COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX00062561 State Charities Aid Association. New York Committee on hospital s« Few hos- pitals needed in greater New York. £A3&£iM* ti^&iU Columbia Untoetsitp intljeCtipofitagcrk College of ipfjpgtctang anb burgeons Uttsrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/newhospitalsneedOOstat TABLE OF CONTENTS RECOMMENDATIONS BY THE STANDING COMMITTEE ON HOSPITALS. PAGE Reasons for submitting recommendations 7 Two parts of the inquiry 8 I. Total number of sick needing hospital care 8 II. Distribution and character of hospitals • g The suggested scheme of hospital relief includes g 1. Emergency relief stations o 2 . Local hospitals g 3 . General hospitals 10 4. Convalescent and incurable hospitals 11 5. Hospitals for tuberculosis and other contagious diseases n 6. Home treatment 11 7. Private hospitals n Special advantages of the large general hospital 12 Specific recommendations in regard to location of various types of hospitals . . . . 14 Emergency Relief Stations 15 Local Hospitals 15 General Hospitals 16 Summary 19 A Report on Present Conditions and Future Needs by Phil P. Jacobs.. . 21 INTRODUCTION. Two objects of investigation; - data on which based 21 CHAPTER I. Hospital Population. Definition of hospitals, etc 22 Bed capacity should be larger than number of patients 23 Reasons for percentage of reserve 23 Opinions of superintendents solicited '. 24 Hospital capacity 24 1 . Manhattan : Present number of beds; beds to be built 24 2. Bronx: Present bed capacity; beds to be built 25 3 . Brooklyn : Present bed capacity largely centralized; new beds/. 1 .' 25 4. Queens 25 5. Richmond .' .\ . . . 26 6. Summary of Hospital Population. 26 CHAPTER II. General Population. page Necessity for studying 27 1 . Manhattan 27 General increases and decreases 27 Increases in density 28 2. The Bronx 29 3 . Brooklyn 29 General increases for 25 years. • 29 Density. 29 4. Queens. • • 3° 5 . Richmond 3 ° 6. Estimate of increase in population of Greater New York to 1920. Factors influencing estimate 30 CHAPTER III. Sickness and Hospital Needs. Reason for considering sickness 32 Scarcity of data 3 2 Table XIV explained 33 Total average daily sickness compared with other results 35 Percentages taken from Table XIV 36 The hospital rate 36 Principle of location of hospitals 37 Home treatment 38 CHAPTER IV. Conclusions. Based upon three preceding chapters. 39 I. Present needs 39 1. Manhattan , 39 General excesses and lack of beds 39 Methods of hospital distribution 42 Middle and Upper East Side 44 Lower Manhattan 45 Reasons for hospital here 45 Ambulance station needed 46 Middle West Side 46 Ambulance station needed 47 Upper West Side 47 Summary of present needs of Manhattan 47 2. The Bronx -. 48 Present needs met 48 3. Brooklyn 48 General excess and lack in borough 48 Heights and Red Hook 48 s 3. Brooklyn — Continued. page North Brooklyn 49 New hospital of 500 beds needed 52 South Brooklyn 52 Ambulance station needed 53 East New York 53 Needs met by Bradford St. Hospital 53 4. Queens 53 Present bed capacity adequate 53 5. Richmond 53 Present needs met 53 6. Summary of present needs 53 II. Future Needs 56 Determining factors in future needs 56 Increased willingness to go to hospitals 56 Needs of business sections 57 General population in 1920 57 Increase in hospital population to 1920 58 Three things affect it, viz. : Rate of sickness in 1920 58 Rate of hospital attendance 58 Increase in general population 59 How far should bed capacity be centralized and how far distributed 59 Five factors summarized 61 Distribution of future bed capacity by Boroughs 61 1. Manhattan: Middle and Upper East Side 62 Hospitals enough in 1920 between Houston and 96th Street on East Side 62 Lower East Side 62 Factors determining needs 63 100 beds needed in 1920 64 Middle West Side ._ 64 100 beds needed in addition to proposed station here 64 Upper Harlem 64 200 beds to New Harlem Hospital and ambulance station near Audubon Park 64 2. The Bronx: Lower Bronx, well supplied 65 100 more beds and ambulance station willjbe needed Jin Northern Bronx 65 3. Brooklyn: North Brooklyn 65 400 beds needed in 1920 66 South Brooklyn 66 100 more beds in Borough Park, ambulance station injBath Beach, and ambulance station in Waverly 66 3. Brooklyn — Continued. page Coney Island and Kings County Hospitals enlarged 66 Summary of Brooklyn needs 67 4. Queens: Hospital in Newton and ambulance station in Woodhaven and Rockaway Beach 67 5. Richmond: Will need ambulance station in 1920 68 6. Blackwell's Island and Chronic Institutions 68 Reasons for omitting in previous discussion 68 Present accommodations, and plans for 1920 69 How this capacity could be increased by more centralization 69 Convalescent hospital of 500 beds needed 69 Capacity of Island should be 3,000 70 7. Summary of future needs 7° CHAPTER V. Summary and Table XIX 71 Acknowledgment 73 APPENDICES TABLE I. Showing population of Manhattan and the Bronx by wards, 1880-190 5 74 TABLE II. Showing density of population and death-rate in Man- hattan, 1905, by wards 75 TABLE III. Showing population of Brooklyn, 1 880-1 905, by wards. 