” County councils in general, he observed, “are not in favour of spending money.” They were composed, he believed, “for the most part of farmers, the majority of them being good decent chaps but their one ambition in life is to get everything they can without paying for it.” In the final analysis, Lockhart believed, Westmorland county only surrendered when, for not co-operating, the hospital board

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imposed a $2 per day surcharge on every Albert county patient and Westmorland sensed it was next in line for such treatment.76 Fortunately for the hospital cause, the rather blunt chairman of the hospital board was more than balanced in the negotiations by the politically astute mayor of Moncton. J. Edward Murphy took over discussions with Westmorland county council while his own city council raised its commitment to $1.5 million in debentures.77 A.J. Swanson was recruited as part of the persuasion process with Westmorland, and this one-time proponent of on-site expansion now expressed his “conscientious opinion that a new hospital consisting of 200 beds should be constructed on the MacBeath site.”78 Acceptance of the gift from Donald A. MacBeath as the site of the new hospital, over ten acres in what was described as the “Mountain View Sub-division,” was formally recommended to the Moncton city council in the spring of 1948.79 By that time as well, with the requirement that county representatives be added to the hospital board, Westmorland county council came on side and asked the New Brunswick legislature’s approval for a county guarantee of up to $850,000 in hospital debentures.80 The final piece in the funding puzzle fell in place when the Federal Health Grant for hospital construction became effective on 1 April 1948, clearing the way for federal-provincial shared cost funding to make up the difference between the hospital’s total cost and the city/county funding.81 In the late fall of 1950 Lockhart was at long last able to report that architectural plans had been considered by bidding contractors, tendering had been completed, and final approval had been received from Moncton city council and Westmorland county to begin construction.82 Total cost of a hospital with a capacity of 224 adult beds and 53 bassinets was estimated at $2,831,935.34. The federal and provincial government grants were each to be $235,166.66, for a total of $470,333.32. The balance of the cost was to be split two-thirds to the city of Moncton ($1,574,401.35) and one-third to the county of Westmorland ($787,200.67). One point that Lockhart had underlined on several occasions was that the city and county guarantees of hospital debentures meant a substantial on-going financial commitment on the part of these local level governments. As he put it, “It is clearly understood that both the City of Moncton and the County of Westmorland will have to pay the interest as well as provide funds for the sinking fund to cover Moncton Hospital Bonds.”83 There was no promise or pretense, as there had been when the Moncton Hospital first issued debentures in the 1920s, that it could meet out of its own revenues the annual bond interest charges (which could be as high as 5 per cent but were actually 3 per cent) and the 3 per cent annual cost of the sinking

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fund. The point was not lost on Mayor Murphy, who early on in these funding arrangements expressed his hope that this burden on local governments would be in the near future a responsibility shouldered elsewhere. It was his expectation that a “National Health Scheme” would eventually take over “all hospitals and the responsibility shift[ed] from the Municipal to a superior government.”84 A final ticklish issue was the board recommendation that a Toronto firm’s bid of $2,141,744, from George Hardy Limited, be accepted to construct the hospital. The remaining contracts, for elevators, landscaping, furnishings, and equipment, among other items, were distributed among a variety of contractors, some of whom were local, but the major contract would go to an outside firm. As Lockhart candidly admitted, “There was much criticism from the local contractors and their friends because we did not recommend the acceptance of a local bid.”85 With the agreement of county and city councils, however, the local contractors, Ambrose Wheeler Limited and Parsons Construction Company, were rejected because each had escalator clauses in their bids so possible cost increases were not covered. The Hardy company, on the other hand, offered a “firm bid” and this decided the matter in favour of the Toronto contractor.86 Meanwhile Lockhart and the new board had also resolved the chaotic administrative situation at the hospital. The board, which took office in mid-May of 1947, included, in addition to Lockhart as chairman and Murphy and Gaskin as Moncton city council representatives, W.V. Creaghan, W.J. Kirby, G.W.R. Myles, J. Edgar Surette, Eric Raworth, A.O. Fownes, Mrs H.F. Radcliffe, and Dr E.W. Ewart.87 The much reduced board was slightly expanded to twelve members in 1949 when its composition was changed to seven residents of Moncton (appointed by Moncton city council), three residents of Westmorland county (appointed by Westmorland county council), plus the mayor of Moncton and Westmorland’s warden. Provision was made for one further board member from Albert county if and when it guaranteed hospital debentures or made other “suitable financial arrangements.”88 Of even more importance than the board changes was the need to fill the hole left by Alena MacMaster’s resignation. The two positions she had held as hospital superintendent and director of the school of nursing were now split. Miss Barbara A. Beattie assumed charge of the nursing school but the other office was filled by short-term appointees until Dr Donald F.W. Porter was appointed executive director in September 1949. In the intervening period, H.D. Warren, Dr Ian A. MacLennan, Dr John C. MacKenzie, and George E. Filliter all did stints ranging from two to eight months with titles varying from acting superintendent to

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consultant to administrator.89 Three of these five administrators, including Porter, who served until 1955, were medical doctors, revealing their acceptance as qualified administrators. In the midst of this turmoil, the ranks of the hospital physicians were considerably augmented, both in terms of specializations and sheer numbers. From a medical staff of twenty-five doctors and eight consultants in 1940, the attending staff listed for 1946 had only slightly increased, to twenty-eight physicians along with eight “consulting staff” and four “courtesy staff.” By 1953, however, there were forty-five doctors on the attending staff in addition to a list of twelve consulting and seven courtesy staff.90 This period of substantial growth from 1946 to 1953 increased the number of junior and senior surgeons and physicians and created or increased the size of a number of departments. By 1953, orthopedics went from one to two physicians, a four-person obstetrics department had been created, a one-person psychiatry department emerged, ophthalmology went from one to three physicians, pediatrics grew from one senior pediatrician to three physicians, cardiologists went from one to two, dental surgeons increased from one to three, while anaesthetists multiplied from three to seven in number. Among the more specific significant additions were Dr George V. Parsons’ arrival in 1945 as the first “fully trained anaesthetist,” pathologist Dr Ian MacLennan’s arrival in 1946 to establish a department of pathology, Dr R. Burnell Eaton’s appointment in 1950 as the first staff member to devote his practice solely to general surgery, and Dr Phyllis Bursey’s appointment in 1952 to open the department of psychiatry and also to be the first woman doctor on the medical staff.91 Dalhousie University eclipsed McGill as the major supplier of Moncton Hospital doctors over this period, but Laval University emerged as another important source, an indication of the continuing Acadian presence in the hospital since all Laval appointees were Maritime Acadians now returning to their native region. Among the 1946 roster of physicians, excluding consultants and courtesy staff, medical training information is available for twenty-five of the twenty-eight. Of these, twelve (48 per cent) earned their medical degrees at McGill, ten (40 per cent) at Dalhousie, with the remaining 12 per cent split one each from Edinburgh, the University of Toronto, and Laval. In 1953, again excluding consultants and courtesy staff, information is available on forty of the forty-five physicians. Dalhousie was now by far the leading source of supply with eighteen (45 per cent) of the doctors while McGill had fallen to nine physicians (22.5 per cent). Laval contributed seven of its medical graduates (17.5 per cent), the University of Toronto followed with three (7.5 per cent), while the remaining

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7.5 per cent were drawn one each from Edinburgh, the University of Manitoba, and Queen’s University.92 The development of this medical roster sometimes encountered setbacks, or changes designed to improve further the qualifications of the staff. In 1942, for example, a visiting examiner from the American College of Surgeons granted only provisional approval. Specific problems such as “poor case histories,” “poor progress notes,” “incomplete minutes,” and “poor attendance at staff meetings” had to be addressed. They were and in 1943 the hospital regained its previous rating. Medical staff bylaws underwent a major change in 1951 to limit “surgical privileges to those who were qualified to write the certification examinations” of the Royal College of Physicians and Surgeons of Canada. Surgeons were given twenty-eight months and three chances to pass the exams93 and, while some failed, in general the much admired surgical skills of the late Dr William Ferguson were emulated successfully by his successors. Continuing links with the older staff remained. The late 1940s brought the death of the last member of the Moncton Hospital’s original 1898 medical staff, Dr Ambrose Myers, but in 1939 his son Ralph joined the hospital staff as a junior physician. Family connections emerged in a number of other cases: veteran Dr George Lyons retired in 1950 but his son Peter became a junior physician at the hospital in 1948; Dr Claude M. Leighton, whose father had been on staff as dentist in earlier years, joined the hospital roster in pediatrics in 1952; J. Arthur Dobson, in anaesthetics, joined his father, Joseph, on staff, also in 1952. Another prominent Moncton family, in hospital affairs and politics, contributed Dr Patrick Murphy to the staff in 1947, the same year his brother, J. Edward, was reshaping the hospital’s board and expansionist course. A major loss after long years of service was the death in 1944 of x-ray department head Dr Fred Richard. He was succeeded as radiologist by Dr Howard R. Ripley, who a year later organized a training school for radiologists. This latter achievement was one of a number of acknowledgments that the skilled expertise available at the Moncton Hospital was facilitating the institution’s evolution into a regional medical service centre reaching well beyond Moncton. In 1947 the provincial Department of Health opened a cancer diagnostic clinic at the hospital and in 1951 the institution was one of four in New Brunswick selected for a new cancer control program. Moreover, as plans for the new hospital were formulated, the idea emerged for an adjacent building to house a health department regional laboratory. This 18,000-square foot, $200,000 facility, funded by the Moncton Hospital board “with the provincial

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Department of Health paying a rental sufficient to retire the cost, plus bond interest and other charges over a 30-year period,” was scheduled to open in October 1953. This unit would serve as the pathology department for the new hospital, provide laboratory examinations for all hospitals in the area that wanted these services previously provided by the provincial health department, and also meet the “technical examinations required by the public health services in this area.”94 As we have seen, there were moments when the relationship between the hospital’s physicians and its board members badly deteriorated, specifically in 1947 when doctors Joseph Dobson and Robert Roach successfully challenged the old hospital board on the question of hospital expansion. Despite the loss of any guaranteed representation for the medical staff on the new hospital board, Moncton city council wisely appointed a member of the medical staff, orthopedist E.W. Ewart, to the new board. As well, Leonard Lockhart’s board was quick to accept a three-person medical staff committee to work with the board. In 1948, doctors Ralph Myers, Joseph Dobson, and Robert Roach comprised this committee, which met with the board on twelve separate occasions that year.95 Hence the doctors were granted a direct and major role in shaping the new hospital facility. This co-operation between board and medical staff probably rendered unnecessary a medical presence on the board itself. Appointment by city council of one of the active medical staff had disappeared by 1953 but among Westmorland county’s board appointees were two doctors, William Webster and A.L. Richardson, one of whom, Richardson, was on the consulting staff of the hospital. In the same year executive director Donald Porter praised “the fullest co-operation [received] from the officers of the Medical Staff” and even cited success in a chronically deficient area: “It is a pleasure to report that the attendance at the Medical Staff meetings improved remarkably.”96 The 80 per cent increase, from twenty-five to forty-five, in the number of doctors on the hospital’s active medical roster kept pace with the 77.2 per cent increase in patients admitted in the same 1941–1953 period. How did the other vital ingredient in a successful hospital, the nursing staff, fare? Overall, when student and graduate nurses are combined, this sector also grew at a tremendous pace, particularly in the post-war years. Indeed, placed in the context of national staffing trends in a period of a nursing shortage, the Moncton Hospital had an especially noteworthy record, which owed a great deal to MacMaster’s enlightened approach. Nationally, by 1942 the war-time demands, which eventually drew approximately 4,000 nurses into military service, began to take a toll on the pool of nurses available on the home front, particularly in hospital employment, which became the “domi-

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nant subsector of nursing work.”97 At the Moncton Hospital, as MacMaster confessed, retaining and attracting nursing staff was a “major problem” by the last two years of the war, a problem that had “caused many hours of anxiety to those concerned with the care of patients.”98 The nursing shortage was not resolved with the end of hostilities. Instead, expanded hospital facilities and the growth in the number of patients only further exacerbated the shortage. To rectify the problem some hospitals turned to a substantial expansion of their nursing schools, thus gradually increasing the supply of graduate nurses available. Another strategy was employing “non-professional” workers – nurses’ assistants or nursing aides – as practical nurses to relieve registered nurses of some of their more routine personal care duties.99 Relying more heavily on student nurses and non-professional nursing aides were more attractive financial options than a huge increase in the number of increasingly better-paid graduate nurses on staff, especially at a time when hospital costs skyrocketed, with a 260 per cent increase in hospital operating expenses from 1950 to 1955.100 During the Depression years, MacMaster had delicately balanced her commitment to the employment of more graduate nurses on staff against the temptation to rely ever more heavily on student labour. This balance was even more successfully applied in the 1940s at the Moncton Hospital with only a limited expansion of the nursing school that was far outweighed by a growth in the number of graduate nurses employed, alongside a limited expansion in the non-professional employees. Student nurses numbered fifty-seven in 1940 and by 1953 they had increased by 26.3 per cent to seventy-two. On the other hand, the graduate nursing staff of fourteen in 1940 had grown to seventy in 1953, or a 400 per cent increase. The broader balance between student nurses, graduate nurses, and non-professionals was a problem addressed by the Canadian Nurses’ Association in 1947 when it recommended that “graduate and student nurses [should] each constitute 30 per cent of the nursing staff” with the remainder possibly drawn from nurses’ aides, orderlies and others. In that year the Winnipeg General Hospital revealed the difficulty of meeting such standards when it reported that 50 per cent of its nursing staff were students while 12.2 per cent were graduates. Under MacMaster and her successors, the cna recommendations were more than met. In 1945, out of a total nursing staff of ninety persons, graduate nurses had increased to twenty-five (27.8 per cent of the nursing staff), student nurses had declined slightly to fiftyfive (61.1 per cent), while non-professionals (largely nurses’ aides, who were seven in number) consisted of ten employees (11.1 per cent). In 1948, a year after the cna guidelines and MacMaster’s resignation, the balance on the 109-person nursing staff was 40.4 per cent graduate

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nurses, 53.2 per cent student nurses, and 6.4 per cent nurses’ aides. By 1953, the 172-person nursing staff was 40.7 per cent graduate nurses, 41.9 per cent student nurses, and 17.4 per cent non-professionals, which now included nurses’ aides, central supply workers, and orderlies.101 This balance was all the more impressive when placed in the context of the competition between growing nursing schools and hospitals in the post-war period. Ten years after the end of World War II, New Brunswick’s fourteen hospitals with nursing schools ranked it fourth in the nation, behind Ontario (with sixty), Quebec (forty-three), and Nova Scotia (sixteen), and ahead of Alberta (twelve), Saskatchewan (ten), Manitoba (eight), British Columbia (six), and Newfoundland and Prince Edward Island (with three each). The offsetting reality was that New Brunswick nursing schools enrolled only 662 students in total, which left the province in eighth place in this category. The smaller population pool of potential applicants in the Maritimes created a competitive situation, as did the attraction of studying and making a career outside the province. Admittedly New Brunswick’s ratio of registered nurses to population improved from 1:1,456 (279 registered nurses) in 1930 to 1:417 (1,226 registered nurses) in 1950. This represented a 339.4 per cent increase in New Brunswick registered nurses, while the increase at the national level (excluding Newfoundland in 1930) went from 14,309 in 1930 to 41,088 in 1950, or 187.1 per cent. Nonetheless, the low number of registered nurses in New Brunswick in 1930, only 279 or 1.9 per cent of the total number in Canada, had only increased to 1,226, or 3 per cent of the national total, in 1950. Moreover by 1955 the ratio of registered nurses to population in Canada was 1:288 while New Brunswick in the same year was 1:356. There remained a “shortage in the number of nurses” required in the province.102 To meet these post-war realities, the Moncton Hospital nursing school embarked upon a limited expansion that maintained the quality of the program, while the hospital also retained on staff a high percentage of the graduates to replace departing nurses and to increase gradually the number of graduate nurses. From 1940 to 1948, the average age on admission of applicants to the Moncton Hospital nursing school was 18.8 while their education level was grade 11 to grade 12.103 In 1945 eight students were rejected or withdrew and the graduating class numbered sixteen. The number of graduating students increased to twentyone in 1948, fell to seventeen in 1950, and rose to twenty-four in 1953. Withdrawals from the program in the same years were two, three, and two which, given the increase in student numbers from fifty-eight in 1948 to seventy-two in 1953, produced a high retention rate. The stu-

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dent nurses completed a three-year program combining ward work and classroom instruction. Lectures in the latter case were still handled by staff doctors as well as by a nursing instructional staff, which grew from two instructors (three including MacMaster) in 1945 to five in 1953 (when it is uncertain whether this included the director of the school). The shaping of young women in a carefully disciplined environment, whether in the nurses’ residence, classroom, or ward, remained an accepted component in nursing education. MacMaster did introduce, however, a system of student government in 1945. This had a dual purpose, she explained: to share “responsibility for the conduct of students when off duty,” and to achieve greater student co-operation in the maintenance of “ideals and standards of nursing.”104 A year after MacMaster’s resignation, her successor as nursing director, Barbara Beattie, made extensive changes to the school’s organization and teaching program. A school of nursing committee was established to advise on educational matters, and consisted of a member from each of the medical staff and the hospital board, a representative from the city’s education department, along with “An Alumnae of the School of Nursing, as well as the Director of Nursing, AssistantDirector of Nursing, Instructors, and the Hospital Administrator.” Program changes included the organization of a pediatric service with a teaching component, and the discontinuation of the obstetrical study arrangement at Montreal Maternity Pavilion (at Royal Victoria Hospital) since an obstetrical teaching department was now opened and, with over 800 births per year, ample clinical opportunities existed at the Moncton Hospital itself. Additional improvements included student nurses’ involvement in community health services through visits with the Victorian Order of Nurses, school nurses, and various city clinics, and rearrangement of the Nurses’ Residence to provide a study room and reference library, enriched by the purchase of reference materials, nursing magazines, and periodicals. This enhancement of the academic curriculum and environment was further emphasized when the entire system of classroom teaching was revamped in 1953. Instead of weary students dragooned into the classroom after eight hours of floor duty, or rising early if they had been on night duty, a “Block system of Teaching” was introduced. Students now went to class from 9 am to 4 pm for “a period of weeks, depending on the number of classes to be taken” and, thus, ward duties would not hamper academic responsibilities. The new system, it was reported, was much more satisfactory to patient service and to student learning.105 The high quality of the graduates produced was maintained amidst these changes. Year after year the entire graduating class passed the qualifying provincial examinations. Moncton Hospital graduates were

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frequently top in the province: for example, in the November 1946 provincial exams, in the May 1947 competition, and in 1953, when one graduate was first and another was third. Some graduates moved on to positions of authority on the Moncton Hospital staff, in some cases quite quickly. When Beattie resigned in 1950, veteran nursing staff member and Moncton nursing school graduate Miss Florence J. Breau replaced her, while Breau in turn was succeeded in 1953 by Miss Katherine Richardson, a 1948 graduate of the program. Although market demand opportunities and higher salaries drew some out of the province, many of the graduates were first appointed to the staff of the Moncton Hospital. The twenty-one graduates of the 1948 class appeared typical when it was reported that fourteen “have remained on our Staff. One has married and six are working in other hospitals.”106 The nursing school provided a convenient source of supply at a time when it was badly needed. In 1945 Alena MacMaster sadly reported “a complete turnover in the personnel of [the] General Duty group” as “eighteen nurses accepted appointment and nineteen resigned to get married or for removal elsewhere.” A “greater stability in the staff” was achieved by 1948, but in 1950 three-quarters of the graduate staff resigned while in 1953 40 per cent departed. Placing in positions of responsibility or administrative duties those who proved their ability and remained on staff was one way to hold on to nurses. The hierarchical division of nurses, general duty versus administrative, which was common in other hospitals as well, clearly emerged in the late 1940s and early 1950s. By 1953, the seventy-person graduate nurse staff divided into forty-seven general duty nurses, amongst whom there was some turnover, versus a more stable group of eleven head nurses, two night supervisors, an operating room supervisor, a maternity supervisor, a central supply supervisor, and five nurses involved in the school of nursing. Short- and long-term leaves, carrying a commitment of further service at the hospital, were introduced. In 1950 four nurses were doing post-graduate work at Columbia University, McGill University, St Michael’s Hospital in Toronto, and Memorial Hospital in New York. Three years later an even larger contingent was away for further studies: two were at the Johns Hopkins Hospital, three nurses were at Dalhousie University’s School for Graduate Nurses, and two were at Saint John General Hospital.107 The hospital board’s sensitivity to the need to improve working conditions was demonstrated in April 1950 when, fulfilling the request of Barbara Beattie and the much earlier desires of Alena MacMaster, the long debated “eight-hour day for the Nursing Staff” finally commenced. The new forty-four-hour week applied to student nurses, graduate nurses, and nurses’ aides.108 Compared to the Victoria General Hospital in Halifax, which only achieved

