The Early Patients

From : "A History of the Montreal General Hospital"
by H.E. MacDermot, M.D., F.R.C.P.(C.),
published by The Montreal General Hospital 1950

Whilst the medical records for the first 30 years or so are not very full, the registers of the patients give details of the names, age, nationality, creed and the diagnosis.

The first name recorded is that of  "Richard King, 39, Anglus, from La Chine, with hepatitis" recommended by the La Chine Canal Company, on May 3, 1822. The building oh the Lachine Canal which had been begun the year before, provided many casualties for the hospital, with such diagnoses as "fracrura,   vulnus," "contusio," and ustus or ambustio," the two last being synonymous with burns. As might be expected, there was a great vanety of nationalities from the very beginning. In May, 1823, for example, the following were recorded within a few days; Hibernus, Anglus, Americanus, Germanicus, Canadensis, Scotus, Norwegian, and Welshman. The last two apparently were not judged worthy of Latin appellations.  But the Irish far out·numbered anyone else and Hibernus and Hiberna (usually shortened to Hib!) were for long the most numerous entries.

At first the policy of making the patients pay something if possible was strictly followed, but the entries for charges-usually 5/-or7/-per week -- became rare after the first few years. A unique entry records that while the patient was sent in as a "pauper" he was willing to pay 5/-per week. In most instances the patients were Irish immigrants, than whom no one could reach greater depths of poverty. They seldom brought anything with them except disease. There is a note on May 23, 1838, by Dr. Stephenson, "the fat emigrant this year." Whether this was a sigh of resignation over what the summer was to bring, or of relief at the opening of navigation once more, who shall say? Not infrequently they ran away from the hospital. Mary Dudeson, Hiberna, admitted with rubeola, is shown as "absconded." Michael Harrrngton, "ran out the same day he was admitted." and Thomas Dowde, on January 15, 1837, is shown on the same day as "Ran out --through fear I believe-after the nurse had shown liim his bed." James Fitzgerald, admitted with dropsy is recorded as "Ran away early in the morning in dread of  Jack Ketch.   On May 31,1837, two patients admitted with "rheumatism" asked for their discharge "sooner than take their medicine." This time they were not Irish. What the medicine was we are not told.

A great many patients were discharged on account of "irregular conduct",  as many as five in one day. The entries of this kind are much more numerous in some years than in others, suggesting perhaps that conditions in the hospital were less congenial at some periods than as others. The discharge of this type often reads simply "irregular," but sometimes it is qualified with, "for improper language," "Would not submit to treatment," "For smoking-- second time discharged," "For abusive language to the nurse."  Catherine Fleming, 20, Irish, admitted with dyspepsia on August 7, 1862, was discharged "for grossly irregular conduct."  "Delirium tremens" was a frequent diagnosis. In the month of September, 1845, seven patients were admitted with that complaint and there were many others that winter. One patient admitted with this complaint was discharged as he "Broke double window." One patient "cut wire screen of window and wrote obscene language on the wall."

There is a good deal of interest in these particular records from the point of view of medical history. Some of the methods of treatment are mentioned; as in the case of S. Goldsmith, an English immigant, admitted September 27. 1849, with "cholera" and discharged October 12, "Cured by strong doses of calomel"  Another English immigrant named Nicholas Neal showed equally strong powers of recovery; his discharge note reads: "This man recovered from cholera and typhus fever whilst in hospital, both bad attacks. His height was 6 feet 5 in"

Another had a rather striking history, not the least being his recovery from several operations. This was Thomas Rolland, an immigrant; admitted December 15, 1851, with "gelatio:" his discharge note informs us on May 21,1852, that he died "from urinary infiltration caused by old neglected stricture.  He had been operated on at 10 years of age for stone, at 35 had Chopart's operation performed on both feet -- had the phalanges of left hand removed -- and lastly had a modification of Syne's operation, also had amputation of thumb performed by Dr. Arnoldi."

The first recorded operation in the hospital is on May 14, 1823, when in a case of compound fracture the thigh was amputated with success by Dr. Robertson." Sometimes emphasis is laid on the success of the operation as such; perhaps in the absence of anaesthetics it was often something to be able to finish an operation at all. For example, in 1823, R. McMahon was admitted with a "vulnus," from which he died two days later, the note being made that "The external iliac artery was tied by Dr. Stephenson with success as to the operation."  In another case "Paracentesis was performed with success as to the operation by Dr. Loedel," but the patient died. Sepsis was not always inevitable, at least not fatally so. On May 4, 1823, in the case of a boy of 11, with white swelling "amputation of the thigh was performed with success by Dr. Lyons" and the boy discharged "cured." And several others with the like result are recorded.

The earliest record of tonsillectomy in the hospital is in the case of  Mary McGinnis, 42, who was admitted on November29, 1838, with "Cynanch. Tons." and discharged in January, 1839, "Cured by extirpation."