76 TABLE IV. Showing population of Queens, 1880-190 5, by wards, 76 TABLE V. Showing population of Richmond, 1 880-1 905, by wards. 76 TABLE VI. Showing density' of population and death-rate, Brook- lyn, by wards 78 TABLE VII. Showing density of population and death-rate, Queens, by wards 78 TABLE VIII . Showing summary of population of Greater New York, 1880-1905, by Boroughs 78 TABLE IX. Showing hospital population of Manhattan and the Bronx 79 TABLE X. Showing hospital population of Brooklyn 81 TABLE XI. Showing hospital population of Queens 82 TABLE XII. Showing hospital population of Richmond 82 TABLE XIII. Showing present capacity, proper bed capacity, and beds needed in 1920, Greater New York 82 TABLE XX . Showing proposed additions in Manhattan 83 TABLE XXI . Showing proposed additions in Brooklyn and Queens.. 8^ NEW HOSPITALS NEEDED IN GREATER NEW YOR'K. Recommendations Submitted By The STANDING COMMITTEE ON HOSPITALS OF THE STATE CHARITIES AID ASSOCIATION To the Board of Managers of the State Charities Aid Association : The location and size of municipal as well as private hospitals in New York City seems often to have been determined without studying the requirements of different localities, and particularly without formulating a general plan of adequate hospital accom- modations for the city as a whole, so that any new hospital, both as to its location and its size, would form part of a well-con- sidered and comprehensive hospital system. It is obvious that New York City, with its 4,000,000 of popu- lation should possess a hospital equipment, commensurate with its importance, both in scope and scientific development, such as obtains in many foreign cities. For the purpose of submitting suggestions to the municipal authorities upon this subject, the Committee on Hospitals, of the State Charities Aid Association, recently engaged a special agent to collect information in regard to existing hospital ac- commodations ; additions, in course^ of erection, or definitely planned for ; and present and prospective needs for additional accommodations so far as could be approximately determined. Through the kindness of several contributors, the Committee was enabled to engage the services for several months of Mr. Phil. P. Jacobs, whose report in full is appended hereto. The 8 Committee does not accept or endorse in all 'particulars Mr. Jacobs' report, but regards it as an important and valuable con- tribution to the subject. Upon consideration of the facts as presented in Mr. Jacobs' report, and otherwise known to the Committee, and after a series of meetings at which many different phases of the subject have been discussed at length, the Committee has reached definite conclusions as to the principles which should determine the loca- tion and size of hospitals to be constructed hereafter in Greater New York. These recommendations deal, not with administrative problems, but with questions of location, size and function. It is intended to outline a general plan of co-ordination of hospitals, which would make each of them serve a definite purpose in a well organized system; and to suggest how the municipality, by making from time to time additions to some existing hos- pitals, and establishing a small number of new hospitals, may secure a well developed hospital system within the next decade. The inquiry naturally divides itself into two portions : i. As to the total number of patients requiring hospital care. 2. As to the distribution and character of the hospitals. I. The fundamental considerations determining the total num- ber of patients are : a. The prospective growth of population. b. The amount and character of sickness likely to occur. c. The extent to which the sick are likely to need and to seek hospital care, as distinguished from home care, or absence of care. AVhile none of these three factors admits of exact calcula- tion, sufficient data are available to serve as a basis for outlining a general scheme of hospital location and distribution, to be revised from