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an eight-hour day in 1954,109 Moncton Hospital was among the Maritime leaders in this change. Despite such measures, staff turnover remained a major problem, but recruitment of the hospital’s own graduates, selective advancement of the best, and encouragement in the acquisition of new areas of expertise or the refurbishment of old skills, all contributed to the Moncton Hospital’s success in coping, and indeed overcoming, this difficulty. The nursing staff’s individual and collective strength matched neatly with that of the physician staff that it supported, worked with, and sometimes directed. Whether nurse, student, doctor, patient, administrator, or support staff, all anticipated from 1947 onward the construction and opening of the new Moncton Hospital. Prior to the tendering process, in order to work more closely with the architects, the firm of Govan, Ferguson, Lindsay, Kaminker, Maw, Langley and Keenleyside, the hospital’s executive director, Donald Porter, took up temporary residence in Toronto. Along with nursing director Barbara Beattie and Dr Joseph Dobson, Porter visited new hospitals in Canada and the United States “to investigate every avenue of new construction and operation that might be a saving or a future necessity.”110 Plans were reviewed and approved by department heads and medical staff. Once construction was launched in the winter of 1950–51, regular progress reports were submitted to the board by Lockhart and Porter. In May 1952, the “structural work, that is, the construction of walls, floors, roofs etc.” was “82% complete.” April 1953 brought the hope that within three months “Job Completed” would be the report, and it was.111 On 21 July 1953 the Moncton Transcript announced that ceremonies opening the “New Hospital” would occur that day and published a special supplement in honour of this great achievement. The “Times and Transcript Hospital Section” provided a detailed view of the new facilities as well as a capsule summary of the growth of medical services in Moncton and throughout New Brunswick. Separate articles outlined the past and continuing contributions of the Ladies’ Aid, the history of the Moncton Hospital, and the funding arrangements behind the new building. Problems faced by hospitals were raised, such as the number of doctors in the province, which, it was reported, had not kept pace with Canada’s 76.7 per cent increase in the 1911–47 period since New Brunswick’s increase in the same time span “was only 11 per cent.” Nurses were also in short supply: although “25 per cent of all girls that graduate from high school in New Brunswick enter the nursing profession,” “one in five withdraws from training before graduating.” Chief hospital dietitian Doris Morton’s department was analysed; patient services were enumerated; plumbing in private rooms, it was emphasized, was carefully placed to reduce

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bothersome noise, while the more numerous four-bed rooms were structured to allow window views for each patient, partitions, and “more privacy and less disturbance from other patients in the room.” Even the visitors’ system had to be explained. A card was to be issued at the main desk to each visitor, which must be returned on leaving, so the maximum two visitors at a time policy could be enforced.112 The elaborate speech-making that marked earlier hospital festivities was conspicuously curtailed. In a brief news item the next day, the opening ceremonies were quickly summarized. Provincial minister of health Dr J.F. McInerney cut the ribbon, Ambrose Wheeler introduced the lieutenant governor, D.L. MacLaren, while “Rev. M.A. MacMillan, president of the Moncton Ministerial Alliance gave the opening invocation.” Rev. J.P. Butler, pastor of St Bernard’s Roman Catholic church, delivered “the concluding benediction,” as the hospital’s interdenominational complexion persisted. Other speakers were board chairman Leonard Lockhart, Moncton mayor Harris A. Joyce, Westmorland county warden Percy J. Eagles, and J.B. Langley, representing the Toronto architectural firm responsible for the project. None of their orations were reported. After the ceremonies, the “750 invited guests” were given a guided tour of the “miles of corridors.” The snipping of the ribbon signaled, the press claimed, “a new era in the history of modern hospital care in this area.” This opening of “the new base hospital for southeastern New Brunswick … symbolized the realization of a dream of ultra modern hospital facilities capable of coping for many years to come with the needs of a rapidly growing city and mushrooming surrounding area.”113 Compared with this coverage, more attention was paid to the movement of patients into the new hospital, which was scheduled for a month later on Saturday, 22 August. The ever efficient executive director of the hospital outlined the procedures to be followed. No visitors were allowed at either hospital on moving day. Of the 150 patients being treated in the old hospital, all those who could safely be discharged “will be asked to leave by 9 and 11:30 that morning.” Those patients whose physicians recommended that removal was an impossibility would be moved to the “first floor of the old hospital for treatment until they can be moved.” Remaining patients would be given a noon meal and then the move would occur between 1:30 and 5:30. Meanwhile at the new hospital on the day before, Friday afternoon at 2:00, admission of emergency patients would commence with “maternity cases in labour … considered as emergencies.” Like clockwork on the appointed day, a fleet of five ambulances, “with police cruiser and motorcycle escort,” moved the sixty-five remaining patients “without a hitch.” They joined twelve emergency patients already admitted. By the

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next day another eight emergency patients were admitted and, within a few more days, waiting list patients were being admitted. On 24 August, Kevin Allison Murray, son of Mr and Mrs Allison Murray of Petitcodiac, arrived to claim the distinction of being the “First baby to be born in the new Moncton Hospital.”114 The transfer and opening had gone smoothly, but buried within the press, public, and hospital pronouncements concerning the birth of this new institution were a number of assumptions and assertions about the Moncton Hospital’s past and future role. Frequent reference was made to the achievement of a “goal marked out more than three years ago by the people of Moncton and Westmorland County.” What had become of adjoining Kent and Albert counties? As early as 1922, Kent county had redirected part of its grant support to the other Moncton-based hospital, Hôtel-Dieu,115 and by the 1940s its residents, as patients, had been substantially redirected as well. Albert county, on the other hand, continued to use the services of the Moncton Hospital but offered in return a small grant that the hospital board considered inadequate, demanding that the county assume 10 per cent of the cost of the new hospital. Despite prolonged discussions, no agreement could be reached with Albert county. As the Moncton Hospital held centre stage and was praised for its past and future contributions, supporters of the Hôtel-Dieu among the Acadian majority in Kent county, and the 40 per cent of Westmorland county who were Acadians, along with the Acadian 30 per cent of Moncton’s own residents might have wondered what this would do to their own hospital. Taking a balanced political stance, the minister of health, J.F. McInerney, praised the “splendid new [Moncton] hospital” as he opened it, but he also referred to “the contemplated new $1,000,000 addition to Hôtel-Dieu.”116 Prior to Moncton Hospital’s expansion, Hôtel-Dieu, with 157 beds and 32 bassinets, actually had edged slightly ahead of the old Moncton Hospital, which before the move at best could muster 153 beds and 32 bassinets.117 While from its inception Hôtel-Dieu had received grants, however limited, from Westmorland and Kent counties as well as the provincial government, Moncton city council only recognized the hospital’s need for support by an annual grant of approximately $1,000 beginning in 1934.118 To be sure, in the late 1940s the Acadian institution was eligible for Moncton’s and Westmorland’s dollar a day per patient grant (for residents of Moncton and Westmorland),119 and the provincial per patient day grant. But Moncton Hospital was clearly the more favoured of the two institutions, at least by Moncton city council. As a result, when editorial writers and press reports emphasized that, as part of the new Moncton Hospital complex, “the New Brunswick Department of

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Health will operate a regional laboratory in a building nearby,” one of several assertions about Moncton Hospital’s new position as the “Base Hospital” for southeastern New Brunswick,120 cause for concern intensified. Consequently, and not surprisingly, in 1952 the first battle fought by the newly appointed “comité consultatif” at Hôtel-Dieu was a “bataille pour renverser la décision du gouvernement provincial de construire un nouveau laboratoire régional en annexe au Moncton Hospital.” The representatives of Hôtel-Dieu suggested instead a laboratory “sur un site neutre” but failed to convince the provincial cabinet.121 Moncton Hospital emerged triumphant at this point, but even as it embarked upon its broader regional role the politics of medical care had become immensely more complicated and competitive. Hôtel-Dieu’s supporters could take consolation from the fact that the expansion of their own institution soon would bring its capacity to 225 beds.122 But, once again, strewn throughout the judgments about Moncton Hospital’s past and future course were comments that its new 1953 building had been planned as the first phase in a series of expansions. “Sufficient land,” it was emphasized, had been “acquired for present and future development of the hospital.” Moreover, the new facility was planned so that “all departments and services [are] capable of individual and independent extension when the need arose.” The east–west wing could be extended for more patient accommodation. The nursery was to expand southward over the isolation floor. The obstetrical and operating departments could expand northward on the second and third floors. “The kitchen, cafeteria and stores areas can expand to the east.” On and on the possibilities went.123 Moncton Hospital had just opened at the new site but already the probable need for future expansion, and indirectly the need to guarantee its position as the leading medical treatment centre in southeastern New Brunswick, were being openly outlined and asserted. As the new hospital began operation, it might be assumed that the old buildings fell silent. Not quite. The Nurses’ Residence and an annex were bought as residential facilities for the Moncton college of St Joseph’s University.124 In early September this space was vacated as the nurses moved into their temporary residence, the 1930 wing of the old hospital, which had been renovated to accommodate their needs. Transportation to and from the new hospital was arranged for them until a new Nurses’ Residence, housing 120 and located immediately behind the hospital, was officially opened in December 1958. The old hospital buildings on King Street were then taken over by Les Religieuses de Notre Dame du Sacré Coeur125 for eventual use as a senior citizens’ residence. The old facilities had ended one life of service and begun another.

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On 26 August 1953 the hospital board met to hear that the hospital would be “Fully Operative” towards the end of the next week.126 There had been battles and casualties in the process but the goal most hospital supporters had sought for such a long time had been achieved. Committed and concerned individuals might have disagreed at times about the nature of the expanded hospital facilities but all agreed that the final outcome was worth the struggle. Subtly in some instances, more profoundly in others, the new hospital on a new site had a transformed medical and nursing staff, a changed board and management system, an altered financial dependency, and a different role to play and constituency to serve. Whether old or new, however, hospitals not only give life but at times witness it snuffed out. Nursing director Florence J. Breau, a precious link with the old hospital, had been admitted to the new hospital as one of its first patients and died there on 30 August 1953. A 1928 graduate of the Moncton Hospital school of nursing, she had devoted her entire career to the hospital. “No successor,” it was stated, “however able, however kind, will ever obscure her memory to those who had the privilege of working with her or under her.” Furthermore, Donald Porter continued in his final salute to Florence Breau, “[s]he was an inspiration to her nurses, who always looked up to her for exemplary conduct and achievement, and a source of genuine pride to the trustees and doctors of the hospital and satisfaction to all those whom she was called upon to serve.”127 Florence Breau’s service symbolized the dedication of the hospital’s staff and its supporters, and her passing tempered and saddened this moment of achievement.

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Conclusion

The journey of the Moncton Hospital from its cramped and inauspicious almshouse birthplace to its spacious MacBeath Avenue site, from a largely privately funded hospital to an increasingly governmentally funded institution, had been smooth at times but rocky on many more occasions. Setbacks, delays, and detours, however, were overcome by committed individuals along with public usage and appreciation of what a modern hospital offered to the community, which in turn brought, sometimes slowly, the necessary government support. The major goal of meeting construction and equipment costs of hospitals with government funds, primarily municipal and county but provincial and federal as well, was achieved by 1953. Relief at the local level from the burden of the substantial on-going sinking fund and operating and bond interest charges remained unachieved though widely anticipated by many, including the Moncton municipal authorities. Just how far the wider Canadian hospital community had come by the early 1950s in gaining public appreciation and public sector acceptance and support is open to debate. As early as 1934 an ever optimistic G. Harvey Agnew observed that when “one considers the origins of our hospital system, its early dependency upon charity and private philanthropy, with no thought of state support, we realize how far we have gone in the interval.” Canada lacked the philanthropic resources available elsewhere, he continued, so without “municipal and state support our hospital system could never have attained its present efficiency.”1 The reality behind this rose-tinted picture was somewhat murkier. In the case of the Moncton Hospital, limited government

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support was available from the outset but, at all levels of government, a reluctance to assume major funding responsibility was also apparent. Consequently, a reliance upon paying patients quickly emerged and became even more pronounced with the creation and growth of private hospital insurance schemes. Almost twenty years after Agnew’s pronouncement, the funding situation of hospitals remained in flux. While the costs of buildings and equipment had been assumed by government, for the most part at the local level, major funding problems remained. Although an enthusiastic booster of the hospital cause, and of the need for the communities served to provide financial support, Leonard Lockhart’s candid assessment was that “[i]t is most unfortunate that communities of indifferent assets have to mortgage their futures to construct new hospitals.”2 The mayor of Moncton who had appointed Lockhart to the Moncton Hospital board, and who shared his new hospital dream, had the same sort of reservation about the municipal capacity, or incapacity, to bear such a burden.3 More precisely analysing continuing hospital problems, Donald F.W. Porter, the executive director of the Moncton Hospital in 1953, argued that under “the best of circumstances” public hospital financing remained largely unsystematic and unpredictable. “Various individual hospitals and various communities,” he maintained, “have their own approach to attempting to place on some more reasonable basis the financing of the construction, equipping and operation of our institutions.” In the Moncton case, its “favourable financial operating position” was due to “a high percentage occupancy” rate that might fall in the future. To offset this possibility, he urged that a “reasonable solution to this difficult problem would appear to lie in the community making a direct money grant on a planned basis to provide for its citizens that margin of ‘safety’ to which they are entitled.”4 That Porter directed his message at more than the local community became clear over the next several years as he spearheaded the campaign for more provincial funding and an overall funding plan. As chairman of the New Brunswick Section of the Maritime Hospital Association, in the summer of 1954 he urged a doubling of the provincial patient grant to $1 per day. This increase would at least provide a “slight breathing spell” until “a more rational method of financing the operation of our hospitals can be provided in our province.”5 When no response was received, Porter inquired about the fate of the association’s request and explained the crisis that was at hand. Hospitals had to submit any contemplated rate increases to the Maritime Blue Cross association, and their proposed increases had been rejected by that organization. They had been informed “that the premiums to the public could not be raised beyond their present level” and further hospital

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rate increases would require a substantial premium increase.6 Even in the prosperous fifties, a consumer revolt was as much a possibility as in the depressed thirties! Apparently the potential private, semi-private, and ward patients, although the majority were covered by private hospital insurance, could only be pushed so far as a source of revenue. The time was rapidly approaching when the “patients of moderate means”7 would prevail upon governments to deliver an equitable approach to hospital patient fees through public, universal, hospital insurance coverage. The goals of capital funding and substantial operating cost assumption by government, whether local, provincial, or federal, were only gradually understood and aimed at as the Moncton Hospital’s funding predicament unfolded between 1898 and 1953. The response of county, municipal, and provincial governments revealed the influence of usage patterns and public pressure on their willingness to act. In the 1920s it was clear that seeking private donations for the substantial capital costs of hospitals no longer worked satisfactorily. Guaranteeing debentures was the new answer. In the Depression, however, at least in Moncton, assuming rather than just guaranteeing bond interest and sinking fund requirements was necessary and city council shouldered this burden. As county usage increased in the 1940s, particularly that of Westmorland county, the adjoining counties had to be brought on side to meet the post-war needs of the Moncton Hospital. One responded, another did not. At the same time, the emergence of a federal government presence in hospital care precipitated a more active and substantial provincial government role. In presenting the case for hospitals, and their adequate support, those of “moderate means,” largely the middle and upper class, were consistently the most active and influential backers of the Moncton Hospital. A coalition of prominent and active community leaders first sparked the hospital movement, and it was the prominent and better-off, for the most part, who continued to dominate on the hospital board and on the executive of the Ladies’ Aid. From the hospital’s first emergence, while care of the sick poor was frequently articulated, care of patients who could pay was also emphasized. Although hospital support and leadership were drawn largely from the urban elite, and the city increasingly identified the hospital as primarily its own institution, there was a sensitivity about the need to attract support and patients from Moncton’s neighbouring counties. This constituency shifted over time, with Moncton residents clearly the majority users in the 1920s and 1930s, but the surrounding counties were a slight majority among the patients admitted in the 1940s and early 1950s. Services offered by the hospital further changed its attractiveness and constituency. Surgery cases substantially

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outnumbered other types of patients by the 1920s, while the addition of maternity services, also in the 1920s, guaranteed that women would be the dominant gender served by the hospital. Various clinics and out-patient services allowed the expansion of hospital outreach and addressed the general health of the community, with school children particularly profitting from these new treatment opportunities. The steady expansion of services was matched, and delivered by, a staff of physicians whose numbers and training probably paralleled the transition underway elsewhere in the Maritimes. Initially there was a high percentage of American-trained doctors on the hospital roster, but a McGill University, and Canadian-trained, dominance emerged in the post-World War I years. After 1945, in the most substantial expansion of physician numbers and specializations, Dalhousie University became the major supplier of staff doctors, although McGill remained a significant presence, and the Canadianized training background of staff was almost total. Nursing numbers, both in terms of student and graduate nurses, likewise steadily increased over the years. But in this area the Moncton Hospital more than met the recommended national standards by controlling and balancing student numbers with an almost equal number, by 1953, of graduate nurses, along with a substantially lower reliance, compared to national norms, on non-professional workers. Particularly during and after World War II, the hospital coped with a nation-wide nursing shortage by recruiting recent graduates from its own school of nursing. The strength of the staff and the ever expanding expertise it offered led to certification, careful review of standards, and higher qualifications required, for example in the area of surgery. It also caused a periodic re-articulation of the hospital’s mission. In the late 1930s, in addition to the full range of normal hospital services, Alena MacMaster emphasized the hospital’s future role in public health, public education, and in co-ordinating the various health agencies at work in the community. By the 1950s, because of provincial government decisions concerning the placement of equipment and programs as well as a regional laboratory, the Moncton Hospital gained recognition as the regional medical service centre for all of southeastern New Brunswick. The Moncton Hospital was fortunate that, at various points in its development, individuals and groups emerged to keep the hospital cause alive or to enthusiastically redirect its course. These dedicated persons provided the information, direction, and fund-raising necessary to arouse and sustain public and governmental support. In its elongated founding moments, the contributions of Annie Purdy stand out, as do those of physicians Ambrose Myers, James Ross, and Oscar McCully, along with hospital board presidents George Willett and