The diagnoses also are of some interest. They remind us again of the series of epidemics of typhus and cholera which periodically afflicted the city.  Some of the diagnostic terms are not now used and sometimes the conditions described are less common or have disappeared. For example, frostbite was more commonly seen then than now.  The winters were probably no worse than they are now, but the conditions amongst the poor, especially  those spending their fist winter in Canada may have more severe effects frcrm the cold. The descriptive term generally used was "gelatus" and occasionally "frostbite." On December 31, 1828, there were 13 admissions for "gelatus," all being immigrants. The winter of 1832·33 must also have been severe, as there were 18 patients with "gelatus" including several in March, one in April and one in May. In 1845 there were 10 between December and February, and on March 31, 1857, a patient was admitted with tetanus and died four days later, with the note "the disease was brought on by frostbite." Conditions must have been most extraordinary to produce the entry on  June 8, 1838, of 
H. Jefferson, 21, from the U.S. with "frozen foot." He had a toe amputated on June 11 and was 
discharged "cured." It may of course have been a late effect.

Some of the diagnoses are not now used, some because we know a little more, others because we have changed one uncertainty for another, others again because we do not now see the condition -- chlorosis, for example. "Whiteswelling" we now know as tuberculosis of the kneejoint; more than once it is recorded as a reason for amputatron. "Porrigo furfurans" would not now be indulged in as a diagnosis, nor perhaps "emansio mensium."  "Psora" was a term of infinite elasticity apparently; it appears frequently.  It seems to have been applied to any obscure skin condition.  We have exchanged it for "eczema!" The term "synochus" was another favourite blanket diagnosis, with reference to any unexplained fever. It is very common in the early books, but does not appear so much after 1842.   Sometimes if was varied by "Febris continua communis," or lust "Febris."  One man was admitted on December 19, 1837, with typhus, and was discharged on December 30, with the note, "Now assisting the cook, unknown to the committee, therefore home."

A change of diagnosis, at least an additional one, was necessary in the case of Amelia Millard, who was admitted with "synochus" on August 8, 1837, and discharged on August 22nd, with the note: "Cured; was brought to bed 9 August '37" and then adds: "Uter. gest." One Irish immigrant admitted with "typhus" was discharged "cured" about three weeks later, with the note that "at 10 p.m. Oct. 13 she was delivered of a daughter." But in another case, in which the order was reversed, the result was less happy. An English girl died in 1844, with the note; "She was confined and brought to the hospital 5 days after, having been neglected by her attendants and consequently took fever and died.

There is little to guide us as to postmortems, although the original regulations of the hospital called far their being done when possible. In 1845 a note is made of "abscess found in left lobe of cerebrum".  In the case of  Pat Ryan, in 1849, with "obstruction in oesophagus" the note is: "Died; an extensive abscess caused by irritating fishbone was found behind the oesophagus, extending from the second cervical vertebra to the 7th or 8th dorsal."  Again, J. Osborn, admitted in June, 1849, with "morbus cordis" died, showing "ossification of the whole aorta."

Some miscellaneous notes are as follows. Louis Laporte, 23, in 1830 was "blown up by gunpowder." Wm. Rose, 17, came in with a fractured tibia, "running from Ste. Eustache when the rebels were in arms, he met with the accident."  One Prevost, Canadian, was admitted on August 21,1838, and died the same day from "contus, etc.; he was knocked down by the racehorse April Fool." James Miller, 25, "no church," a U.S. immigrant, admitted "for dissection". Mary Kelly, Irish, admitted in 1837 with "contusio" is shown as being discharged on the same day "having requested Dr. Campbell to procure her an abortion."  A seaman admitted with typhus in l847 "died by hanging himself to a tree in the M.G.H. garden at 10 p.m." a week later.

The poverty of many of the patients is shown in the note (August 21,1821):

"That as the clothes of many of the patients have never been regularly washed, etc., a part of the stable be  partitioned off for the purpose of purifying those parts of the wearing apparel of the patients unfit to be cleaned in the hospital on account of vermin and contagious matter (This does not comprehend linen)."

The hospital was not long in finding out that it was regarded as a general refuge. The Committee more than once insists that it be made clear that the hospital is not an asylum for the aged and infirm.

Sometimes there was difficulty in getting rid of mentally deranged patients. It was six months before they could get a lunatic woman placed in the asylum at Quebec; the Grey Nunnery was unable to take her.

Dr. Holmes complains in 1823 that:

"an inconvenience was felt from patients not leaving the hospital when discharged."
"Resolved that no provisions shah be given to any patient afterhe or she shall be
discharged by the Medical Officer in attendance,and if he or she shall not have left the hospital in 24 hours after such discharge that the patient shall then be turned out and the secretary shall notify the governor who has recommended such patient that he may remove such patient if he or she be notable to leave  the hospital."

A little later on (1825) Mr. Beniah Gibb on his visit says:

"I this day visited the hospital and found everything apparently in good order except a poor German laying in a shakedown in oneof the  upper passages, apparenty insane, and think he might be removed if possible."

And the Committee explains that

"the German is deranged and could not be kept in the ward with the other patients."

But the general tenor of all the reports is that of contentment amongst the patients and of the greatest solicitude for their care.

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