time to time, subject to modification as circum- stances may change, or as later and more specific data may modify present estimates. II. The fundamental considerations affecting" the distribution and character of hospitals, assuming that general conclusions have been reached as to the total number of patients to be cared for, relate to questions of environment. Of what size should hospitals be? What should be their exact location, classification, and relation one to another? What class or classes of patients should be received in each ? There should be stated at the outset, the following general principle, — that a sick person who is to receive hospital care, should receive that hospital care in his own neighborhood, if suitable surroundings and proper environment can be had there, but (with certain exceptions noted hereafter), he should be removed to some other locality, if that step be necessary in order to secure environment favorable to recovery from his particular disease, or facilities and equipment needed therefor. The application of this principle will lead to somewhat diverse results in the different boroughs of the city, and in different parts of the same borough ; for instance, — in the upper portion of the borough of Manhattan there are many open spaces and attractive sites for neighborhood hospitals, where land is still comparatively inexpensive, but no such sites are avail- able in the lower densely crowded portions of the city. The following appears to be a well co-ordinated scheme of hospital relief: i. Emergency relief stations. Relief stations with six to eight beds should be established in districts which are not at present provided with hospitals, and the population of which does not require at present the establishment of a local hospital. Each emergency relief station should be provided with ambu- lance service. The Bradford Street Hospital, which has been maintained for some years by the Charities Department in East New York, with a capacity of eight beds, is not unlike the type of relief station suggested. We assume, in this report, the re-organization of the ambulance service in accordance with the detailed recommenda- tions adopted by this Committee, and submitted December 2, 1907, to the Commission on Hospitals appointed by his Honor the Mayor. 2. Local Hospitals having 100 to 200 beds comprising mainly existing hospitals, with such additional hospitals as may be re- quired to meet the needs of large growing communities, now without hospital provision. Each of these hospitals should be IO provided with ambulance service, and should care for such classes of cases as : a. Acute surgery, such as fractures, dislocations, wounds, ap- pendicitis, etc. b. Acute labor cases. c. Acute diseases, such as Bright's disease, pneumonia, hem- orrhages, apoplexy, critical heart diseases, urgent dyspnoea, acute poisoning, convulsions, coma, delirium, typhoid fever, acute rheumatism, acute alcoholism, etc. In addition to providing for these classes of cases, there always should be a sufficient number of beds to allow a 10 or 20 per cent, margin for catastrophes and accidents, and also to receive pa- tients from the neighborhood, who perhaps more properly belong to general hospitals, hereafter described, but who, on account of prejudice, ignorance, or other causes, must first be received into a hospital in their own neighborhood. 3. General hospitals having 1,000 to 1,500 beds. These hos- pitals should be located primarily with reference to a favorable environment, and to the possibility of securing a sufficiently large area for the most approved ward classification of patients, and their distribution in a considerable number of different buildings, with opportunity for outdoor exercise for such patients as need it ; of isolation of various classes of patients requiring quiet or unlimited supply of fresh air, sunlight, or the psychic benefits of change of scene. Accessibility to large masses of population should be considered, but -should be subordinated to securing such environment as would be favorable for the best treatment of patients. In these hospitals should be received non-acute cases, such as anemias, chronic heart and chronic lung diseases (ex- cluding tuberculosis), chronic Bright's disease, neuritis, nervous prostration, hysteria, palsy, diseases of the stomach and intes- tines, cancer, syphilis, general operative surgery, including ab- dominal surgery, genito-urinary surgery, the surgery of tumors, varicose and other ulcers, etc. There should be special wards with every modern facility for the treatment- of