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Frederick Sumner. The willingness of members of the medical staff and hospital board to plunge into municipal and county politics was crucial in gaining the then limited government support for capital and operating costs. More than balancing this service was that of the indefatigable Ladies’ Aid, which at every critical early step delivered a substantial portion of the private donations so necessary to the hospital’s survival and expansion. Expansion in patient numbers and facilities brought a heavy dependence on the nursing school, whose student nurses played a vital role. At times there was an instability among nursing students and graduates, disenchantment with the board’s selection of hospital physicians, and increasing criticism of hospital policies from Westmorland county councillors and labour union leaders within Moncton. These complaints culminated in the restructuring of the hospital board in 1917, which made it a more representative body and cleared the way for a reorganized medical staff as well as a shift of substantial administrative leadership from the board to the hospital superintendent. The importance of the appointment of Alena MacMaster in 1919 as both hospital superintendent and director of the nursing school cannot be underestimated. She put her personal stamp on every aspect of the hospital’s operation from her appointment until her resignation in 1947. Standardization, certification by the American College of Surgeons, expansion of patient services, and the careful shaping of her beloved nursing school into a first-rate training institution for young women were only a few of her many contributions. These were achieved with the co-operation of board members, willing to lobby at the municipal and county levels for greater support and symbolized by the ever-supportive long-time board president, A. Cavour Chapman. The hospital had quickly escaped from its almshouse image and in the inter-war years it became a source of pride to the communities it served. At the same time, even the most active of hospital supporters in the Ladies’ Aid recognized that private support alone was insufficient to meet hospital needs. An even more active government role and experimentation with other schemes such as pre-paid hospital insurance, predicted by Alena MacMaster in the mid-1930s, were required. These came in the post-World War II years, but so did the most divisive debate in the hospital’s history, over its proper expansionist course. The medical staff, which had increased in numbers, in specializations, and in the community’s respect for its skills and expertise, led the battle for a new hospital on a new site. Allied with some sympathetic board members, supportive municipal politicians, and an aroused Taxpayers’ Association, the goal of a new hospital was achieved. To try to name all

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the determined campaigners in this phase of the hospital’s history surely slights someone, but doctors Joseph Dobson and Robert Roach, along with Mayor J. Edward Murphy and eventual hospital board chairman Leonard Lockhart must be acknowledged. A neglected figure, over a longer period of time, was the unacclaimed C. Hanford Blakeny. In the 1920s, as chairman of the Rotary Club committee, he helped the hospital by pressuring city council for a guarantee of hospital debentures; in the 1930s he was Moncton’s mayor as his council assumed a heavier hospital burden in the depths of the Depression; and in the 1940s, as Moncton’s member of the legislature and provincial cabinet minister, he was an ardent advocate of an expanded hospital facility and expanded role on a new site. As in the case of Annie Purdy, the official hospital sources rarely mention his name but his guardian angel-like intervention was a reality. The Moncton Hospital story demonstrates an institution’s far from inevitable and rarely easily achieved quest to fulfill a vital need of the communities around it. Its history is, however, very much a history of individual commitment by supporters, board members, doctors, nurses, student nurses, and administrators, which earned the respect and support of the public. Leonard Lockhart honestly expressed the mysterious emotional commitment hospitals brought out: “Hospital work is a challenge which I find very difficult to explain, but a further discussion on the activities of our staff would indicate to you their sincere desire to serve at all times, far and beyond anything that is expected of them.”8 Florence Breau and Alena MacMaster were only two of many who would have nodded in agreement that this struggle to serve enriched their lives and those whom the hospital served so well. Throughout this study, wherever possible, comparisons have been made with the evolution of the modern hospital in other parts of Canada and the United States. However, this history’s tendency to push hospital studies and themes in the somewhat neglected direction of funding, combined with the limitations of the Canadian hospital genre, allowed questions to be answered fairly clearly in the Moncton case but perhaps not as convincingly for other communities and regions. Until other academic hospital histories appear, this lack of clarity about smaller hospitals in Canada will continue. Yet the slow and halting interventions in hospital funding by provincial and federal governments, along with the burden placed on county and municipal levels, was clearly not restricted to Moncton, New Brunswick. Other small Canadian communities were also lacking the philanthropic base or medical school linkages available in some large metropolitan centres, and had hospitals that suffered through a precarious existence, heavily dependent on limited local support and paying patients.

conclu.fm Page 185 Friday, December 12, 2003 8:57 AM

185

Conclusion

While the first half of the twentieth century witnessed the emergence of Canada’s modern hospital system, in many smaller communities the process was often not easily accomplished. While their “struggle to serve” remains less precisely documented, the struggle of small hospitals is readily apparent. Likewise the need for committed hospital backers and dedicated leadership, both at the board and staff levels, can be assumed. Whether all were blessed with Lockharts or MacMasters might be debatable. The important role of women, in Ladies’ Aids, as nurses, and as administrators, despite the fragility of their authority and limitations placed upon their role, was not unique to southeastern New Brunswick. As well, the relative strength of the medical and nursing services delivered, and quick embrace of the therapeutic advances enjoyed in more research oriented institutions, was common across Canada. Above all, the urban-hinterland relationship, and the need to understand its impact on health services, was a drama played out in every part of this northern nation. To be sure, the modern reality of an overwhelming concentration of population in a limited number of major metropolitan centres leads to a not surprising inclination to overlook the rural and small city/town side of Canadian life. But grasping the complexity of the interactive relationship among the varied communities a small hospital served, and indeed at times the unconcealed metropolitan aspirations of the small city of Moncton, is an important key to understanding hospital history and development. The emphasis upon the external forces at work in hospital growth that balanced internal developments has until now been overshadowed by an emphasis on the new therapeutic approaches and surgical techniques of cuttingedge teaching hospitals, or primarily celebratory studies of smaller public hospitals. In summary, although not based in a large metropolitan city, the Moncton Hospital’s history illuminates and expands our comprehension of the development of Canadian hospital services as well as a community’s response to and redefinition of its local health care institution, both of which have been marginalized and neglected for too long.

conclu.fm Page 186 Friday, December 12, 2003 8:57 AM

appendic.fm Page 187 Friday, December 12, 2003 8:58 AM

Appendices

appendix one Patients admitted to the Moncton Hospital, 1919–1930 1919–1920

1924–1925

1929–1930

1,197

1,381

2,087

Number of private/semiprivate

990

1,144

1,747

Number of public patients

207

237

340

495

718

1,007

86

138

197

Patients admitted

Residence of patients: Moncton

private/semi public

261

306

387

public

73

72

101

Kent

private/semi

91

53

66

public

36

14

29

Albert

private/semi

n/a

n/a

146

public

n/a

n/a

4

143

167

141

12

13

9

13,657

18,452

25,084

Westmor.

Others

private/semi

private/semi public

Total number of hospital days

appendic.fm Page 188 Friday, December 12, 2003 8:58 AM

appendix two Patients admitted to the Moncton Hospital, 1933–1939 1933

1935

1939

Patients admitted

1,955

2,285

2,619

Number of private/semiprivate

1,391

1,645

1,923

564

640

696

private/semi

804

897

1,035

ward

424

486

443

private/semi

Number of ward patients Residence of patients: Moncton

Westmor.

342

436

535

ward

97

104

170

Kent

private/semi

27

41

46

Albert

private/semi

ward

ward Others

private/semi ward

Total number of hospital days

10

9

1

115

151

159

18

31

59

103

120

148

15

10

23

23,957

27,266

30,085

appendic.fm Page 189 Friday, December 12, 2003 8:58 AM

appendix three Patients admitted to the Moncton Hospital, 1941–1953 1941

1945

1950

1953

Patients admitted

3,648

5,434

5,730

6,466

Number of private/semiprivate

3,311

5,280

5,464

5,315

337

154

266

1,151

Number of ward patients Residence of patients: Moncton

Westmor.

private/semi

1,693

2,320

2,272

2,335

ward

264

82

145

394

private/semi

945

1,924

2,114

1,912

36

49

91

461

168

n/a

n/a

n/a

ward Kent

private/semi

Albert

private/semi

ward

ward Others

private/semi ward

Total number of hospital days

6

n/a

n/a

n/a

245

495

542

667

21

12

15

170

260

541

536

401

10

11

15

126

39,611

55,562

53,848

57,241

appendic.fm Page 190 Friday, December 12, 2003 8:58 AM

notes.fm Page 191 Friday, December 12, 2003 8:58 AM

Notes

abbreviations armh Annual Report of the Moncton Hospital, Moncton, N.B. for the Year Ending May 31, ---mha Moncton Hospital Archives mm Moncton Museum New Brunswick Acts Acts of the Legislative Assembly of New Brunswick panb Public Archives of New Brunswick rmh Report of the Moncton Hospital for the Fiscal Year Ending December 31, ----

introduction 1 Vogel, The Invention of the Modern Hospital, 135. 2 Atwater, “Of Grandes Dames, Surgeons, and Hospitals,” 414–15. 3 Rosenberg, The Care of Strangers; Starr, The Social Transformation of American Medicine; Stevens, In Sickness and in Wealth; Vogel, The Invention of the Modern Hospital; Rosner, A Once Charitable Enterprise. Gunter B. Risse provides an outstanding history of hospitals in Mending Bodies, Saving Souls. 4 To cite a selective list: Angus, Kingston General Hospital; McGee, The Victoria Public Hospital; Terry, The Royal Vic; Bayard, History of the General Public Hospital in the City of Saint John, N.B.; Cosbie, The Toronto General Hospital; Hollobon, The Lion’s Tale; Gibson, St. Mary’s of the Lake in Kingston; MacDermot, A History of the Montreal General Hospital;

notes.fm Page 192 Friday, December 12, 2003 8:58 AM

192 Notes to pages 4–9

5 6

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

22 23 24 25 26 27

Clarke, A History of the Toronto General Hospital; Runnalls, A Century with the St. Catharines General Hospital; Lewis, Royal Victoria Hospital 1887–1947; Stephen and Smith, The History of St. Joseph’s Hospital. See Gagan, “A Necessity Among Us”; Howell, A Century of Care; Cortuila, “Social Class and Health Care in a Community Institution.” Connor, “Hospital History in Canada and the United States,” 103. Connor’s own recently published study, Doing Good: The Life of Toronto’s General Hospital, is an excellent contribution to the Canadian hospital history genre. Hamowy, Canadian Medicine, 6. Shortt, “The Canadian Hospital in the Nineteenth Century,” 3–4. Witness Stevens’ title In Sickness and in Wealth. See Starr, The Social Transformation of American Medicine, ix. See also Maioni, Parting at the Crossroads. See Taylor, Health Insurance and Canadian Public Policy; Naylor, Private Practice, Public Payment; Naylor, ed., Canadian Health Care and the State. See both Gagan, “A Necessity Among Us,” and Gagan, “For ‘Patients of Moderate Means.› Agnew, Canadian Hospitals, 1920 to 1970. Connor, “Hospital History in Canada and the United States,” 103. Strong-Boag, “Making a Difference,” 239. Gidney and Millar, “The Reorientation of Medical Education,” 53. Pickstone, Medicine and Industrial Society, 2. Careless, Frontier and Metropolis, may still be usefully applied. Abel-Smith, The Hospitals, 1800–1948, ix. See, for example, Porter and Wear, eds., Problems and Methods in the History of Medicine; Porter, The Greatest Benefit to Mankind. Craig, “The Role of Records and of Record-Keeping,” 376–97. See also Liebenberg and McGee, A Guide to Health Care History Materials, 12–13, which briefly mentions some of the Moncton Hospital Archives’ inadequacies. Rosenberg, The Care of Strangers, 9. MacLellan, History of the Moncton Hospital. See, for example, McGee, The Victoria Public Hospital; Bourque, Rêves de visionnaires; MacLellan, History of the Moncton Hospital. See Rosenberg, “Inward Vision and Outward Glance,” 348; Gagan, “A Necessity Among Us,” 55. See Stevens, ‹A Poor Sort of Memory,› 551–84; Stevens, “Sweet Charity,” 287–314, 474–95. For studies of Equal Opportunity, see Krueger, “The Provincial-Municipal Government Revolution in New Brunswick,” 51–99; Young, “Remembering Equal Opportunity,” 88–102; Stanley, Louis Robichaud; Canadian Institute for Research on Regional Development, The Robichaud Era.

notes.fm Page 193 Friday, December 12, 2003 8:58 AM

193 Notes to pages 9–15 28 Vogel, The Invention of the Modern Hospital; Rosner, A Once Charitable Enterprise; Atwater, “Of Grandes Dames, Surgeons, and Hospitals,” 435. 29 This process is outlined in Starr, The Social Transformation of American Medicine, 178–9; Rosenberg, “Inward Vision and Outward Glance,” 350, 359, 363; Rosenberg, The Care of Strangers, 344–5.

chapter one 1 Shortt, “The Canadian Hospital in the Nineteenth Century,” 4. 2 See, for example, Howell, A Century of Care; Gagan, ‘A Necessity Among Us’; Côté, “L’Implication des Soeurs de la Providence.” 3 A small sample of examples would include Howell, “Medical Professionalization,” 5–20; Gagan, ‹For Patients of Moderate Means,› 151–79; McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax”; McPherson,”Skilled Service and Women’s Work.” For historiographic reviews, see Howell, “Back to the Bedside,” 185–94; Mitchinson, “Canadian Medical History,” 125–35; Warsh, “The Historiography of Canadian Health Care,” 137–43; McPherson and Stuart, “Writing Nursing History in Canada,” 3–22; Strong-Boag, “Making a Difference,” 231–48; Mitchinson, “Medical Historiography in English Canada,” 205–27. 4 See Howell, A Century of Care, 13–24, and Bayard, History of the General Public Hospital in the City of Saint John, N.B., 4–8. 5 See the comments of Gagan, ‘A Necessity Among Us,’ xii; Connor, “Hospital History in Canada and the United States,” 93–104. 6 Gagan, ‘A Necessity Among Us,’ 10. 7 Ibid., 15–17. 8 McGee, The Victoria Public Hospital, 13–20. 9 Moncton’s historical background is provided in Larracey, Resurgo: The History of Moncton 2; Appleton, “The Town of Moncton;” Hickey, ed., Moncton 1871–1929; and LeBlanc, “Moncton, 1870–1937.” 10 Hickey, ed., Moncton 1871–1929, 7. 11 Stevens, “Sweet Charity,” 287. 12 mha, “Report of the First Year’s Operations” for the Moncton Hospital, June 1899. 13 Moncton Daily Times, 29 January 1895, 1. 14 See Allain, “Need for Health care was thorny debate,” 1. 15 Moncton Daily Times, 11 January 1895. 16 Moncton Daily Times, 2 January 1895. Unfortunately the press used the husband’s initials and last names in reporting women’s names. The 1891 Census Westmorland County New Brunswick, Volume 1 and the Census, 1901, Victoria Co., Westmorland Co., York Co., Micro 5655, Reel t-6445, available at the Bell Library, Mount Allison University, were used to find

notes.fm Page 194 Friday, December 12, 2003 8:58 AM

194 Notes to pages 16–21

17 18 19 20

21 22

23 24 25 26

27 28

29 30 31 32

33 34

the women’s first names as well as information for both genders concerning age, occupation, and religion. Moncton Daily Times, 4 January 1895, 1. Moncton Daily Times, 8 January 1895. See Howell, “Elite Doctors and the Development of Scientific Medicine.” Stewart, Medicine in New Brunswick, 14. The development of organized medicine in early New Brunswick is examined in Mitham, “For ‘The Honor and Dignity of the Profession.› For a brief overview of hospital development in New Brunswick, see Province of New Brunswick Report of the Health Survey Committee 1951, 50–78, Bell Library, Mount Allison University. Howell, “Medical Professionalization,” 10–11. Stewart, Medicine in New Brunswick, 370. Dr Donald I. MacLellan has prepared a valuable “History of the Medical Staff” of the Moncton Hospital, mha, which contains a wealth of information concerning the hospital’s doctors. I used the manuscript version, which unfortunately lacked footnotes and pagination. This chronicle, virtually unchanged, has now been published: see MacLellan, History of the Moncton Hospital. As quoted in Allain, “Need for Health care was thorny debate,” 1. Stewart, Medicine in New Brunswick, 374. Moncton Daily Times, 10 August 1911, 8. As quoted in Moncton Daily Times, 5 January 1911, 3. For a discussion of the impact of asepsis and antisepsis on the development of surgery in the modern hospital, see Vogel, The Invention of the Modern Hospital, 60–1, and Rosen, A History of Public Health, 291–4. See Howell, “Medical Professionalization,” 12–13. As quoted in Moncton Daily Times, 5 January 1911, 3. To place McCully’s views concerning tuberculosis in the context of changing conceptions concerning its cure, see Katherine McCuaig, “Tuberculosis: The Changing Concepts of the Disease in Canada 1900–1950,” in Roland, ed., Health, Disease and Medicine, 296–307; McGinnis, “The White Plague in Calgary,” 1–15; and Conrad, Caring on the Grand. McCully’s views on tuberculosis treatment echoed those of the eminent William Osler, whose opinion is quoted in McCuaig, The Weariness, the Fever, and the Fret, 18. Moncton Daily Times, 11 April 1921, 1, 5; Stewart, Medicine in New Brunswick, 374. Grenfell’s activities are treated in Rompkey, Grenfell of Labrador. Moncton Daily Times, 11 April 1921, 1, 5. Whether hospital services should be publicly or privately financed became a contentious political issue during the late 1880s in Galt, according to Hagopian, “Debunking the Public Health Myth,” 49, 67. Moncton Daily Times, 14 January 1895. Ibid.

notes.fm Page 195 Friday, December 12, 2003 8:58 AM

195 Notes to pages 22–31 35 Moncton Daily Times, 26 January 1895, 1. 36 mha, Enid E. Barron, “A History of the Ladies Hospital Aid Association,” 1965; Moncton Daily Times, 11 June 1908, 1. 37 Moncton Daily Times, 26 January 1895, 1. 38 Moncton Daily Times, 7 February 1895. 39 Moncton Daily Times, 13 February 1895, 1. 40 See mha, “Act of Incorporation and Amending Acts of the Moncton Hospital Board.” 41 Moncton Daily Times, 2 April 1895. 42 Allain, “Need for Health care was thorny debate,” 1, offers an excellent discussion of the Jubilee activities. See also Moncton Daily Transcript, 7 May 1897, 8 May 1897, 11 May 1897, 17 May 1897, and 26 May 1897. 43 Moncton Daily Times, 15 February 1898, 1. 44 Moncton Daily Times, 16 February 1898, 1. 45 mm, Moncton Hospital File, “The Evolution of the Moncton Hospital,” The Atlantic News 1 (August 1927), 6; Moncton Daily Times, 22 February 1898, 23 February 1898, 21 April 1898. 46 mha, “Bye-Laws of the Moncton Hospital.” 47 Moncton Daily Times, 21 April 1898, 5 May 1898, 12 May 1898, 13 May 1898,8 June 1898, 9 June 1898, 10 June 1898, 11 June 1898. 48 The names were listed in Moncton Daily Times, 13 June 1898. 49 This description combines information from Moncton Daily Times, 13 June 1898, and mm, Moncton Hospital File, Souvenir Of The Moncton Hospital 1900, 9. 50 Moncton Daily Times, 13 June 1898. 51 Gagan, ‘A Necessity Among Us,’ 16. 52 McGee, The Victoria Public Hospital, 19. In an earlier time period and larger city, Halifax city council in 1855 voted £5,000 for the erection of a city hospital. See Howell, A Century of Care, 18. 53 See Rutherford, “Tomorrow’s Metropolis,” 439–40. Rutherford points out that in 1910, “after running its power and transport utilities for fifteen years, Moncton returned these facilities to a private company, apparently to save money.” 54 Moncton Daily Times, 13 June 1898. 55 Moncton Daily Times, 14 September 1909, 1. 56 Moncton Daily Times, 13 June 1898.

chapter two 1 Moncton Daily Times, 14 September 1909, 1. 2 Gagan, “For ‘Patients of Moderate Means,› 158. This study of the Owen Sound General and Marine Hospital, established in a community of 10,000 in 1893, provides a parallel to the Moncton Hospital.

notes.fm Page 196 Friday, December 12, 2003 8:58 AM

196 Notes to pages 33–6 3 See Moncton Daily Times, 13 July 1898; 8 June 1904, 2; 14 June 1906, 1; 13 June 1907, 1; 10 June 1909, 1; mm, Moncton Hospital File, Souvenir of the Moncton Hospital 1900. 4 See mha, “An Act to Amend Chapter 61, Acts of Assembly 58th Victoria,” 22 March 1901; “An Act Relating to ‘The Moncton Hospital,› 10 April 1902, and “An Act Further Relating to ‘The Moncton Hospital,› 9 May 1903. 5 Thernstrom, The Other Bostonians, 50–1, 289–93. 6 Moncton Daily Times, 11 June 1908, 1. 7 mha, Enid E. Barron, “A History of the Ladies Hospital Aid Association,” 1965, 1. 8 Occupational information and women’s names throughout are gathered from 1891 Census, Westmorland County, New Brunswick, Volume 1 and New Brunswick Census, 1901, Victoria Co., Westmorland Co., York Co., Micro 5655, Reel t-6445, in the Bell Collection, Mount Allison University. 9 Serving on the board were doctors Oscar J. McCully, James D. Ross, Ambrose R. Myers, Leveritt H. Price, Gaius T. Smith, Louis N. Bourque, Fred J. White, and James A. McNaughton. 10 mha, “Bye-Laws of the Moncton Hospital.” 11 MacLellan, History of the Moncton Hospital, 3. 12 McAlpine’s Moncton City Directory – 1898 (St John [1899]), 27, 29, 35, 39, 43, 57, 93, 102, 105, 109, 112–13, 121, lists fourteen physicians in Moncton, including the osteopath. 13 Flexner, Medical Education in the United States and Canada, 13. 14 See Howell, “Reform and the Monopolistic Impulse,” 13. 15 This breakdown slightly qualifies the observation of Weisz, “The Geographical Origins,” 105, that “[s]cattered anecdotal information on doctors in New Brunswick suggest that before 1890 doctors in that province were likely to obtain medical diplomas in the northeastern United States.” Figures concerning medical practitioners in rural British Columbia in 1898 reveal a quite different breakdown, with 59.3 per cent trained in Canada, 24.4 per cent in Great Britain, and only 14 per cent American-trained. See Norris, “The Country Doctor in British Columbia,” 29. 16 Flexner, introduction to Medical Education in the United States and Canada, x. 17 For comments on McGill’s standards and facilities, see Bliss, William Osler, 60–1. 18 Ludmerer, Learning to Heal, 3. See Bonner, Becoming a Physician, 9, for the contention that the weaknesses of nineteenth-century American medical schools may be “overstated.” 19 Ludmerer, Learning to Heal, 11–12. See also Ludmerer, “Reform at Harvard Medical School,” 343–70. For a different reading of the nature of the Harvard reforms, see Huddle, “Looking Backward,” 340–65.

notes.fm Page 197 Friday, December 12, 2003 8:58 AM

197 Notes to pages 36–9 20 Flexner, Medical Education in the United States and Canada, 325. See also Kett, “American and Canadian Medical Institutions,” 199; McPhedran, Canadian Medical Schools, 12–14. For the argument that Canadian medical schools did not have the “bad name” of their weaker American counterparts, and that reforms were well underway north of the border considerably before Flexner, see Gidney and Millar, “The Reorientation of Medical Education,” 52–78. 21 Flexner, Medical Education in the United States and Canada, 321. 22 Penney, ‹Marked For Slaughter,› 27. 23 Ludmerer, Learning to Heal, 112, 244. 24 Flexner, Medical Education in the United States and Canada, 293–4, 298– 300; Ludmerer, Learning to Heal, 112, 244. 25 Stewart, Medicine in New Brunswick, 370–8; MacLellan, History of the Moncton Hospital, 4–8. 26 See Ludmerer, Learning to Heal, 92, 146–7, 185. 72 Flexner, Medical Education in the United States and Canada, 269–70, 275–8. 28 Stewart, Medicine in New Brunswick, 374; Flexner, Medical Education in the United States and Canada, 325. 29 Frost, McGill University, 1:144; Sissons, A History of Victoria University, 125, 142; Flexner, Medical Education in the United States and Canada, 325; Kett, “American and Canadian Medical Institutions,” 196–8; Stewart, Medicine in New Brunswick, 372. 30 Stewart, Medicine in New Brunswick, 378; Flexner, Medical Education in the United States and Canada, 325. 31 Stewart, Medicine in New Brunswick, 377. 32 For differing views of Flexner’s contribution, see Hudson, “Abraham Flexner in Perspective,” 545–61, and Bonner, “Abraham Flexner and the Historians,” 3–10. 33 Moncton Daily Times, 2 September 1898. 34 Moncton Daily Times, 14 September 1899. 35 See Moncton Daily Times, 6 October 1898, 3 November 1898, 5 November 1898, 19 November 1898, 8 December 1898, 15 December 1898, 11 July 1899, and 15 July 1899. 36 Moncton Daily Times, 12 October 1899, 27 January 1900, 29 January 1900, 7 February 1900. 37 Moncton Daily Times, 12 October 1899, 10 August 1901. 38 Moncton Daily Times, 10 May 1900. 39 Moncton Daily Times, 14 June 1900; mm, Moncton Hospital File, Souvenir of the Moncton Hospital 1900. 40 Moncton Daily Times, 20 January 1903, 5; mm, Moncton Hospital File, “The Evolution of the Moncton Hospital” and “Moncton Hospital Opening,” The Atlantic News 1 (August 1927), 6 and 21.

notes.fm Page 198 Friday, December 12, 2003 8:58 AM

198 Notes to pages 39–44 41 Moncton Daily Times, 9 August 1901, 15 August 1901, and 20 January 1903, 5. 42 Moncton Daily Times, 9 February 1903, 3. 43 Moncton Daily Times, 24 February 1903, 8; Moncton Daily Times, 25 June 1903, 4. 44 What was possible in better placed and better endowed communities was revealed in the $1.2 million raised in 1906 in support of the Toronto General Hospital. The province, county, city, university, and medical faculty contributed $565,000 while wealthy donors such as George Cox, the estate of Hart Massey, and Cawthra Mulock each gave $100,000. Timothy Eaton, Edward Osler, and Joseph Flavelle each made contributions that were more than the total raised in Moncton. See Connor, Doing Good, 187. 45 Moncton Daily Times, 10 August 1901. 46 Moncton Daily Times, 20 January 1903, 5; Moncton Daily Times, 24 April 1903, 1; Moncton Daily Transcript, 10 November 1903, 1; Moncton Daily Transcript, 12 November 1903, 2. 47 All quotes are from the full-page coverage provided in Moncton Daily Transcript, 12 November 1903, 2. 48 Moncton Daily Transcript, 25 June 1901, 2. 49 Shortt, “The Canadian Hospital in the Nineteenth Century,” 5. 50 Howell, A Century of Care, 9, 114. 51 Cortuila, “Social Class and Health Care in a Community Institution,” 140–2. 52 Shortt, “The Canadian Hospital in the Nineteenth Century,” 9; Gagan, ‹For Patients of Moderate Means,” 158. Connor, Doing Good, 146, observes that 46 per cent of the Toronto General Hospital’s revenue in 1903 came from paying patients. 53 mha, “Bye-Laws of the Moncton Hospital.” 54 Ibid. 55 mm, Moncton Hospital File, Souvenir of the Moncton Hospital 1900, 15. 56 mha, “Report of the First Year’s Operations” for the Moncton Hospital, June 1899; Moncton Daily Times, 8 June 1904, 2; Moncton Daily Times, 10 June 1909, 1, 4. 57 Figures are taken from Canada, Dominion Bureau of Statistics, Seventh Census of Canada, 1931 Volume II Population By Areas, 35–6 and 38; Canada, Dominion Bureau of Statistics, Eighth Census of Canada 1941 Volume II Population by Local Subdivision, 5 and 9; Canada, Dominion Bureau of Statistics, Ninth Census of Canada 1951 Volume I Population, 2–1. 58 mha, “Report of the First Year’s Operations” for the Moncton Hospital, June 1899. 59 See appendices 1, 2, and 3 for a summary of patient numbers from 1919– 20 to 1953. These figures were gathered from the hospital’s annual reports and, when these were lacking, from annual Moncton Daily

notes.fm Page 199 Friday, December 12, 2003 8:58 AM

199 Notes to pages 45–52

60 61

62 63

64 65 66 67 68 69 70

71 72 73 74 75 76 77 78 79 80 81 82

Times reports on the hospital’s activities. These are the basis as well for figures 2 to 5. Rosner, A Once Charitable Enterprise, 86–9. panb, Moncton Research Notes and Papers, mc 624 ms 1a, armh 1911, 11. Excluded are 100 housewives, 60 no occupations, 30 schoolboys, 19 schoolgirls, and 2 students. Rosner, A Once Charitable Enterprise, 86. See Porter, The Greatest Benefit to Mankind, 370–4; Starr, The Social Transformation of American Medicine, 156–7. For the slower acceptance of “Listerism” in Canada, see Connor, “Listerism Unmasked,” 207–39. MacLellan, History of the Moncton Hospital, 9, 13, 20. Atwater, “Of Grandes Dames, Surgeons, and Hospitals,” 432–5. MacLellan, History of the Moncton Hospital, 20. panb, Moncton Research Notes and Papers, mc 624 ms 1a, armh 1911, 12; MacLellan, History of the Moncton Hospital, 8. See Stevens, ‹A Poor Sort of Memory,› 551–84; Stevens, “Sweet Charity,” 287–314, 474–95. Rosenberg, “Inward Vision and Outward Glance,” 348; Gagan, ‘A Necessity Among Us,’ 55. Public meetings of the hospital board were held in June of each year and detailed reports were reprinted in the press, from which these figures are largely drawn. See mha, “Report of the First Year’s Operations” for the Moncton Hospital, June 1899; mm, Moncton Hospital File, Souvenir of the Moncton Hospital 1900, 11, 13; Moncton Daily Times, 8 June 1904, 2; Moncton Daily Times, 14 June 1906, 1; Moncton Daily Times, 13 June 1907, 1; Moncton Daily Times, 11 June 1908, 1; Moncton Daily Times, 10 June 1909, 1, 4. Stevens, ‹A Poor Sort of Memory,› 558–9. Larracey, Resurgo: The History of Moncton 2:460–3. mm, Moncton Hospital File, Souvenir of the Moncton Hospital 1900, 8. Moncton Daily Times, 13 June 1907, 1. Moncton Daily Times, 6 January 1904, 3. Moncton Daily Times, 7 January 1904, 3. Moncton Daily Times, 30 January 1908, 1. Moncton Daily Times, 28 January 1909, 1. Moncton Daily Times, 30 January 1909, 2. Moncton Daily Times, 27 January 1910, 1, 5. Gautreau and Winans-Orr, The Life and Times, xxv. The division of medical staff into active and consultants that Connor, Doing Good, 143, outlines for the Toronto General Hospital was equally applicable at the Moncton Hospital. The active staff doctors handled the bulk of the public patients, as well as their own paying patients, while more senior doctors served as consultants, invited to major operations and offering advice in critical or special cases.

notes.fm Page 200 Friday, December 12, 2003 8:58 AM

200 Notes to pages 52–7 83 mha, Enid E. Barron, “A History of the Ladies Hospital Aid Association,” 1965, 1. 84 Moncton Daily Times, 28 February 1907, 1; 2 May 1907, 1. 85 Moncton Daily Times, 4 October 1909, 1. 86 Moncton Daily Times, 11 June 1908, 1. 87 Robinson had been elected and re-elected as a Westmorland mpp in 1897, 1899, 1903, 1907, and 1908, and briefly served as provincial premier in 1907–08. New BrunswickLegislative Library, Elections In New Brunswick, 1784–1984, 96–7, 100, 102; Doyle, Front Benches & Back Rooms, 18. 88 Moncton Daily Transcript, 12 September 1907, 4. 89 Moncton Daily Times, 14 September 1907, 1. 90 See Moncton Daily Times, 13 June 1907, 1; 14 June 1906, 1. 91 Moncton Daily Times, 14 September 1907, 1. 92 Moncton Daily Times, 21 September 1907, 1. 93 Moncton Daily Times, 24 September 1907, 1; 26 September 1907, 7. 94 Moncton Daily Times, 11 June 1908, 5. 95 MacLellan, History of the Moncton Hospital, 19. 96 See Angus, Kingston General Hospital, 91. 97 mm, Moncton Hospital File, Souvenir of the Moncton Hospital 1900, 11; Moncton Daily Times, 11 June 1908, 1. 98 Moncton Daily Times, 26 November 1909, 8. 99 Moncton Daily Times, 7 January 1910, 8. 100 Moncton Daily Times, 14 January 1895. For a discussion of the nursing situation prior to the creation of nursing schools, and evidence that the Moncton nursing school’s development closely matched the situation elsewhere, see Reverby, Ordered to Care, 11–90. A useful reassessment of nursing workers and their leaders is provided in Melosh, “The Physician’s Hand.” 101 Wotherspoon, “Training and Containing Nurses,” 380. 102 McPherson, “Skilled Service and Women’s Work,” 9. 103 Wotherspoon, “Training and Containing Nurses,” 380. 104 Moncton Daily Times, 8 June 1904, 2. 105 Moncton Daily Times, 14 June 1906, 1. 106 Moncton Daily Times, 13 June 1907, 1. 107 Moncton Daily Times, 11 June 1908, 1, 5; 13 January 1908, 8; 10 June 1909, 1, 4. 108 While no information is available concerning Dr L.C. Harris, the other new doctors named (Richard, Ferguson, Burgess, and MacNaughton) demonstrate a growing McGill dominance in terms of medical training. Richard received a B.A. from St Joseph’s College in 1895 and M.D.C.M. from McGill in 1900; Ferguson received his B.A. and M.D.C.M. from McGill in 1881 and 1884; MacNaughton graduated from McGill in 1901. Burgess revealed the old New York connection with a Bellevue Hospital

notes.fm Page 201 Friday, December 12, 2003 8:58 AM

201 Notes to pages 57–63

109 110 111 112

113 114 115 116 117

118 119

120 121

122

medical degree in 1891. See Stewart, Medicine in New Brunswick, 375–7 and 379; Moncton Transcript, 2 October 1935, 10. Moncton Daily Times, 10 June 1909, 4. See the excellent discussion of nursing training in McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 25–8. Moncton Daily Times, 10 June 1909, 4. Wotherspoon, “Training and Containing Nurses,” 380–1; McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 26. For useful reviews of nursing historiography, see James, “Writing and Rewriting Nursing History,” 568–84; D’Antonio, “Revisiting and Rethinking,” 268–90. As quoted in Howell, “Reform and the Monopolistic Impulse,” 20. McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 27–30. This applies to nurses the arguments concerning female teachers used by Guildford, ‹Separate Spheres› 141–3. McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 3–4. See Reverby’s assessment in Ordered to Care, 51, of physicians’ graduation speeches to nurses as “[e]ndless homilies about loyalty and paeans to the moral good of deference [which] sent the nursing student into her occupational world.” Moncton Daily Times, 14 September 1909, 1. For a review of the voluminous literature on Nightingale and a revision of her central role, see D’Antonio, “Florence Nightingale by Herself,” 278– 87, and Helmstadter, “Robert Bentley Todd,” 282–319. Moncton Daily Times, 5 January 1911, 3. McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 24–5. Even at the best of nursing schools, such as Johns Hopkins, survival in the face of very difficult conditions seemed the order of the day. See the concluding words of Douglas O. Baldwin in “Discipline, Obedience, and Female Support Groups”: “The women who survived this three-year trial owed their sanity to the camaraderie that the strict conditions forged amongst them.” Moncton Daily Times, 14 September 1909, 1, 4.

chapter three 1 Moncton Daily Times, 3 May 1919, 8. 2 These and the additional reasons yet to be mentioned are largely drawn from Vogel, The Invention of the Modern Hospital, 2–3; Rosner, A Once Charitable Enterprise, 4–5; Atwater, “Of Grandes Dames, Surgeons, and Hospitals,” 416.

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202 Notes to pages 63–8 3 Twelve Moncton physicians, including the excluded osteopath, Dr J.K. Ogle, were listed in Directory of Moncton City Town of Sunny Brae Villages of Humphreys Lewisville Leger Corner and Westmorland County 1919–20, 30, 34, 38, 47, 67, 72, 116, 126, 130, 135, 138, and 149. 4 Shortt, ‹Before the Age of Miracles,› 134. 5 Berger, “The Influence of the Automobile on Rural Health Care, 1900–29,” 327. 6 MacLellan, History of the Moncton Hospital, 20, 23, 25, 27. 7 See figure 1, p. 43. 8 Figures are gathered from the Moncton Daily Times reports on hospital activities and from the hospital’s annual reports. 9 The newspaper reports on the total hospital revenues have been adjusted in those few years where provincial government or county council grants were paid for two-year periods; these have been annualized for this analysis. See Moncton Daily Times, 15 June 1911, 1, 5, 8; 11 June 1914, 1, 4; 15 June 1916, 2, 8; 13 June 1918, 2, 8; 12 June 1919, 2, 8. By comparison, private patient fees as a percentage of annual income at the Owen Sound General and Marine Hospital soared to the same level as at the Moncton Hospital by 1919; patient fees were 60.8 per cent of annual income in 1910 and 73.3 per cent in 1919. See Gagan, ‘A Necessity Among Us,’ 31 and 64. 10 Moncton Daily Times, 15 June 1911, 1, 5, 8; 13 June 1912, 1, 8; 12 June 1913, 1, 3, 5; 11 June 1914, 1, 4; 10 June 1915, 3, 5; 15 June 1916, 2, 8; 14 June 1917, 2, 8; 13 June 1918, 2, 8; 12 June 1919, 2, 8. 11 panb, Moncton Municipal Records, rs 418 g2s1, rmh, 1965, 4; Moncton Daily Times, 15 June 1911, 1, 5, 8; 13 June 1918, 2, 8. 12 Moncton Daily Times, 10 June 1915, 3, 5. 13 Moncton Daily Times, 22 January 1914, 5. 14 Moncton Daily Times, 11 April 1918, 5. 15 panb, Moncton Research Notes and Papers, mc 624 ms 1d, W.B. Stewart, “The Early Days of the Moncton Hospital X-Ray Department,” March 1966, 1–3. For the development and impact of these “decisive new windows into the body,” see Porter, The Greatest Benefit to Mankind, 605–7. It was the late 1920s before “most Ontario hospitals” had x-ray facilities, according to Connor, “The Adoption and Effects of X-Rays in Ontario,” 98. 16 Moncton Daily Times, 10 June 1915, 3, 5; 13 June 1918, 2, 8. 17 Hamilton, “Tuberculosis in New Brunswick,” 2, 61, 102–3. For a similar reluctance in another province, see Baldwin, “Volunteers in Action,” 121–47. 18 Moncton Daily Times, 12 June 1913, 3; 10 June 1915, 8. 19 Moncton Daily Times, 20 January 1911, 1, 4. 20 Moncton Daily Times, 19 January 1912, 1, 4. 21 Moncton Daily Times, 24 January 1913, 1, 2; 22 July 1913, 7.