diseases of the eye and ear, nose, and throat, gynecological cases, nervous diseases, orthopedic cases, mental diseases, and children's diseases. II 4. Convalescent hospitals and hospitals for incurables. These may be located in direct connection with the general hospitals above referred to, if these hospitals be suitably located, and if sufficient land be available therefor. Such proximity is desirable, both for reasons of economy and administration and also because many acute conditions will develop among incurable patients re- quiring treatment in a general hospital. The convalescent hospitals should provide for convalescent typhoid cases, rheumatism, tubercu- lar joints, healed fractures, etc., and many other types of disease and injury. The hospitals for permanent diseases should provide for inoperable cancers, aneurysms, cirrhosis of the liver, paralysis, locomotor ataxia, etc., etc. 5. Special hospitals for tuberculosis and for the acute con- tagious diseases. As the location and size of these hospitals are determined by special considerations, and as in many cases they should be located outside the city limits, they are not considered at length in this report. The Committee is of opinion that tuberculosis patients should be excluded from both local and general hospitals as rapidly as separate hospitals for their care can be provided. 6. Home treatment. Not all sick persons require hospital care, and in fact some patients may be treated with better results at home. In view of the fact that public outdoor relief is prohibited by the charter of this city, the municipality cannot undertake direct assistance of the sick poor in their homes. We are of the opinion, however, that a closer co-ordination of the hospitals, public and private, with the philanthropic agencies that assist the poor in their homes, would be effective in securing hospital care for a larger proportion of those who really need hospital treat- ment, and in preventing the admission of those not needing such care. It would also facilitate the return of patients from hos- pitals to their homes, and would further their gradual rehabilita- tion in the industrial world, without subjecting them to the extra- ordinary strain which now ensues too frequently upon discharge from a hospital. When the conditions in the home are, or can be made, sanitary and consistent with the maintenance of a proper standard of living, home care may be preferable for certain types of patients, notably those having temporary mild illness, or mild 12 chronic ailments not incapacitating them wholly from locomotion or possibly from light work. 7. Private hospitals. Many private, i. e., non-municipal hos- pitals, have been established from time to time. Some of these are supported wholly by endowment or voluntary contribution, others receive a proportion of their income from a per capita payment from the public treasury. A number of these hospitals maintain ambulance service, a few of them receiving appropria- tions from the City Treasury for this purpose. Mr. Jacobs' report contains a table (see p. 26), showing what extensions are in course of erection, or definitely planned for by these hospitals. In so far as additional accommodations become available through private effort (other than those now contemplated), other than by the enlargement of existing private hospitals, or the establishment of additional ones, the provision to be made by the city in these localities may be correspondingly reduced. Certain characteristics and advantages of large general hos- pitals for the classes of patients enumerated above as suitable for care in general hospitals as distinguished from local hospitals may profitably be considered. These are: 1. Patients may be classified according to their ailments for treatment and study, separate wards or pavilions being ex- clusively devoted to groups of diseases. For example, in a hos- pital of 100 to 200 beds there will be at any one time only a small number of cases of any particular disease. In the large general hospital there will be always enough of each class of cases to constitute a special service, with a special visiting staff ; and, if need be, a gymnasium for modern mechanical methods of exercising paralyzed muscles; a large hydrotherapeutic estab- lishment for special methods of bathing, douching, massaging, etc.; an elaborate electrical system of apparatus for treatment; etc., etc. 2. The greatest modern discoveries in the treatment of dis- ease have been evolved from large hospital services, as for instance the original experiments of Lord Lister in antiseptic surgery, and the discovery of diphtheria antitoxin by von Behring. In the treat- ment of typhoid fever, for instance, one cannot expect to achieve, with two or three cases in a ward full of mixed sreneral diseases, the 13 scientific advances which may be obtained in a large service pre- senting simultaneously dozens of typhoid cases in all stages of the disease. 