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203 Notes to pages 69–79 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

39 40 41 42 43 44

45 46 47 48 49 50 51 52 53

Moncton Daily Times, 23 July 1913, 1, 2. Moncton Daily Times, 22 January 1914, 1, 5. Moncton Daily Times, 21 January 1915, 1, 2. Moncton Daily Times, 28 July 1915, 1, 2; 20 January 1916, 1, 4. Moncton Daily Times, 11 June 1914, 1, 4; 10 June 1915, 3, 5. Moncton Daily Times, 11 June 1914, 4. Moncton Daily Times, 15 June 1911, 1, 5, 8; 13 June 1912, 1, 8. Moncton Daily Times, 28 July 1915, 1, 2. Moncton Daily Times, 20 January 1916, 1, 4. Moncton Daily Times, 22 January 1916, 2. Moncton Daily Times, 15 June 1916, 2. Moncton Daily Times, 26 July 1916, 2. Moncton Daily Times, 27 July 1916, 2. Moncton Daily Times, 27 July 1916, 2; 18 January 1917, 2. Moncton Daily Times, 25 July 1917, 2; 13 June 1918, 2, 8; 18 January 1918, 2. panb 48 – 1916/148, “Factum for Respondents,” 4. Sumner’s and Doyle’s replacements were reported in the Moncton Daily Times of 10 June 1915, 3, 5; the newspaper headlines quoted are from the Moncton Daily Times, 15 June 1916, 2, 8, and 14 June 1917, 2, 8. panb, rs 415 e2d1, Records of the Office of Premier Hugh John Flemming, 1952–1960, Francis P. Murphy to T. Babbitt Parlee, 17 February 1955. panb 48 – 1916/148, “Appellant’s Factum,” 5. Ibid., “Factum for Respondents,” 4–6. Moncton Daily Times, 15 June 1916, 2, 8; 22 June 1916, 5, 8. panb 48 – 1916/148, “Statement of Claim,” 1–5. Years later, Murphy recalled Robinson’s legislative intervention on his behalf. See panb, rs 415 e2d1, Records of the Office of Premier Hugh John Flemming, 1952–1960, Francis P. Murphy to T. Babbitt Parlee, 17 February 1955. panb, New Brunswick Acts 1917, “An Act consolidating and amending the Acts relating to ‘The Moncton Hospital,› 22 June 1917, 164–8. Moncton Daily Times, 14 June 1917, 2, 8. Moncton Daily Times, 13 June 1918, 2, 8; 12 June 1919, 2, 8. Sumner died a little over a year later, in November 1919. Moncton Daily Times, 31 May 1918, 7. Moncton Daily Times, 4 April 1911, 7; 10 August 1911, 8. Moncton Daily Times, 13 March 1911, 2. Moncton Daily Times, 13 June 1912, 1, 8. Moncton Daily Times, 12 June 1913, 1, 3, 5. Richard replaced Taylor as x-ray specialist and remained in that position for thirty years. Moncton Daily Times, 31 May 1918, 7. Standardization required considerably more than the changes mentioned in the press. The requirements, only

notes.fm Page 204 Friday, December 12, 2003 8:58 AM

204 Notes to pages 79–84

54

55 56 57 58

59 60 61 62 63 64 65 66 67 68

69 70 71 72 73 74 75 76 77 78 79

80

met by the Moncton Hospital in the 1920s, are outlined in Agnew, Canadian Hospitals, 1920–1970, 32–3, 251–2. This is a blend of names and information from Stewart, Medicine in New Brunswick 186, 357, 360, 366–7, 373, 378–9, and MacLellan, History of the Moncton Hospital, 23–4. MacLellan, History of the Moncton Hospital, 25. Moncton Daily Times, 13 June 1918, 2, 8. Moncton Daily Times, 13 October 1911, 7. Mitchinson, The Nature of their Bodies. This study discusses the emergence of medical obstetrics, 152–91. Among urban middle-class women in the U.S., on the other hand, it has been suggested that by the late 1920s “in some northern U.S. cities, it was unusual for a woman of ‘comfortable’ circumstances to deliver her baby at home.” See Borst, “Teaching Obstetrics at Home,” 224–5. Moncton Daily Times, 23 May 1912, 1. Moncton Daily Times, 3 June 1915, 8; 17 May 1917, 3; 29 March 1919, 2; 24 January 1920, 2. Moncton Daily Times, 18 May 1916, 2; 8 March 1919, 5. Moncton Daily Times, 27 March 1915, 8; 8 December 1915, 2. Riegler, “The Work and Networks of Jean I. Gunn,” 42; Gagan, ‘A Necessity Among Us,’ 51. Moncton Daily Times, 22 May 1919, 5. Gautreau and Winans-Orr, The Life and Times. McPherson, Bedside Matters, 26. Riegler, “The Work and Networks of Jean I. Gunn,” 188–9. Moncton Daily Times, 12 June 1913, 1, 3, 5; 11 June 1914, 1, 4; 10 June 1915, 3, 5; 15 June 1916, 2, 8; 13 June 1918, 2, 8. For a glimpse of the difficulties in work and living conditions at a sister institution, which caused the loss of some aspiring nurses, see McGee, The Victoria Public Hospital, 46–8. Moncton Daily Times, 12 June 1913, 1, 3, 5; 13 June 1918, 2, 8. McPherson, Bedside Matters, 30. Moncton Daily Times, 15 June 1916, 2, 8. MacLellan, History of the Moncton Hospital, 25–7. Moncton Daily Times, 7 April 1916, 6. McPherson, Bedside Matters, 31. Moncton Daily Times, 31 May 1918, 7. Moncton Daily Times, 10 April 1919, 5. These figures are found in McPherson, Bedside Matters, 48 and 52. Ibid, 26, 53. Moncton Daily Times, 15 June 1911, 5; 22 December 1911, 1; 11 January 1912, 7; 24 February 1912, 7; 5 June 1915, 8; 3 December 1915, 8; 25 January 1916, 8; 12 February 1918, 8. mm, Moncton Hospital File, “Administrators of the Moncton Hospital.”

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205 Notes to pages 84–93 81 Moncton Daily Times, 21 March 1918, 8; 11 April 1918, 5; 19 April 1918, 2, 8; 17 June 1918, 8. 82 mm, Moncton Hospital File, “Administrators of the Moncton Hospital.” 83 Moncton Daily Times, 15 May 1919, 5; 9 January 1919, 5; 31 May 1918, 7. 84 Moncton Daily Times, 15 May 1919, 5. 85 As quoted in Gautreau and Winans-Orr, The Life and Times, 5. 86 Moncton Daily Times, 10 July 1919, 7. 87 Moncton Daily Times, 11 September 1919, 7; Gautreau and Winans-Orr, The Life and Times, 4. 88 White, “Who’s in Charge Here?,” 109–11. 89 See Reverby, Ordered to Care, 106–7. 90 See Starr, The Social Transformation of American Medicine, 178–9. 91 Moncton Daily Times, 13 June 1918, 8. 92 See LeBlanc, “Moncton, 1870–1937,” 32 and 170. 93 Moncton Daily Times, 21 April 1911, 7; 22 April 1911, 7; 19 May 1911, 1; 21 July 1911, 7; 14 September 1911, 8; 9 May 1912, 7; 15 August 1912, 8; 4 October 1912, 1. 94 Moncton Daily Times, 10 October 1912, 1; 24 October 1912, 8; 5 May 1911, 8;29 November 1915, 8; 8 December 1915, 2. 95 Moncton Daily Times, 10 May 1917, 2, 8. 96 Moncton Daily Times, 19 April 1919, 5. 97 Moncton Daily Times, 12 June 1919, 2, 8. 98 Moncton Daily Times, 3 May 1919, 8. 99 Moncton Daily Times, 24 January 1919, 5. 100 Doyle, Front Benches & Back Rooms, 126–34, 141. 101 Moncton Daily Times, 11 April 1918, 5. 102 J.W. Loggie, “New Brunswick of Today From a Public Health Standpoint,” The Canadian Hospital 12 (November 1935), 14–15; Heagerty, Four Centuries of Medical History in Canada 1:362–3. See also Sturgeon, Health Care in New Brunswick, 9. 103 Larracey, Resurgo: The History of Moncton 2:463. 104 Moncton Daily Times, 10 April 1919, 8. 105 Moncton Daily Times, 9 January 1919, 5. 106 Moncton Daily Times, 13 March 1919, 2. 107 Moncton Daily Times, 15 March 1919, 6. 108 Moncton Daily Times, 10 April 1919, 5, 8. 109 Moncton Daily Times, 5 February 1920, 5.

chapter four 1 mha, rmh 1940, 26–7. 2 Excellent syntheses concerning the interwar period in the Maritimes are provided by Frank, “The 1920s: Class and Region, Resistance and Accommodation,” and Forbes, “The 1930s: Depression and Retrenchment.”

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206 Notes to pages 94–100 3 See fig. 1, p. 43. 4 This transformation is discussed in McCann, “Metropolitanism and Branch Businesses,” 124–5; and throughout LeBlanc, “Moncton, 1870–1937.” 5 LeBlanc, “Moncton, 1870–1937,” 161–2, 170. 6 McCann, “Metropolitanism and Branch Businesses,” 124; Larracey, Resurgo: The History of Moncton 2:293. 7 See LeBlanc, “Moncton, 1870–1937,” 194–6. 8 mha, Ruth Duffey, “Hospital Care in the Moncton Area, 1895–1982,” 9– 11; Bourque, Rêves de visionnaires, 30–1, 37–47; Côté, “L’Implication des Soeurs de la Providence,” 54–5. 9 See figure 2, p. 44, and appendices 1, 2, and 3. 10 At the Kingston General Hospital, the number of patients using public wards increased from 43 per cent in 1929 to over 63 per cent in 1934. See Angus, Kingston General Hospital, 118. 11 See “Bed Occupancy in Canadian Hospitals during 1931,” The Canadian Hospital 9 (October 1932), 12–13, 30. 12 mha, “Bye-Laws of the Moncton Hospital.” 13 Moncton Daily Times, 22 January 1914, 5; 11 April 1918, 5. 14 mha, armh 1924, 9. Only a few public ward occupants opted to pay. 15 “A Tour through the Moncton Hospital,” The Busy East 21 (July 1931), 4–8. 16 mha, rmh 1932, 8. 17 “Facts You Should Know About the Moncton Hospital,” The Busy East 21 (July 1931), 13. 18 “Rates and Index Numbers of Hospital Charges throughout Canada,” The Canadian Hospital 8 (May 1931), 16. 19 Gagan, ‘A Necessity Among Us,’ 61–2; Gagan, “For ‘Patients of Moderate Means,” 164. 20 See “Hospitals Handicapped By Meager Grants,” The Canadian Hospital 4 (November 1927), 11–12; Angus, Kingston General Hospital, 117. 21 “Grants to the Hospitals of Ontario to Remain the Same,” The Canadian Hospital 9 (April 1932), 14. 22 panb, Records of the Deputy Minister of Health, rs 136 h4, “General Hospitals, New Brunswick Year 1927,” 28 February 1929. 23 mha, armh 1930, 18. 24 See panb, Records of the Deputy Minister of Health, rs 136 n1c, “New Brunswick” (chc 1932–5), Response to questions from the Canadian Hospital Council. 25 panb, New Brunswick Acts 1923, “The Public Hospitals Act, 1923,” 14 April 1923, 54–8. 26 “New Brunswick Introduces New Hospital Legislation,” The Canadian Hospital 8 (June 1931), 25. 27 “Comparative Statistics of Ontario Hospitals,” The Canadian Hospital 5 (February 1928), 30.

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207 Notes to pages 100–7 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

46 47 48 49 50 51

52 53 54 55

Gagan, ‘A Necessity Among Us,’ 80. See Gautreau and Winans-Orr, The Life and Times, 5. Moncton Daily Times, 13 May 1919, 4. Larracey, Resurgo: The History of Moncton 2:204, 212–13. See Moncton Daily Times, 5 March 1921, 5. mha, armh 1920, 34. Moncton Daily Times, 13 May 1920, 5. The press reported a $3,000 down payment but it was eventually raised to $4,000. Moncton Daily Times, 5 March 1921, 5. Moncton Daily Times, 14 April 1921, 8; 5 March 1921, 5. Moncton Daily Times, 1 November 1920, 8. Moncton Daily Times, 19 May 1921, 5; 16 August 1921, 8. Moncton Daily Times, 15 September 1921, 8. Moncton Daily Times, 22 October 1921, 5. Moncton Daily Times, 15 December 1921, 3. Moncton Daily Times, 4 August 1920, 5. Moncton Daily Times, 29 September 1920, 1. Moncton Daily Times, 22 January 1921, 1; 15 December 1921, 1, 3. panb, New Brunswick Acts 1923, “An Act to enable the Trustees of the Moncton Hospital to issue Debentures,” 14 April 1923, 263–5; “An Act to authorize the City of Moncton to Guarantee Certain Debentures to be issued by the Moncton Hospital,” 10 April 1923, 271–3. mha, armh 1924, 27–8. Moncton Daily Times, 9 September 1920, 8. mha, armh 1924, 9. panb, Moncton Municipal Records, rs 418 g2b1, A.J. MacMaster to A.C. Chapman, 19 January 1926. mha, armh 1928, 24. Moncton Daily Times, 10 November 1921, 8; panb, Moncton Municipal Records, rs 418 g2b1, A.J. MacMaster to A.C. Chapman, 19 January 1926. mha, armh 1928, 23. MacLellan, History of the Moncton Hospital, 33. mha, armh 1925, 17. mha: armh 1924, 21–2; rmh 1939, 32–3; armh, 1930, 24–5. In 1936, New Brunswick was second from the bottom among provinces in hospital live births, at 18.6 per cent of its births, compared to the national average of 35.9 per cent, while in 1940, because of the number of births still occurring outside of hospitals, New Brunswick led the nation with an infant mortality rate of eighty per 1,000 live births. See “Interesting New Statistics on Canadian Hospitals,” The Canadian Hospital 15 (May 1938), 30; Taylor, Health Insurance and Canadian Public Policy, 5. For additional information on hospital birthing patterns, see Strong-Boag and

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208 Notes to pages 107–11

56 57 58 59 60 61 62

63 64 65 66 67 68

69

70

McPherson, “The Confinement of Women,” 142–74; Smith and Nickel, “From Home to Hospital,” 49–64; Oppenheimer, “Childbirth in Ontario,” 36–60. mha: armh 1925, 16–17; armh 1928, 24–5. Moncton Daily Times, 11 November 1920, 5; 10 November 1921, 8. Standardization requirements are discussed in Gagan, ‘A Necessity Among Us,’ 70–1; Agnew, Canadian Hospitals, 1920 to 1970, 32–3, 251–2. Moncton Daily Times, 9 June 1921, 2. MacLellan, History of the Moncton Hospital, 30. mha, armh 1928, 22–7. The debentures could be up to thirty years but eventually were issued for twenty years. See panb, New Brunswick Acts 1927, “An Act to authorize the City of Moncton to guarantee certain debentures to be issued by the Moncton Hospital,” 21 April 1927, 307–10; “An Act to enable the trustees of the Moncton Hospital to issue debentures,” 20 April 1927, 310–312. “A Brief History of the Moncton Hospital,” The Busy East 21 (July 1931), 15. See Moncton Hospital File, The Atlantic News 1 (August 1927), specifically “Questions And Answers?” 32–3. Moncton Daily Times, 19 September 1927, 3; 20 September 1927, 3. Moncton Daily Times, 14 September 1927, 5; 13 September 1927, 8. See Moncton Daily Times, 10 September 1927, 8; 15 September 1927, 8; 28 September 1927, 8; 1 October 1927, 8. “A Brief History of the Moncton Hospital,” The Busy East 21 (July 1931), 15. Admittedly, $20,000 of the $74,000 came in one donation from the Canadian National Railways. Bourque, Rêves de visionnaires, 45, reports that Hôtel-Dieu’s 1927 campaign produced $40,000 out of the anticipated $50,000 target. Once again, the debentures could be up to thirty years but were issued for twenty years. See New Brunswick Acts 1929, “An Act to Authorize the City of Moncton to Guarantee Debentures to be issued by the Moncton Hospital,” 25 March 1929, 373–6; New Brunswick Acts 1930, “An Act to Enable the Moncton Hospital to Issue Debentures,” 1 April 1930, 243–4, and “An Act to Authorize the City of Moncton to Guarantee Debentures to be Issued by the Moncton Hospital,” 10 April 1930, 245–7; New Brunswick Acts 1931, “An Act to Enable the Moncton Hospital to Issue Debentures,” 13 March 1931, 226–7, and “An Act to Authorize the City of Moncton to Guarantee Debentures to be issued by the Moncton Hospital,” 13 March 1931, 228–31, all panb. This is a $40,000 upward adjustment to the figures given in “Facts You Should Know About the Moncton Hospital,” The Busy East 21 (July 1931), 12–13, since these figures did not include the $40,000 debenture issue approved in March 1931.

notes.fm Page 209 Friday, December 12, 2003 8:58 AM

209 Notes to pages 111–18 71 Moncton Daily Times, 27 October 1930, 4, 9–20. See Adams, “Modernism and Medicine,” 42–61, for a study of how many hospitals’ “modern” buildings were designed by this firm, which had a virtual monopoly on Canadian hospitals at this time. 72 This detailed tour was later republished, with additional and updated material, in “A Tour through the Moncton Hospital,” The Busy East 21 (July 1931), 4–8. The above description draws at times from The Busy East as well as the Moncton Daily Times, 27 October 1930, 9–20. 73 Moncton Daily Times, 29 October 1930, 1, 3. 74 mha, armh 1930, 21–2. 75 mha: armh 1925, 20; armh 1930, 24–5; rmh 1940, 27. 76 “Facts You Should Know About the Moncton Hospital,” The Busy East 21 (July 1931), 3, 13. 77 mha: armh 1930, 18; rmh 1933, 14–15; rmh 1934, 14–15; rmh 1935, 19. 78 See Lemon, “Public Relief Policy in Moncton.” 79 See panb, Moncton Municipal Records, rs 418 a1, Micro f 399, Minutes of Moncton City Council Meeting, 23 February 1931. 80 mha, rmh 1933, 14–15; rmh 1935, 19. 81 mha, armh 1925, 25–6; rmh 1935, 19; rmh 1939, 21. 82 See “Hospitals and Municipalities,” The Canadian Hospital 13 (October 1936), 52; Harvey Agnew, “A Study of Hospital Legislation in Canada,” The Canadian Hospital 11 (January 1934), 8. 83 Harvey Agnew, “A Study of Hospital Legislation in Canada,” The Canadian Hospital 11 (January 1934), 8–9. 84 “Per Diem Allowance in New Brunswick Would Benefit Hospitals,” The Canadian Hospital 12 (October 1935), 20–1. 85 panb, Records of the Deputy Minister of Health, rs 136 h4, “New Brunswick Hospitals 1939 – General,” 3 December 1940. Moncton Hospital continued to receive a $1,500 grant, as did Hôtel-Dieu. 86 mha, rmh 1932, 9. 87 mha, rmh 1932, 23; rmh 1935, 25–6. 88 mha, rmh 1932, 25. 89 As quoted in MacLellan, History of the Moncton Hospital, 52. 90 mha, rmh 1935, 27. 91 See Harvey Agnew, “An Observer Looks at Group Hospitalization,” The Canadian Hospital 15 (February 1938), 13. 92 See panb, New Brunswick Acts 1939, “An Act to Incorporate ‘The Group Hospitalization Service Commission of the Moncton Hospital and Hotel Dieu De l’Assomption,” 6 April 1939, 226–8. 93 mha, rmh 1940, 29. 94 mha, rmh 1935, 25. 95 panb, Moncton Municipal Records, rs 418 g2b1, A.C. Chapman to City Clerk Lt. Col. L.T. Tingley, 13 March 1936.

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210 Notes to pages 119–26 96 Moncton Daily Times, 9 June 1921, 2; 15 July 1920, 5; 14 April 1921, 8. 97 mha: armh 1930, 13; rmh 1940, 11. 98 These board stalwarts included A. Cavour Chapman, Reid McManus, F.W.S. Colpitts, Dr Henry H. Coleman, Allie E. McSweeney, Hugh Stewart, George A. Robinson, A.W. Jamieson, Bliss A. Bourgeois, George A. Spencer, Ambrose Wheeler, Ella W. White, R.H. Bannon, Margaret Givan, Fred M. Brown, W. Bliss Logan, J.A. Godfrey, C.S.G. Rogers, and Janet Ferguson. This list is provided in Gautreau and Winans-Orr, The Life and Times, 15–16. 99 Moncton Daily Times, 10 June 1920, 5; 16 June 1921, 8; mha, rmh 1936, 11; Gautreau and Winans-Orr, The Life and Times, 16. 100 These non-executive board members were R.H. Bannon, Norman Sinclair, Reid McManus, S. Boyd Anderson, Hugh M. Stewart, George O. Spencer, F.W.S. Colpitts, Fred M. Brown, William F. Lane, Walter S. Chapman, Henry H. Coleman, A.W. Jamieson, Fred W. Copeland, Bradley W. Cummings, Mrs (E.W.) Margaret Givan and Mrs (F.J.) Ella W. White. Information gathered from mha, armh 1930, 13; “Thumbnail Sketches of Members of the Moncton Hospital Board,” The Busy East 21 (July 1931), 25–9; Larracey, Resurgo: A History of Moncton 2:167, 213, 222–3, 245; Belliveau, The Monctonians, 68, 78–9; LeBlanc, “Moncton, 1870–1937,” 162–3; Moncton Daily Times, 31 December 1929, 8. 101 The list of shareholders is contained in LeBlanc, “Moncton, 1870–1937,” 163. 102 mha, armh 1920, 4–5. 103 mha, rmh 1940, 12–15. 104 Weisz, “The Geographical Origins,” 105–6, points out that the number of Maritimers enrolled in the McGill medical school peaked in the 1890s and sharply declined in the late 1920s. 105 This information is gathered from mha, armh 1930, 14–15 and rmh 1940, 12–13; “Members of the Medical Staff,” The Busy East 21 (July 1931), 23–4; MacLellan, History of the Moncton Hospital, 44–5, 47, 49, 53, 56, 59–62. 106 Moncton Daily Times, 14 April 1921, 2, 8; 14 July 1921, 7. 107 mha, armh 1930, 23. 108 MacLellan, History of the Moncton Hospital, 56–7; mha, rmh 1933, 23. 109 MacLellan, History of the Moncton Hospital, 56–9. 110 Moncton Daily Times, 14 May 1919, 8. 111 Moncton Daily Times, 11 April 1921, 1, 5. 112 Moncton Transcript, 2 October 1935, 10. See also the tribute by Alena J. MacMaster in rmh 1935, 27, mha. 113 See photograph in Stewart, Medicine in New Brunswick, 343. 114 MacLellan, History of the Moncton Hospital, 44.

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211 Notes to pages 127–31 115 Moncton Daily Times, 9 June 1921, 2; MacMaster, “The Training School for Nurses,” 12. 116 mha, armh 1920, 7–8. 117 Moncton Daily Times, 13 October 1921, 5. 118 mha, armh 1925, 14. Nineteen additional sleeping rooms for student nurses were added in this expansion. 119 mha, armh 1930, 27–8; rmh 1940, 39. 120 See McPherson, Bedside Matters, 115–63. 121 McPherson, “Skilled Service and Women’s Work,” 103. 122 mha, armh 1930, 27. 123 McPherson, Bedside Matters, 115–63, deals with these problems thoroughly and convincingly. Throughout the 1920s and 1930s, in addition to their free room and board, student nurses at the Moncton Hospital were paid a monthly allowance of $8 in their first year, $12 in the second, and $15 in the third. See MacMaster, “The Training School for Nurses,” 11. 124 Chapter 4 of Gautreau and Winans-Orr, The Life and Times, 51–78, examines MacMaster’s local, provincial, and national activities. For a discussion of the growing professionalization of nursing, see Kinnear, “The Professionalization of Canadian Nursing, 1924–32,” 153–74. 125 mha, armh 1925, 14; armh 1930, 27. 126 See Gautreau and Winans-Orr, The Life and Times, 61–5. 127 See McPherson, Bedside Matters, 160. Reverby, Ordered to Care, 180, argues that this ‹great transformation’ from private duty to hospital staffing” occurred during the Depression. 128 mha, rmh 1940, 39. 129 See McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 108. This was also the case in Newfoundland. See White, “Who’s in Charge Here?”, 102. Beattie, Obligation and Opportunity, 88, documents the attraction of American nursing schools to Maritime women: one-third of the women entering Boston’s nursing schools from 1900 to 1939 were Maritimers. 130 See mha, armh 1930, 44–6; McPherson, “Nurses and Nursing in Early Twentieth-Century Halifax,” 24; McGee, The Victoria Public Hospital, 117–19. 131 See McPherson, Bedside Matters, 128; mha, armh 1930, 44–6. 132 MacMaster, “The Training School for Nurses,” 10. 133 mha, armh 1920, 6. 134 Gautreau and Winans-Orr, The Life and Times, 28. 135 mha: armh 1930, 28; rmh 1932, 35, 37; Gautreau and Winans-Orr, The Life and Times, 32. 136 mha, armh 1924, 16; Gautreau and Winans-Orr, The Life and Times, 33. 137 Gautreau and Winans-Orr, The Life and Times, 32, 106–7; mha, rmh 1935, 38.

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212 Notes to pages 131–50 138 139 140 141 142 143 144

mha, rmh 1932, 38; Gautreau and Winans-Orr, The Life and Times, 33. MacMaster, “The Training School for Nurses,” 11. Gautreau and Winans-Orr, The Life and Times, 29–30, 44–7. mha, rmh 1935, 35. See Riegler, “The Work and Networks of Jean I. Gunn,” 399–400, 456–7. mha, rmh 1940, 40–1. As quoted in MacLellan, History of the Moncton Hospital, 57–8.

chapter five 1 2 3 4

5 6 7

8 9 10 11 12

13

14 15 16 17

18 19

Moncton Transcript, 21 July 1953, 4. Larracey, Resurgo: The History of Moncton 2:327, 332–3. Stewart, Medicine in New Brunswick, 191. All figures are taken from Canada, Dominion Bureau of Statistics, Ninth Census of Canada 1951 Volume 1 Population, 2–1, 3–1, 56–3, 56–5, 57–5. See appendix 3. Bourque, Rêves de visionnaires, 94. “New Memorial Hospital Opened at Sackville,” The Canadian Hospital 23 (November 1946), 36–7. Sears and McKay, eds., This is Sackville, n.p. These two sources differ in the opening date and size; The Canadian Hospital is correct. MacLellan, History of the Moncton Hospital, 70, and 73. See figure 2, p. 44. See figures 3 and 4, p. 96. “What is a Public Ward?” The Canadian Hospital 26 (September 1949), 29. See “Enthusiasm for Blue Cross Keynote of Maritime Conference,” The Canadian Hospital 21 (July 1944), 31–4; “Blue Cross is Keynote of Maritime Hospital Meeting,” The Canadian Hospital 22 (July 1945), 41–2. Under the original Maritime Hospital Service Association contract, a subscriber, wife, and children under seventeen years received ward care for a $1 a month premium and semi-private care coverage at $1.50 per month. See Pincombe, 40 years under the Blue, 9. mha, rmh 1945, 32. See Pincombe, 40 Years under the Blue, 12, 44–5. See figure 4, p. 96. Pincombe, 40 Years under the Blue, 55; Province of New Brunswick Report of the Health Survey Committee 1951, 70, Bell Library, Mount Allison University. Taylor, Health Insurance and Canadian Public Policy, 108, 171. “Changing Concepts of Health Care,” The Canadian Hospital 19 (May 1942), 24.

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213 Notes to pages 150–2 20 Ibid., “Three in Four Favour Health Insurance,” 36. 21 Taylor, Health Insurance and Canadian Public Policy, 166; Naylor, Private Practice, Public Payment, 158. 22 “Health Insurance a Step Nearer,” The Canadian Hospital 20 (April 1943), 26. 23 See Taylor, Health Insurance and Canadian Public Policy, 1–68. 24 See “Health Insurance Program Announced by the Federal Government,” The Canadian Hospital 25 (June 1948), 27–8; panb, Records of the Office of Premier John B. McNair, rs 414 e2f, “Summary of Proposed Dominion Grants and Contributions” in R.B. FitzRandolph to J.J. Hayes Doone, 15 September 1948; Taylor, Health Insurance and Canadian Public Policy, 163–4; Naylor, Private Practice, Public Payment, 152–3. 25 The “rather well off” position of the New Brunswick government in the post-war reconstruction period is analysed in Young, ‹and the people will sink into despair,› 127–66. 26 “N.B. Doctors Present Views on Health Programme,” The Canadian Hospital 23 (January 1946), 72. 27 “New Brunswick Increases Financial Aid to Hospitals,” The Canadian Hospital 24 (May 1947), 50. 28 panb, Records of the Office of Premier John B. McNair, rs 414 e2c1, R.J. Dolan to C.R. McElman, 29 July 1952. 29 Ibid., F.A. McGrand to J.B. McNair, 5 January 1948. 30 This outspoken critic was Dr Donald F. Porter, soon to resign from government and become executive director of the Moncton Hospital. See “A Provincial Official Expresses His View,” The Canadian Hospital 26 (June 1949), 27–8. 31 See Young, ‹and the people will sink into despair,› 157–8. 32 See figure 5, p. 97. 33 See mha, rmh 1948, 16, 31. 34 mha, rmh 1940, 8, 28. 35 panb, Moncton Municipal Records, rs 418 g2b2, Leonard Lockhart to Moncton City Council, 11 September 1948; “New Brunswick,” The Canadian Hospital 29 (January 1952), 62. 36 mha: rmh 1940, 21; rmh 1953, 31. 37 panb, Moncton Municipal Records, rs 418 g2b2, Leonard Lockhart to Moncton City Council, 11 September 1948. 38 panb, Records of the Deputy Minister of Health, rs 136, Transfer Case #8, “Brief Presented to the Executive Council of the Province of New Brunswick by the New Brunswick Section of the Maritime Hospital Association,” 7 July 1954. Porter served as chairman of the committee that prepared this brief. For the same sort of explanation at the national level, see “Hospitals Being Forced to Increase Rates Again,” The Canadian Hospital 25 (April 1948), 40–1; Hornal, “Hospital Finance – the Changing Picture,” 38.

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214 Notes to pages 153–6 39 Hornal, “Hospital Finance – the Changing Picture,” 38–9. 40 panb, Records of the Deputy Minister of Health, rs 136, Transfer Case #8, “Brief Presented to the Executive Council of the Province of New Brunswick by the New Brunswick Section of the Maritime Hospital Association,” 7 July 1954. 41 mha, rmh 1939, 33. 42 See Hornal, “Hospital Finance – the Changing Picture,” 38. 43 See Taylor, Health Insurance and Canadian Public Policy, 111–12. 44 In 1945 the provincial grant was $1,500, Moncton provided $28,704.40, Westmorland county $3,743, Albert county $862.50, and other muncipalities $724.15, for a total of $35,534.05 out of total hospital revenues of $271,804.60. In 1953 the provincial grant was $28,620.50, municipalities (which probably referred to Moncton and Westmorland county) provided $23,337.33, while Moncton and Westmorland bond interest plus a small Albert county payment provided $35,871.45, for a total of $87,829.28 out of total hospital revenue of $717,992.84. See rmh 1945, 20, and rmh 1953, 24–5, both mha. 45 Substantially higher Ontario per diem payments explain the gap, although Ontario’s payments were more restricted. The Ontario provincial government in 1954 paid $2.35 per day for each patient in a public ward bed (whether indigent or paying) and a further $1.95 per diem for each indigent patient. In addition, Ontario municipalities paid $6 per day for indigents in their hospitals. See Taylor, Health Insurance and Canadian Public Policy, 111–12. 46 For a brief summary of Swanson’s contributions to hospital development in Ontario, see Agnew, Canadian Hospitals, 1920 to 1970, 88–9. 47 panb, Moncton Municipal Records, rs 418 g2f1, A.J. Swanson, “Survey of Hospital Facilities and Proposed Extension of the Moncton Hospital,” April 1945, 3–4. 48 See Gagan, ‘A Necessity Among Us,’ 137. 49 panb, Moncton Municipal Records, rs 418 g2f1, A.J. Swanson, “Survey of Hospital Facilities and Proposed Extension of the Moncton Hospital,” April 1945, 3. 50 panb, New Brunswick Acts 1945, “An Act to enable the Moncton Hospital to issue Debentures,” 7 April 1945, 244–6; “An Act to authorize the City of Moncton to guarantee debentures to be issued by the Moncton Hospital,” 7 April 1945, 247–9. 51 See mha, “Moncton Hospital Proposed Extensions Report of SubCommittee,” 10 May 1945. 52 mha, Meeting of Special Building Committee of Moncton Hospital, 12 February 1946. 53 Following the death of A. Cavour Chapman in 1943, Ambrose Wheeler became chairman of the hospital board and served until his resignation/replacement in 1947.

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215 Notes to pages 157–63 54 All quotes are from mha, Meeting of Special Building Committee of Moncton Hospital, 12 February 1946. 55 panb, Moncton Municipal Records, rs 418 g2d1, Minutes of Moncton Hospital Board of Trustees Meeting, 15 August 1946. 56 See Larracey, Resurgo: The History of Moncton 2:332, 351. 57 See mha: “Summary of [Architect’s?] Interview with Miss MacMaster,” 22 October 1946; “Report re. Studies for Moncton Hospital,” by Govan, Ferguson and Lindsay, 7 January 1947; Harry J. Crudge to George O. Spencer, 23 January 1947. 58 mha, Harry J. Crudge to George O. Spencer, 23 January 1947. 59 This meeting and debate are reported in Moncton Daily Times, 13 February 1947, 2. 60 See Moncton Daily Times, 6 February 1947, 2; 12 February 1947, 2. 61 Moncton Daily Times, 19 February 1947, 2. 62 Moncton Daily Times, 22 February 1947, 2. At the same time, Mayor G.F.G. Bridges announced that he would not be a candidate. 63 MacBeath was a veteran Main Street merchant who, while offering this donation, still retained a large tract of land in the area that he developed as a residential subdivision. See Larracey, Resurgo: The History of Moncton, 2:352. 64 All quotations are from mha, “A Special Meeting of the Hospital Board of Trustees in conjunction with the Special Building committee,” 24 February 1947. 65 Ibid. See also Moncton Daily Times, 25 February 1947, 2. 66 Moncton Daily Times, 26 February 1947, 2. 67 Moncton Daily Times, 13 March 1947, 2. 68 Moncton Daily Times, 9 April 1947, 2; panb, New Brunswick Acts 1947, “An Act to authorize the City of Moncton to Guarantee Debentures to be issued by the Moncton Hospital,” 25 April 1947, 465–8; “An Act to amend An Act Consolidating and Amending the Acts Relating to the Moncton Hospital,” 25 April 1947, 469–75; “An Act to enable the Moncton Hospital to issue Debentures,” 25 April 1947, 475–8. The new Hospital Act had all eleven hospital board members appointed by Moncton city council, two of whom were to be members of city council while the other nine, including the chairman, were to be non-council members. 69 Gautreau and Winans-Orr, The Life and Times, 92–3; Moncton Daily Times, 20 May 1947, 2. 70 See newspaper clippings in mha, J.E. Murphy Scrapbook; Moncton Daily Times, 14 May 1947, 2, and 15 May 1947, 2. 71 As quoted in Gautreau and Winans-Orr, The Life and Times, 93. See also 94–7. 72 mha, Leonard Lockhart to Mayor and Aldermen Elect, 11 April 1949. 73 panb, Moncton Municipal Records, rs 418 g2b1, Leonard Lockhart to City Council, 7 August 1947; rs 418 g2b2, John C. MacKenzie, “Report on Survey of the Moncton Hospital, Moncton, N.B.,” 1947, 14.

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216 Notes to pages 163–5 74 panb, Moncton Municipal Records, rs 418 g2b1, Leonard Lockhart to City Council, 7 August 1947. 75 mha, Leonard Lockhart to Moncton Mayor and Aldermen Elect, 11 April 1949; panb, Records of the Deputy Minister of Health, rs 136 e14a, Leonard Lockhart to A.D. Ganong, 18 July 1949. 76 panb, Records of the Deputy Minister of Health, rs 136 e14a, Leonard Lockhart to A.D. Ganong, 18 July 1949. 77 This was approved by the New Brunswick legislature in April of 1948. See panb, New Brunswick Acts 1948, “An Act to authorize the City of Moncton to Guarantee Debentures to be issued by the Moncton Hospital,” 9 April 1948, 420–4. 78 These are Leonard Lockhart’s words describing Swanson’s position. See mha, Leonard Lockhart to Moncton Mayor and Aldermen Elect, 11 April 1949. 79 panb, Moncton Municipal Records, rs 418 g2f2, Leonard Lockhart to L.T. Tingley (City Clerk and Treasurer), 7 May 1948. 80 See panb, New Brunswick Acts 1948, “An Act to authorize the Municipality of the County of Westmorland to Guarantee Debentures to be issued by the Moncton Hospital,” 9 April 1948, 601–4. 81 See Donald F.W. Porter and John B. Langley, “Now Under Construction – New Moncton Hospital,” The Canadian Hospital 29 (March 1952), 43–8, 92, 94. 82 panb, Moncton Municipal Records, rs 418 g2f3, Leonard Lockhart to Moncton Mayor and Aldermen, 2 November 1950; mha, Leonard Lockhart to Westmorland Warden and Councillors, 14 November 1950. 83 mha, Leonard Lockhart to Moncton Mayor and Aldermen Elect, 11 April 1949; panb, Moncton Municipal Records, rs 418 g2b1, Leonard Lockhart to L.T. Tingley, 22 September 1947. 84 panb, Moncton Municipal Records, rs 418 g2a1, J.E. Murphy to L.T. Tingley, 15 December 1948. 85 mha, rmh 1950, 5. 86 panb, Moncton Municipal Records, rs 418 g2f3, T. Babbitt Parlee to Frank S. Moffitt, 31 October 1950; Leonard Lockhart to Moncton Mayor and Aldermen, 2 November 1950. 87 Moncton Daily Times, 14 May 1947, 2; mha, J.E. Murphy Scrapbook, Moncton Transcript, 15 May 1947. Although the Transcript praised the composition of the new board for its balanced representation, containing “a generous sprinkling of younger business men,” representation for labour, and “the voice” of one woman, its occupational make-up differed only slightly from past boards. The individuals listed above were respectively the president and manager of a woodworking company, a lawyer, an engineer for cnr, a vice-president and manager of a retail store, a manager and investment dealer, a cnr mechanic, a drugstore owner, another president and

notes.fm Page 217 Friday, December 12, 2003 8:58 AM

217 Notes to pages 165–72

88

89 90 91

92

93 94

95 96 97 98 99 100 101 102 103 104 105 106 107 108

manager of a woodworking firm, the president and manager of an auto dealership, the wife of a service station operator, and a doctor. Information gathered from 1949–50 Greater Moncton City Directory, Volume No. 5 (Saint John, 1949), 2–3, 6, 9, 17, 24, 37, 53, 68, 70, 74, 79, 160–1, 174–5. panb, New Brunswick Acts 1949, “An Act to Amend an Act Consolidating and Amending the Acts Relating to the Moncton Hospital,” 28 April 1949, 418–22. See mha, “History – The Moncton Hospital School of Nursing,” 4; mm, Moncton Hospital File, “Administrators of the Moncton Hospital.” mha, rmh 1945, 12–13; rmh 1953, 15–17. MacLellan, History of the Moncton Hospital, 74, 86, 90. For the difficulties women faced in securing entry to the medical profession, see Bonner, To the Ends of the Earth. The decline of McGill and rise of Dalhousie paralleled the shift in rural British Columbia, where a McGill dominance was gradually replaced as medical graduates of Manitoba, Alberta, and then the University of British Columbia became available. See Norris, “The Country Doctor in British Columbia,” 37–8. This medical staff information is largely drawn from MacLellan, History of the Moncton Hospital, 64–94. Moncton Transcript, 21 July 1953, “The Times and Transcript Hospital Section.” Moncton Hospital was profiting from the New Brunswick government’s decision to move towards regionalization of health services as recommended in the 1951 health survey. See Sturgeon, Health Care in New Brunswick, 15. mha, rmh 1949, 4. mha, rmh 1953, 4, 13, 16. See McPherson, Bedside Matters, 205–7. mha, rmh 1945, 43. McPherson, Bedside Matters, 207, 221–2. Ibid., 208. McPherson, Bedside Matters, 238–9; mha, rmh 1945, 42; rmh 1948, 8; rmh 1953, 7. Russell, The Report of a Study, 49–50, 66–7, 70–1. Gautreau and Winans-Orr, The Life and Times, 28. mha, rmh 1945, 42–3; rmh 1948, 7–8; rmh 1950, 8; rmh 1953, 7. mha, rmh 1948, 7; rmh 1953, 8. mha, rmh 1948, 7–8, 12–13; rmh 1953, 9; mha, “History – The Moncton School of Nursing,” 4. mha, rmh 1945, 43; rmh 1948, 8; rmh 1950, 9; rmh 1953, 7–8; McPherson, Bedside Matters, 230. mha, rmh 1950, 8; rmh 1948, 9.