3. The best work in diagnosis and treatment to-day is only possible through co-operation with a large clinical laboratory, where bacterial cultures, blood examinations, etc., can be made and where germicidal serums,' antitoxins, etc., can be prepared, and where pathological work can be carried on. For this a competent staff is needed and their work cannot be scat- tered over five 200-bed hospitals, and done as well as it can be done in a single institution five times the size. 4. The advantage to the medical profession of a large, properly classified hospital service are incalculable. The treatment of the individual sick within its walls constitutes but a small part of the work of any modern hospital, for its influence is educa- tional, and benefits the entire community. The visiting and house staffs and the nurses are all destined to work ultimately among the sick of the community, a large majority of whom never enter hospitals. The larger and better classified the hospital service, the greater the experience and better the training given by it. 5. The large general hospital permits the use of the low pa- vilion type of construction, such as is seen in the great modern European hospitals. The plan lends itself readily to increase in capacity from time to time and has distinct advantages in ques- tions of heating, ventilation, light and segregation and isolation of various classes of patients. 6. New York City ought to be the great center for medical education in the country, attracting physicians and nurses for study from every state. At present this is far from the fact. It possesses some 60 general hospitals, with a total bed capacity of nearly 10,000, most of these hospitals being small and im- perfectly equipped for treatment, as compared with advanced hospital construction elsewhere ; but it has not a single large general hospital with a service classified so as to afford wards for all the important types of disease, and with all the structural and environmental facilities requisite for treatment. In pro- portion as minor scattered hospitals invade the fields of general hospital work, outlined above, the development of the large general hospital type of structure with all its unique possibilities 14 for treatment, for medical education, for scientific research and opportunities for humanitarian medical discovery will be retarded. 7. The published case records of a large classified service are not only of much practical use to the institution itself but are of the greatest possible value to medical science. To indicate how varied the equipment of a large modern gen- eral hospital should be, the following outline of what is provided in many modern hospitals elsewhere is presented : Administration building, separate kitchen and laundry build- ing, power house, nurses' home, crematory, and disinfection plant, ice house, large pathological building with laboratories, morgue, large building for clinical laboratory with bacteriologi- cal rooms, etc., workshop and wagon house, filtration plant, day rooms for convalescents, libraries for patients, house staff, and pathological department, clinical record room, large bath house containing, besides mechanical apparatus, a gymnasium, Roman, Turkish, hot-air and electric-light baths, sand baths, carbonic- acid baths, showers and douches of all kinds, with proper ad- justments for regulating water pressure and temperature, be- sides a large plunge bath and massage rooms. There should be also inhalation rooms for treatment of respiratory diseases, an extensive electric department for the Roentgen ray, Finsen light, etc., and a photograph department. Balconies should open from the wards into which patients' beds may be easily moved, and flat roofs should be provided for exercise, and protected with wind shelters, etc., for open-air treatment of many diseases. The increasing variety of disease other than tuberculosis, such as pneumonia, anemias, etc., for which the medical profession are now demanding open-air treatment, emphasizes the import- ance of placing the large general hospitals upon sites remote from dust, noise and other objectionable features of dense popu- lation environment. SPECIFIC RECOMMENDATIONS. The following specific recommendations in regard to the loca- tion of various types of hospitals, above described, are respect- fully submitted. As to each type of hospital we have indicated 15 first what the existing needs are, and second the needs to 1920, so far as they can be foreseen : EMERGENCY RELIEF STATIONS. I. PRESENT NEEDS. Manhattan. — 1. Between the entrances to the Brooklyn and the Manhattan bridges, to the south and east of Chatham Square (unless St. Gregory's Hospital secures sufficient financial sup- port to insure permanent service). 2. Middle west side, near the new Pennsylvania Station, ap- proximately midway between the New York and Roosevelt Hospitals. 3. One Hundred and Twentieth Street and East River, on or near the old Harlem Hospital site. Brooklyn. — 4. Near Flushing Avenue and Broadway. 5. South Brooklyn, in Borough Park District, between Bath Junction and Ocean Parkway. II. FUTURE NEEDS TO 1920. Manhattan. — 6. On west side of upper Harlem, near Audubon Park, or to the north. 7. Bowery and Spring Street. Bronx. — 8. Near Kingsbridge Brooklyn. — 9. In Williamsburg, near AVilliamsburg Park. 10. In Bath Beach. 11. In south part of Waverly District, between Remsen Ave- nue and Rockaway Parkway, near Ford's Corner Station. Queens. — 12. In western lamaica, in Woodhaven or Richmond Hill. 13. In Rockaway Beach. Richmond. — 14. On southern shore, near Red Bank. LOCAL HOSPITALS. I. PRESENT NEEDS. .We are of the opinion that no additional local hospitals are , required at present. i6 II. FUTURE NEEDS TO 1920. Local hospitals of substantially the following sizes should be established in the following neighborhoods, so as to be opened at approximately the dates indicated below: Manhattan. — 1. One hundred beds to replace ambulance sta- tion No. 2, on Middle West Side, by 1915. 2. Two hundred beds to be added to the New Harlem Hos- pital by 1920. 3. One hundred beds on Lower East Side, near Bowery and Spring, if this should be found necessary, by 1920. The Bronx. — 4. One hundred beds to be added to New Ford- ham Hospital, by 1920. Brooklyn. — 5. One hundred beds to replace ambulance station No. 3, near Flushing and Broadway, by 1912. 6. One hundred beds to be added to Cumberland Street Hos- pital, by 1920. 7. One hundred beds in East New York, by 1912 (The New Bradford Street Hospital). 8. One hundred beds in Borough Park to replace ambulance station No. 4, by 1920. 9. Two hundred beds to be added to New Coney Island Hos- pital, by 1920. Queens. — 10. One hundred beds in Newtown, by 1920. GENERAL HOSPITALS. The new Bellevue EJospital would naturally be one of the general hospitals indicated in the above plan of hospital organi- zation. The present plan as approved by the city authorities, upon which construction has made some progress, provides with an ample allowance of floor space and cubic air space for 2,000 beds. If it were possible to reduce this number somewhat, say to 1,600 beds without impairing the value of the plan as a whole, and with a view to expending the amount so saved in the erection of other general hospitals elsewhere, we believe such a step would be wise. It cannot be too strongly stated, however, that the total number of additional general hospital beds needed in Manhattan and The Bronx by 1920 will be largely in excess 17 of 1, 600. We are of the opinion, however, that, beyond enlarg- ing Bellevue to 1,600 beds, the excess should be located prefer- ably elsewhere than at 26th Street and East River. Blackwell's Island offers very exceptional and extraordinary advantages for a general hospital, including convalescent and chronic wards, with its abundance of light and air, its coolness in summer, its ever-changing panorama of passing boats, its ac- cessibility to four of the five boroughs of the city, its cheapness of maintenance (through water transportation of fuel and sup- plies), and the fact that the city already owns the land. A boat is now under construction for the Charities Department w r hich will be able to convey an ambulance from Manhattan Island to the hospitals on Blackwell's Island in five minutes. The present inadequate means of access to Blackwell's Island, all patients being sent from East 26th Street, and the boat leaving but twice a day, entails many hardships through long delays and is one of the most serious restrictions upon the usefulness of the hospitals on Blackwell's Island. It is exceedingly desirable that provision should be made for the quick conveyance of am- bulances from points on Manhattan Island, opposite Blackwell's Island, to Blackwell's Island, at