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218 Notes to pages 173–80 109 Howell, A Century of Care ,84. 110 mha, Leonard Lockhart to Warden and Councillors, Westmorland County, 14 November 1950; D.F.W. Porter, “Special Report on Planning of the New Hospital,” 18 June 1950. 111 panb, Moncton Municipal Records, rs 418 g2f4, “Progress Report – New Moncton Hospital,” 19 May 1952; rs 418 g2f5, “Progress Report – New Moncton Hospital,” 20 April 1953. 112 Moncton Transcript, 21 July 1953, “The Times and Transcript Hospital Section.” 113 Moncton Transcript, 22 July 1953, 2. 114 Moncton Daily Times, 18 August 1953, 3; 24 August 1953, 3, 14. 115 Bourque, Rêves de visionnaires, 41. 116 Moncton Transcript, 22 July 1953, 2. 117 Moncton Transcript, 21 July 1953, “Moncton Times and Transcript Hospital Section.” 118 Bourque, Rêves de visionnaires, 69–70. 119 panb, Moncton Municipal Records, rs 418 g2b2, Leonard Lockhart to Reverend Sister Superior, Hôtel-Dieu, 28 July 1949. 120 Moncton Transcript, 21 July 1953, 4; 22 July 1953, 12. 121 Bourque, Rêves de visionnaires, 91–2. 122 Ibid., 95. Hôtel-Dieu’s new wing was opened in 1956 and brought it “à peu près la même que le Moncton Hospital.” 123 See Donald F.W. Porter and John B. Langley, “Now Under Construction – New Moncton Hospital,” The Canadian Hospital 29 (March 1952), 43–8; Moncton Transcript, 21 July 1953, 4, and the “Moncton Times and Transcript Hospital Section,” which in the article “Departments Can Be Extended Independently” offered a word for word repeat of the expansion possibilities outlined by Porter and Langley. 124 Moncton Transcript, 21 July 1953, “Moncton Times and Transcript Hospital Section.” 125 Moncton Daily Times, 27 August 1953, 18; panb, rs 418 g2b2, Moncton Municipal Records, Leonard Lockhart to L.T. Tingley, 12 February 1955; panb, Moncton Municipal Records, rs 418 g2s1, “The Moncton Hospital Annual Report 1965,” 2. 126 Moncton Daily Times, 27 August 1953, 18. 127 Moncton Daily Times, 31 August 1953, 16.

conclusion 1 Agnew, “A Study of Hospital Legislation in Canada,” The Canadian Hospital 11 (January 1934), 26. 2 panb, Records of the Deputy Minister of Health, rs 136 e14a, Leonard Lockhart to A.D. Ganong, 18 July 1949.

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219 Notes to pages 180–4 3 See panb, Moncton Municipal Records, rs 418 g2a1, J.E. Murphy to L.T. Tingley, 15 December 1948. 4 mha, rmh 1953, 14. 5 panb, Records of the Deputy Minister of Health, rs 136, Transfer Case #8, “Brief Presented to the Executive Council of the Province of New Brunswick by the New Brunswick Section of the Maritime Hospital Association,” 7 July 1954. 6 panb, Records of the Office of Premier Hugh John Flemming, rs 415 e2e, D.F.W. Porter to Hugh John Flemming, 18 January 1955. 7 I borrow the insight of Gagan, “For ‘Patients of Moderate Means’.” 151– 79. 8 panb, Moncton Municipal Records, rs 418 g2b2, Leonard Lockhart to L.T. Tingley, 12 February 1955.

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biblio.fm Page 221 Friday, December 12, 2003 8:59 AM

Bibliography

archival sou rces As described in the introduction, although the Moncton Hospital Archives (mha) remains a neglected part of the hospital library, with its materials largely unorganized and unclassified, it was the major repository employed for this study. Despite such archival limitations, an almost complete run of annual hospital reports from 1899 to 1965 was available for use and forms the base of this research. When reports were missing or sketchy, detailed press coverage filled the void and, in the first half century of the hospital’s existence, press coverage was extensive. With the help of dedicated library staff, a substantial number of archival items were made available that proved vital in reconstructing the hospital’s history. These included minutes of hospital board meetings, committee meetings, correspondence, commissioned surveys and reports, architects’ studies, the acts of incorporation and amending acts, hospital bylaws, press clippings and scrapbooks, and various studies (for example, brief histories of the Ladies’ Aid, the nursing school, the early x-ray department, and hospital services in Moncton). The Provincial Archives of New Brunswick (panb) in Fredericton provided much important documentation, including hospital correspondence, reports, and studies frequently missing from the mha. Particularly valuable at the panb were rs 418, the Moncton Municipal Records, and rs 136, the Records of the Deputy Minister of Health. The 1916 legal battle of Francis P. Murphy was contained in rs 48 – 1916/148, Francis P. Murphy vs Moncton Hospital. Other useful collections were rs 126, Department of Public Works; rs 146, Albert County Council; rs 408, Records of Premier Walter Foster; rs 414, Records of

biblio.fm Page 222 Friday, December 12, 2003 8:59 AM

222

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the Office of Premier John B. McNair, 1945–1952; rs 415, Records of the Office of Premier Hugh John Flemming, 1952–1960; rs 595, Records of the Royal Commission Studying Hospital Services, 1902; mc 624, Moncton Research Notes and Papers; and mc 639, Maritime Press Ltd/Stan Robinson Collection. Also housed at the panb were the annual Acts of the Legislative Assembly of New Brunswick, which were examined for the period from 1895 to 1965. The Bell Library at Mount Allison University provided a source vital to the hospital’s history, as well as that of its surrounding communities. This was the microfilmed Moncton Daily Times from 1895 to 1953. When issues of the Times were missing, or a critical or controversial hospital issue was under discussion, the Moncton Daily Transcript, available at the Moncton Public Library, was consulted. The Bell Library also contained the 1891 Census, Westmorland County, New Brunswick, Volume I; Census, 1901, Victoria Co., Westmorland Co., York Co., Micro 5655, Reel t-6445; and Canada, Dominion Bureau of Statistics, Ninth Census of Canada 1951 Volume I Population (Ottawa, 1953), Seventh Census of Canada, 1931 Volume II Population By Areas (Ottawa, 1933). Finally, at the Bell Library the provincial Board of Health, later Department of Health, annual reports from 1908 to 1954 were examined. Through Mount Allison’s inter-library loan service, issues of The Canadian Hospital from 1925 to 1954 were examined and provided substantial information. At the Moncton Museum, the Moncton Hospital File proved rewarding. The Moncton Public Library contained McAlpine’s Moncton City Directory – 1898 (St John, [1899]); Directory of Moncton City Town of Sunny Brae Villages of Humphreys Lewisville Leger Corner and Westmorland County 1919– 20 (Moncton, 1919); The City Directory of Moncton, N.B., 1930 (Moncton, 1930); The City Directory of Moncton, N.B., 1938 (Moncton, 1939); 1949– 1950 Greater Moncton City Directory, Volume No. 5 (Saint John, 1949).

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– ‹To produce an article we are not capable at present of producing’: The Evolution of the Dalhousie University School of Nursing, 1946–1956.” Nova Scotia Historical Review 15 (1995), 26–41. Valverde, Mariana. The Age of Light, Soap, and Water: Moral Reform in English Canada, 1885–1925. Toronto: McClelland & Stewart, 1991. van Leeuwen, Marco H.D. “Logic of Charity: Poor Relief in Preindustrial Europe.” Journal of Interdisciplinary History 24 (spring 1994), 589–613. Vogel, Morris J. The Invention of the Modern Hospital: Boston,1870–1930. Chicago: University of Chicago Press, 1980. Vogel, Morris J. and Charles E. Rosenberg, eds. The Therapeutic Revolution: Essays in the Social History of American Medicine. Philadelphia: University of Pennsylvania Press, 1979. Waite, P.B. The Lives of Dalhousie University. Volume Two,1925–1980: The Old College Transformed. Montreal and Kingston: McGill-Queen’s University Press, 1998. Wangensteen, Owen H. and Sarah D. Wangensteen. “Lister, His Books, and Evolvement of his Antiseptic Wound Practices.” Bulletin of the History of Medicine 48 (1974), 100–28. Warsh, Cheryl Krasnick. “The Historiography of Canadian Health Care: An Update.” Acadiensis 26 (spring 1997), 137–43. Warwick, Wm. “The Development of Public Health in New Brunswick.” Canadian Public Health Journal 26 (April 1935), 168–75. Weisz, George. “The Geographical Origins and Destinations of Medical Graduates in Quebec, 1834–1939.” Histoire Sociale/Social History 19 (May 1986), 93–119. Whalen, Hugh J. The Development of Local Government in New Brunswick. Fredericton: Queen’s Printer, 1963. Whalen, James M. “Social Welfare in New Brunswick, 1784–1900.” Acadiensis 2 (autumn 1972), 54–64. Wheatley, J.M.O. Extension to 1954 of the New Brunswick Health Survey Report of 1951. Fredericton: Government of New Brunswick, 1954. White, Linda. “Who’s in Charge Here? The General Hospital School of Nursing, St. John’s, Newfoundland, 1903–30.” Canadian Bulletin of Medical History 11 (1994), 91–118. Wotherspoon, Terry. “Training and Containing Nurses: The Development of Nursing Education in Canada.” In Sociology of Health Care in Canada, B. Singh Bolaria and Harley D. Dickinson, eds. Toronto: Harcourt Bruce Jovanovich, 1988. Young, R.A. ‹and the people will sink into despair’: Reconstruction in New Brunswick, 1942–52,” Canadian Historical Review 69 (June 1988), 127–66. – “Remembering Equal Opportunity: Clearing the Undergrowth in New Brunswick.” Canadian Public Administration 30 (spring 1987), 88–102.

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Abel-Smith, Brian, 6, 9 Addy, Mary, 33 Agnew, G. Harvey, 5, 179, 180 Albert County, 33, 20, 149; grants from, 66, 99, 152, 163–4, 175; population, 43–5, 64–5, 94, 148 alcoholism. See diseases and conditions Allen, Wilbur, 72 Alward, Pauline, 146 Ambrose Wheeler Limited, 165 American College of Surgeons, 107–8, 124, 125, 167, 183 American Hospital Association, 108 Anderson, S. Boyd, 113 Atkinson, Paul McL., 78, 79, 81, 122 Atkinson, William G., 87 Atlantic News, 109 Atwater, Edward C., 3, 9 Baltimore Medical College, 123 Barnes, Lillian, 60

Batavia Hospital, New York, 47 Baxter, Charles R., 122, 125, 143 Baxter, J.B.M., 113–14 Beattie, Barbara A., 165, 171, 172, 173 Bellevue Hospital Medical College, New York, 37, 123 Belliveau, Camille, 76, 77 Benedict, Carrie, 15 Benedict, James S., 15 Black, J.W.S., 68 Blackwood, James, 90 Blakeny, C. Hanford, 103, 156, 158, 160, 161, 184 Blue Cross. See hospital insurance – Blue Cross Botsford parish, 51, 68, 72 Botsford, Robert L., 37, 79 Boudreau, Francis E., 122 Bourgeois, Bliss A., 120 Bourque, Louis N., 37, 49, 52, 57, 79, 81, 82, 89, 90, 122, 143 Bradley, Charles W., 24 Breau, Florence J., 119, 172, 177, 184 Brewer, W.W., 20–1

Britton, Harry E., 122, 143 Brodie, F. Neil, 40 Brooklyn Hospital, New York, 45–6 Brown, Fred M., 157 Brown, J.E., 41 Buckmaster, R.M., 35 Burden, Fred E., 122 Burgess, Sherman W., 57, 79, 81, 122, 143 Bursey, Phyllis, 166 Busy East, 114–15 Butler, J.P., 174 Caldwell, Robert J., 122 Calkin, J.D., 79, 122 Campbell, Clinton C., 71, 74 Campbell, D.A., 36 Canadian National Railways, 86, 150. See also Intercolonial Railway Canadian Nurses’ Association, 169–70 Canadian Red Cross Society, Moncton branch, 80, 107 cancer. See diseases and conditions Central Methodist Church, Moncton, nb, 15

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Chandler, A. Henry, 37, 38, 52, 79 Chandler, Edward Botsford, 126 Chapman, Alfred Cavour, 71, 72, 74, 77, 78, 88–9, 91–2, 101, 102, 103, 105, 113, 119, 120, 121, 133, 144, 183 Chapman, Alfred E., 22, 24 Chapman, Mary, 33 Charters, Agnes, 33 Charters, H.C., 103 Cincinnati College of Medicine and Surgery, 79 city-countryside relationship, 6, 10, 43–5, 49–51, 63–4, 65, 67–74, 163–4, 175, 181, 183, 185 City University of New York, 123 Cole, Edward C., 28–9 Coleman, Henry H., 37, 70, 75, 77, 79, 82, 84, 85, 90, 120, 122, 123 College of Physicians and Surgeons for New Brunswick, 16 Colpitts, F.W.S., 78 Columbia University, 172 community persuasion, 10, 13, 14, 19–23, 25–6, 30, 68, 88–92, 102–4, 107, 108–11, 132–3, 153–4, 163, 182, 183, 184, 185 Connor, J.T.H., 4, 5 Cook, Edward, 55 Copp, R.M., 56 Corbett, Lottie E., 82, 83, 84 Cortuila, Mark, 4 Cox, Robert, 122 Craig, Barbara L., 6 Creaghan, W.V., 165 Crudge, Harry J., 155, 158, 160 Cruise, William, 36 Crutchlow, Everett, 125 Daily Times (Moncton, nb), 21, 24, 38, 40, 54, 78, 100–1, 112

Dalhousie University, 36, 123, 125, 166, 172, 182. See also Halifax Medical College Damery, Edythe B., 82, 84 Dernier, Lydia, 34 diabetes. See diseases and conditions Dickson, Cora, 84, 85, 102 diphtheria. See diseases and conditions diseases and conditions: alcoholism, 47, 64; cancer, 151, 167; diabetes, 107; diphtheria, 25, 107; influenza, 64; La Grippe, 47, 64; neurasthenia, 47; pneumonia, 47, 64; rheumatism, 47; smallpox, 25; statistics of, 47, 64, 107; tuberculosis, 64, 67, 107, 131; typhoid fever, 47, 64, 107; venereal disease, 64 Dobson, J.A., 143, 167 Dobson, Joseph W., 122, 159, 160, 161, 167, 168, 173, 184 Doherty, Miss, 82 Doiron, Leo, 126 Dorchester, nb, 14, 49 Doucet, Vincent P., 122 Doyle, Harriet, 84, 85, 90, 102, 120 Doyle, James, 22, 50, 71, 72, 75, 77, 78 Eagles, Percy J., 174 Eaton, R. Burnell, 166 education, medical: in Britain, 35, 37–8; in Canada, 35–6, 197n20; criticism of clinical education, 35–8; in U.S., 35–6, 196nn18, 19. See also Moncton Hospital medical staff, education of education, nursing, 56; in Canada, 57–8, 60, 81, 82, 83, 128, 131, 132, 200n100; in New Brunswick, 128, 130, 170; in

U.S., 60, 201n121. See also Moncton Hospital Training School for Nurses; Moncton Hospital nursing staff; nursing profession Eliot, Charles, 36 Emmerson, Henry R., 41 Evangelical Alliance, 41 Ewart, E.W., 122, 165, 168 Farrell, R.T., 55 federal government, 48, 150–1, 164, 181; health grants program, 151, 164 Ferguson, Janet, 120, 158 Ferguson, William A., 52, 55, 57, 79, 81, 122, 123, 126, 143 Fergusson, W.F., 121 Filliter, George E., 165 First Baptist Church, Moncton, nb, 15, 64 Fitzpatrick, W.S., 122 Flannagan, James, 22 Fleming, George W., 79 Fleming, Murray, 15, 22, 24 Flexner, Abraham, 35–8 Folkins, John A., 122 Forbes, A.E., 143 Fownes, A.O., 165 Fraser, Miss, 56 Gagan, David, 4, 5, 13 Galt, on, 18–19 Gaskin, E.B., 158, 161, 165 Gass, Charles A., 122 Gaudet, Edward T., 79 Gaudet, J. Alfred, 126 Gaudet, Miss, 56 Geary, James A., 68, 75, 78 George Hardy Limited, 165 Georges-L. Dumont Hospital, 95. See also HôtelDieu de l’Assomption Gidney, R.D., 5–6 Girouard, Edouard, 32, 54, 75, 76 Girvan, Margit, 34 Girvan, Robert G., 122, 143

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Givan, Frederick W., 24 Good Hannah, 34 Goodridge, L.E., 122, 143 Gorham, Mary, 33 Govan, Ferguson, Lindsay, Kaminker, Maw, Langley & Keenleyside, 157, 158, 161, 173, 174 Grant, Margaret, 27, 51 Grenfell, Wilfred, 18 Group Hospitalization Service Commission, 118, 149, 150. See also hospital insurance Gunn, Jean, 131 Halifax Medical College, 36. See also Dalhousie University Hamilton, Annie, 33 Hamilton, Hugh, 24, 27, 32, 51, 71, 72, 75, 76, 77, 78, 113 Hamilton City Hospital, 4, 42 Hamowy, Ronald, 4 Hannington, Ella, 21, 33 Hannington, Henry C., 21, 24 Harris, John H., 68, 75, 78, 90 Harris, John L., 24, 32, 57 Harris, L.C., 79 Harvard University, 3, 16, 36, 37 Hawke, John T., 77 Heagerty Committee Report, 150 health grants program. See federal government Hennigar, Ellen, 33 Hickman, C.S., 49, 50 Holmes, Oliver Wendell, 3 Hooper, Edward B., 15 Horseman, Harvey, 65, 105 hospital insurance, 4, 8, 9, 11, 117–18, 149–52, 153, 154, 181, 212n13; Blue Cross, 149–50, 153, 154, 180–1. See also Group Hospitalization Service Commission;

Maritime Hospital Service Association Hospitals and Charitable Institutions Act of Ontario 1897, 99 hospitals: administration by women, 10, 85–6; in Canada, 4, 8, 13, 41–2, 47–8, 62–3, 97, 98–9, 116, 152, 154, 180, 184– 5; funding, 8, 9, 10, 47– 8, 99–100, 116, 180, 184; historiography, 3–6, 12, 184, 191n4, 192nn5, 6, 193n3; in New Brunswick, 9, 99, 116, 152, 194n20; in Ontario, 4, 99, 100; in pei, 116; in U.S., 7, 8–9, 14, 45, 46, 47, 48, 62–3, 86, 184 Hôtel-Dieu de l’Assomption, 45, 95, 109, 111, 118, 126, 148, 175–6 Howell, Colin, 4 Humphrey, Emma, 39, 80 Humphrey, W.F., 39, 40 influenza. See diseases and conditions Intercolonial Railway, 14, 40, 86. See also Canadian National Railways Jefferson Medical College, Philadelphia, pa, 37 Johns Hopkins University, 36, 172 Jones, Andrew H., 24, 27, 32, 50, 51, 52, 75, 78, 113 Jones, Bessie, 33 Jones, Howe Alonzo, 79, 122 Jordan Memorial Sanatorium, River Glade, nb, 67 Joyce, Harris A., 174 Keith, C.B., 77 Kent County, 33, 40, 45, 65, 77; grants from, 48, 51, 66, 68, 73, 99, 175;

population, 43–4, 64, 94, 148 Killam, Amasa E., 21 King, Neva, 124 King, Wallace G., 79 King, William Lyon Mackenzie, 151 King’s Daughters, 14–16, 19–20, 23, 24, 25, 30 Kingston General Hospital, 42, 55 Kirby, W.J., 165 Kirby, W.P., 143 Kitchener Hospital, 100 Koch, Robert, 47 labour unions: in Moncton, 86–8, 91, 102, 183 La Grippe. See diseases and conditions Landry, A. Raymond, 78, 79, 103, 122, 126 Laval University, 36, 123, 166 Léger Corner, 25, 28 Leger, Euclide, 143 Leger, J.E., 126 legislation. See Moncton Hospital – legislative acts Leighton, Claude M., 167 Les Religieuses de Notre Dame du Sacré Coeur, 176 Lister, Joseph, 47 Lockhart, Leonard, 152, 159, 161, 162, 163, 164, 165, 168, 173, 174, 180, 184, 185 Ludmerer, Kenneth K., 35–6 Lyons, George A., 107, 122, 143, 167 Lyons, J.M., 76 Lyons, Peter, 167 MacBeath, Donald A., 160, 164 McClelan, A.R., 109 McClure, George J., 84, 85, 86, 87, 91, 102 McConnell, Miss, 55, 56

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McCully, Oscar J., 17–18, 20, 27, 30, 32, 37, 38, 58–60, 70, 78, 79, 182 MacDonald, Adele M., 84 MacDonald, E. Blanche, 82, 83 MacDonald, R.D., 122 MacDonald, Sophie G., 55, 56, 57, 60, 83 MacEachern, Janet, 51, 57, 60 McGee, Arlee, 13 McGill University, 18, 36, 37, 79, 123, 166, 172, 182, 196n17 McInerney, J.F., 174, 175 McKeen, Harry L., 122 MacKenzie, John C., 163, 165 MacKenzie, K.W., 122 MacLaren, D.L., 174 MacLaren, Marion G., 119 McLean, Hugh H., 113, 122 MacLellan, Donald I., 7 MacLennan, Ian A., 165, 166 McManus, Reid, 76, 77, 78, 121, 156, 160 MacMaster, Alena Jean, 10, 54, 93, 142, 145, 156, 171; and accreditation, 107–8, 121, 124; appointment, 84–5, 183; biography, 81, 85, 162; contributions, 172, 182, 183, 184; on costs and revenues, 105, 106–7, 117, 118; on employment problems of rn s, 128–30; and expansion of services, 100, 101, 106–7, 114; and hospital insurance, 117–18, 149–50; and nursing staff balance, 168–9; professional memberships, 128, 130; relationship with doctors, 121, 123–5, 126; resignation, 162; responsibilities, 85– 6, 119; rethinking of

hospital role, 108, 132– 3, 148, 182, 184, 185; and School of Nursing, 126–32, 171, 172; as student, 54, 60 MacMillan, M.A., 174 MacNaughton, James, 57, 79, 81, 120, 122, 143 McSweeney, Agnes, 33 McSweeney, Allie E., 85, 90, 91, 103–4, 120, 160 McSweeney, Beatrice, 33 McSweeney, Peter, 21, 24, 32, 33 Magee, Bessie, 51 Magee, Fred, 51, 68 Maritime Hospital Association, 149, 152, 180 Maritime Hospital Service Association, 149. See also hospital insurance – Blue Cross Marnie, Hattie, 33 Marnie, James S., 32 Marven, Joseph A., 78, 121 Masters, Annie, 33 Meahan, Henry A., 15, 20, 40, 41 medical education. See education, medical medical specialties. See Moncton Hospital medical staff, specializations and services medicare, 4 Melanson, C.A., 89, 90 Melanson, H. Paul, 122, 161 Memorial Hospital, New York, 172 Millar, W.P.J., 6 Miller, Israel L., 24, 26, 32 Miller, Maisie, 130 Miller, Miss, 54–5 Miss A.J. MacMaster School of Nursing, 162. See also Moncton Hospital Training School for Nurses Moncton Almshouse, 9, 14, 25, 26, 31, 32, 38, 118, 183

Moncton, City of, 7, 14, 77, 113; economic changes, 13–14, 94; ethnicity, 94, 148; and labour unions, 86; population, 13, 43–4, 64, 93, 148 Moncton City Council, 7, 9, 18, 23, 24, 26–7, 179, 181, 183, 184; membership, 48–9; pre-1910 financial support to hospital, 40, 48–9, 66, 68; inter-war years support to hospital, 100, 101, 102, 104, 109, 111, 115–16; post-1945 role re hospital, 155–62, 164–5; reluctance to support hospital, 22–3, 88– 92 Moncton City Hospital. See Moncton Hospital Moncton Gyro Club, 107 Moncton Hospital: accreditation and standardization, 5, 78, 79, 107–8, 124, 125, 167, 182, 183 – administration, 7, 10, 51, 62, 119–20, 165–6, 183, 185; clarification of superintendent’s authority, 85–6; search for superintendent, 83–5 – ambulance, 52, 80, 86 – architectural design and buildings, 28, 40, 41, 111–12, 135–41, 157, 158, 161, 165, 173–4 – Archives, 6–7 – Board of Trustees: 5, 7, 16, 70; changing structure, 74–8, 183; committees of, 27, 109, 155–6, 168; composition of, 23– 4, 27, 32–3, 120–1, 165, 181, 210nn98, 100, 216n87; criticism of, 49, 54–5, 69, 74, 75, 86–7, 158–62, 183; municipalization of, 157, 158, 161–2, 165, 168, 181; on

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post-war expansion, 155–62; problems with doctors and nurses, 52– 5; relationship with doctors, 158–62, 168; women on, 10, 32, 52, 74, 80–1 bylaws, 27, 33–4, 75–7, 84, 85 community service and outreach, 57, 107, 132, 182 constituency served, 9, 10, 31, 32, 43–5, 49, 63, 64–5, 93–5, 148–9, 181; 1910/11 occupational patient analysis, 45–7 cost of services, 42, 66, 86, 97–9 (fig. 5), 101, 102, 104, 105–6, 114– 15, 152 disposition of old buildings, 176 donations/fund-raising, 21, 25, 27, 38–9, 40, 41, 65, 86, 101, 105, 107, 109–11, 160–1, 208n68 financing/funding, 5, 7, 8–9, 11, 20, 26–7, 28, 38, 179–80, 181; debentures and bonds, 104–5, 109, 110, 111, 115, 116, 155, 161, 164, 179, 181; expenses, 169; federal presence, 150–1; government grants to, 153, 164, 179, 181; grants from Albert County, 66, 99, 152, 163–4, 175, 181; grants from federal government, 48, 151, 164, 181; grants from Kent County, 40, 66, 99, 175, 181; grants from Moncton City Council, 40, 66, 89–91, 116, 152, 164; grants from New Brunswick, 28, 47–8, 51, 65– 6, 88–9, 93, 98–100, 116, 133, 152, 181; grants from Westmorland County, 40, 49–50,

–

– –

– –

– –

–

–

– –

–

66, 99, 152, 163–4, 181; from insured and paying patients, 153; Moncton City Council post-1945 funding role, 157, 164–5, 179–80, 181; revenues, 20, 42–3, 48, 57, 65–6, 105–6, 115, 116, 152, 180 francophone presence, 45, 94–5, 111, 126, 148, 166, 175, 176 incorporation, 20, 23–4 Ladies’ Aid Association, 8, 10, 16, 52, 185; on Board of Trustees, 10, 32, 52, 74, 80–1, 84–5; composition of, 33–4; 80, 181; founding of, 22, 25, 31, 33; fundraising 13, 39, 41, 52, 56, 80, 90, 100, 101, 102, 124, 183; religion of, 34, 80 Ladies’ Hospital Sewing Circle, 39 legislative acts, 23–4, 33, 74, 77, 104–5, 109, 111, 155, 157, 161 number of beds, 9, 44, 62, 108, 109–10, 149 opening (1898), 28–30; opening (1903), 39, 40, 41; opening (1930 addition), 111–14; opening (1953), 147, 173–5 patient diagnostic patterns: pre-1910, 47; 1910–20, 64; medical treatments, 47, 64,107, 131; surgical treatments, 47, 64, 79 role of the clergy/ churches, 15, 16, 18, 20– 1, 31, 34, 38, 40, 41, 52 role of labour unions, 86–8, 102, 121 role of women, 10, 13– 21, 24, 30, 32, 80–1, 183, 185 rules and regulations, 27, 42, 106

– staff, medical. See Moncton Hospital medical staff – staff, nursing. See Moncton Hospital nursing staff – staff, other, 119–20, 169 – studies, 153–5, 163 – See also diseases and conditions; Moncton Hospital Training School for Nurses; patients Moncton Hospital medical staff, 5, 6, 7, 8, 9, 10, 15, 16–8, 20, 27, 29; – congenial relationship with Board, 168 – education of, 35–8, 79, 123, 166–7, 182, 196n5, 200n108, 217n92 – francophone doctors, 126 – higher standards, 167 – in post-WWII expansion debate, 158–61, 183 – 1940s expansion in numbers, 166, 168 – on City Council, 48–9, 123–6 – press perceptions, 125–6 – roster problems, 70–1 – specialization and services offered, 79, 100, 101, 121–2, 123–6; anaesthesiology, 107, 122, 166; cancer diagnostic clinic, 151, 167; cardiology, 122, 166; dentistry, 79, 122, 166; eye, ear, nose, and throat clinic, 79, 114, 122; insulin services, 107; isolation unit, 101, 106; obstetrics/maternity, 80, 82, 90, 106– 7, 110, 131, 166, 182, 207n55; ophthalmology, 122, 166; orthopaedics, 122, 166; outpatient services, 79–80, 114, 117; pathology laboratory, 106, 107, 108, 166; pediatrics, 122, 166;

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pharmacy, 117; physiotherapy, 114; psychiatry, 166; radiology (x-rays), 66, 68, 79, 86, 102, 107, 122, 124, 202n15; regional laboratory, 167–8, 217n94; regional medical centre, 176, 181–2, 185; surgical, 79, 82, 122, 166; tonsils and adenoids free school clinic, 107; tuberculosis clinic, 107, 151; urology, 122; venereal disease clinic, 107, 117, 151 – staff arrangements, 34–5, 51, 52, 55, 63, 70–1, 78– 9, 122–3, 199n82 – surgical/medical changes, 123–4, 135 Moncton Hospital nursing staff, 7, 8, 9, 10, 19, 54– 5; balance between graduates and students, 169– 70, 182, 185; division of labour, 172; graduate nurses, 127–30; hours of work, 172; image of, 57– 60, 201n117; marriage data, 129–30; Nurses’ residence, 52, 56, 66, 81, 127, 171, 176; place employed, 129; postgraduate studies, 172, 173; post-WWII growth, 168–70, 182; shortage, 168–9, 182; WWI opportunities, 81, 82, 83 Moncton Hospital Training School for Nurses, 10, 19, 24, 31, 51, 81, 82, 127; admission requirements, 130; age on admission, 130, 170; career opportunities of graduates, 128–9, 172; changes under B. Beattie, 171; curriculum, 57–8, 81, 82, 130–2, 171; destination of graduates 1909–30, 129–30; discipline, 131, 171;

education level on admission, 170; founding of, 55–7, 58, 60, 61; nurses’ hours on wards, 131–2, 172–3, 183; limited post-1945 expansion, 170–1; marriage data of graduates, 129– 30; other nursing schools, 56; quality of graduates, 171–2; reliance on student nurses, 172, 183; student government, 171; teaching staff, 81–2, 130, 171. See also education, nursing; Miss A.J. MacMaster School of Nursing; nursing profession Moncton Medical Society, 120 Moncton Rotary Club, 103–4, 121, 184 Moncton Taxpayers’ Association, 159, 161, 183 Montreal General Hospital, 42 Morton, Doris, 173 Murphy, Francis (Frank) P., 75, 76, 77–8, 87, 155 Murphy, J. Edward, 155, 156, 157, 158, 159, 160, 161, 162, 164, 165, 167, 180, 184 Murphy, Patrick, 167 Murray, Bessie, 33 Murray, Charles, 19 Murray, Charles A., 79 Murray, Kevin Allison, 175 Myers, Ambrose R., 15, 26, 30, 32, 37, 38, 50–2, 54, 55–6, 70, 79, 81, 122, 125, 143, 167, 182 Myers, Ralph P., 122, 167, 168 Myles, G.W.R., 165 Myles, Grace, 84 neurasthenia. See diseases and conditions New Brunswick, 3, 9, 153, 181; Department of

Health, 7, 89, 107, 167– 8, 176, 182; ethnic composition, 94; grants to hospitals, 21, 27, 28, 48, 67, 89, 99, 100, 116, 151–2; hospital legislation, 23–4, 33, 62, 69, 74, 75, 77, 89, 92, 99, 104, 109, 111, 116, 155, 157, 161 New Brunswick Association of Registered Nurses, 128 New Brunswick Medical Association, 151 Newcomb, Alice, 119 New York University, 37 Nightingale, Florence, 58, 59–60 nursing profession, 58–9, 83, 127–32; in Canada, 56, 81, 82, 168–70; doctors’ perception of, 58– 60; exploitation of nurses, 56–60. See also education, nursing; Moncton Hospital nursing staff; Moncton Hospital Training School for Nurses Oliver, Dorothy F.R., 119, 130 Oulton, Merville A., 79 Owen Sound General and Marine Hospital, 4,12, 13, 29, 42, 80–1, 100 Oxley, P.L., 122 Parsons Construction Company, 165 Parsons, George V., 166 patients: gender, 80, 107, 182; paying patients, 9, 19–20, 42–3, 65–6, 95, 96 (fig. 3), 97–8, 115, 118, 149, 153, 180, 181, 184; public/ward patients, 9, 19, 31–2, 34, 42, 63, 65, 66, 69, 72–4, 95, 96 (fig. 4), 97–8, 105, 106, 115, 118, 149,

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150, 107, 181; usage, 9, 44–5 (fig. 2), 49, 62–5, 95, 108, 115, 148, 181. See also diseases and conditions Pickstone, John V., 6 pneumonia. See diseases and conditions Porter, Donald F.W., 152, 165, 168, 173, 177, 180 Price, Clara, 102 Price, Hanford, 89, 90, 91, 101 Price, Leveritt, 37, 52, 55, 79, 81, 122, 143 Price, O.B., 113 primary sources, 6–7 Prince Edward Island: grants to hospitals, 116 Provincial Archives of New Brunswick, 7 Pullen, William A., 122 Purdy, Annie, 15, 19–20, 24, 30, 56, 182, 184 Purdy, Clinton T., 15, 37, 48, 49, 53, 54, 55, 70, 79, 81

Richardson, Katherine, 146, 172 Ripley, Howard R., 167 Roach, Robert D., 122, 158, 160, 161, 168, 184 Roberts, William F., 89 Robertson, George A., 120 Robinson, Annie, 33 Robinson, Clifford W., 27, 32, 53, 54, 71, 75, 77, 78, 88, 109, 113, 121 Rodd, Marjorie, 117 Rosenberg, Charles E., 3, 7 Rosner, David, 3, 9, 45–6 Ross, Arthur W., 122 Ross, James D., 3, 15, 16– 17, 20, 27, 29, 32, 36, 50, 52, 58, 60, 61, 78, 182 Ross, James M., 32 Ross, Sophia, 33, 34 Royal College of Physicians and Surgeons of Canada, 167 Royal Victoria Hospital, Montreal, 131, 171 Ryder, Helen, 119

Queen’s University, 36, 37, 123, 167 Queen Victoria’s Diamond Jubilee, 25, 32

Sackville, nb, 14, 50, 51, 68, 71, 74; hospital, 149 St Bernard’s Catholic church, 15, 40, 174 St George’s Anglican church, 15 Saint John General Hospital, 99, 172 St Joseph’s University, 176 Saint Luke’s Hospital, New Bedford, ma, 82, 131 St Michael’s Hospital, Toronto, 172 St Thomas Hospital, 100 Sharpe, Miss, 54–5 Shediac, nb, 14, 70, 79 Shortt, S.E.D., 4, 64 Siddall, Medley G., 68, 69, 73 Sinclair, Norman, 86, 87 smallpox. See diseases and conditions Smith, Gaius T., 37, 49, 52, 79

Radcliffe, H.F., 165 Raworth, Eric, 165 Rayworth, Augusta, 34 Rayworth, John S., 32, 50, 51, 53, 57, 71, 75 Read, John, 15 Reade, B.F., 79, 89 Redmond, Clarence, 113 Reid, Frederick P., 24 Reilly, E. Albert, 121 Rexton Hospital, Rexton, nb, 148 rheumatism. See diseases and conditions Richard, Fred A., 57, 79, 81, 122, 123, 124, 143, 167 Richardson, A.L., 168 Richardson, Andy R., 122

Smith, Sarah M., 40 Snell, Florence, 83 Sormany, Alphonse, 70, 72, 87, 88–9, 91, 122 Spencer, George O., 103, 156, 157, 158 Starr, Paul, 3 Steeves, Edward O., 37, 48, 49 Stevens, A.A., 74 Stevens and Lee, 111, 209n71 Stevens, Rosemary, 3, 8, 14, 48 Stewart, John, 89, 90, 91, 122 Stone, Arthur E., 156, 157 Stratford Hospital, 100 Strong-Boag, Veronica, 5 Sumner, Frederick W.: as mayor, 13, 19–20, 22–3, 24, 32, 48, 49; as trustee and hospital president, 50, 51, 56, 60, 61, 67, 68, 69, 75, 77, 78, 121, 183 Sumner, Margaret, 22, 33 Surette, J. Edgar, 165 surgery. See Moncton Hospital medical staff – specialization and services offered Survey of Nursing Education in Canada. See Weir Report Swanson, A.J., 153–4, 164 Taylor, B.A., 157 Taylor, George O., 79, 122 Taylor, Henry I., 113 T.B. and Morris E. LeBlanc, 40 Thernstrom, Stephan, 33, 34, 45 Tilley, Alice, 13 Toombs, Benjamin, H., 32 Toronto General Hospital, 80–1, 132 Transcript (Moncton, nb), 53, 77, 147, 173 Trueman, Amos, 41 tuberculosis. See diseases and conditions

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Index

Tweedie, Lemuel J., 41 typhoid fever. See diseases and conditions unions. See labour unions University of Edinburgh, 37, 38, 123, 166, 167 University of Manitoba, 36, 167 University of New York, 37 University of Pennsylvania, 37 University of the City of New York, 37, 123 University of Toronto, 6, 36, 37, 123, 166 University of Vermont, 79 University of Victoria College, 37 University of Western Ontario, 36 venereal disease. See diseases and conditions Veniot, Peter J., 88 Victoria General Hospital, Halifax, ns, 42, 129, 172–3

Victoria Public Hospital, Fredericton, nb, 12, 13, 29, 129 Victorian Order of Nurses, 118, 171 Vogel, Morris, 3, 9 Walker, Lucy, 33 Wallace, L.F., 78, 85, 90 Warren, H.D., 165 Webster, William, 168 Weeks, W.W., 15, 20 Weir Report, 131 Wells, Bertie M., 119 Westmorland County, 14, 33, 183; ethnicity, 148; grants and debentures from, 48, 49–51, 66, 67– 8, 71–4, 99, 152, 163–4; patient statistics, 64, 65, 163; population, 43, 94, 148; post-1945 hospital expansion, 163–4, 175, 181 Wheeler, Ambrose, 109, 111, 144, 156, 157, 158, 159, 160, 161, 162, 174

Whelpley, R.E., 90, 91, 104 Wherrett, George J., 107 White, Ella, 102 White, Fred J., 18, 37, 38, 48, 52, 53, 55, 57, 79, 81, 122, 123, 126 Whitney, Henry A., 24 Wilbur, Mrs J.J., 34 Willett, George B., 14, 21, 22, 24, 26, 27, 30, 31, 32, 38, 39, 40, 41, 42, 48, 49, 51, 52, 56, 60, 68, 70, 71, 72, 75, 78, 113, 182 Willett, Laura, 33, 52 Wilson, Ruth, 118, 125, 149, 156, 162 Winnipeg General Hospital, 129–30, 169 Wood, Josiah, 41 Wran, Joseph H., 32