frequent intervals and with the minimum of delay. If it should be found to be practical to pro- vide elevators in connection with the Blackwell's Island Bridge, by which ambulances and visitors could reach the island at any time, this would contribute still further to the usefulness of the island hospitals. We recommend that there be a general hospital at the upper end, and one at the lower end of Blackwell's Island, with some administrative features in common, each to be developed to not more than 1,500 beds. This would leave the central two-thirds if not three-fourths of the island available for park purposes as soon as the penal institutions and the almhouse are removed,, and for additional hospital pavilions, if required in the future- While Blackwell's Island offers these exceptional opportuni- ties as contrasted with the crowded sections of Manhattan, southeast Bronx, and parts of Brooklyn, its advantages are not superior to these of the outlying sections of the city, and it w^ould in our judgment be a mistake to bring patients from these outlying parts of the city to Blackwell's Island, unless the particular type of disease required facilities for treatment, which are not available except at the large general hospitals maintained there or at Bellevue. The borough of the Bronx should in time have its own gen- eral hospital. Fordham Hospital, facing Bronx Park, has an admirable location and we recommend that it be enlarged as may be required for general hospital purposes for this borough ; and that land for this purpose be acquired now, when it can be bought cheaply. In Brooklyn, the Kings County Hospital, providing at present for 600 patients, should, in course of the next decade, be enlarged to a capacity of 1,000 patients. There should also be established without delay an additional general hospital in the borough of Brooklyn, in the Ridgewood district, near Decatur Street, and Irv- ing Avenue, where excellent sites at reasonable prices are available. Wards for chronic patients already exist at the Kings County Hospital, which, however, are inadequate. Suitable wards for convalescents should be provided at this institution. Both chronic and convalescent wards should be provided at the pro- posed additional general hospital in Brooklyn. The additional beds on Blackwell's Island would naturally be devoted in part to these classes of patients. To sum up, the proposed additional general hospital provisions would be : I. PRESENT NEEDS. Brooklyn. — Five hundred beds in the Ridgewood district, northwest of the Cemetery of Evergreens, near Decatur Street and Irving Avenue. (Ward 28.) II. FUTURE NEEDS TO 1920. Brooklyn. — Four hundred beds to be added to the Kings County Hospital. Blackwell's Island. — Seven hundred beds to be added to the City Hospital, and five hundred beds to the Metropolitan Hospital (making the capacity of each 1,500 beds). i 9 SUMMARY BY TIME. A summary of the various classes of hospitals proposed above, in addition to those now in course of construction, on the basis of the proposed date of construction is as follows : I. PRESENT. NEEDS. Manhattan: Bedg 3 Emergency relief stations 24 Brooklyn: 2 Emergency relief stations 16 1 General hospital ' 500 Total present needs 540 II. FUTURE NEEDS TO 1920. Manhattan : 2 Emergency relief stations 16 1 Local hospital, by 191 5 100 Enlarge Harlem Hospital, by 1920 200 Enlarge Blackwell's Island General Hospitals, by 1920 1,200 The Bronx : 1 Emergency relief station 8 Enlarge Fordham Hospital, by 1920 100 Brooklyn : 3 Emergency relief stations 24 4 Local hospitals, 2 in 1902 ; 2 by 1920 400 Enlarge Coney Island Hospital, by 1920 200 Enlarge Kings County Hospital, by 1920 400 Queens : 2 Ambulance stations 16 1 Local hospital, by 1920 100 Richmond : 1 Ambulance station 8 Total future needs to 1920 2,772 Total present and future needs to 1920 3^3 12 20 To provide 3,312 beds by 1920, would mean an average addition of 276 beds per annum. Respectfully submitted, HELEN F. DRAPER, Acting Chairman, HOMER FOLKS, Secretary, CAROLINE McP. BERGEN, JOHN S. BILLINGS, GEORGE BLAGDEN, GEORGE F. CLOVER, J. T. DURYEA, C. IRVING FISHER, LEWIS F. FRISSELL, TFIEODORE L. FROTHINGHAM, S. S. GOLDWATER, JAMES H. HAMILTON, A. S. KAVANAGH, FRANKLIN B. KIRKBRIDE, EDGAR J. LEVEY, SAMUEL LLOYD, WILLIAM P. NORTHRUP, ALEXANDER C. PROUD FIT, W. GILMAN THOMPSON, GRACE T. WELLS, LINSLY R. WILLIAMS, Committee. New Hospitals Needed in Greater New York. A report by Phil P. Jacobs,- January i, igol INTRODUCTION. In Greater New York, where the care of the sick in its 160 hospitals with their army of 200,000 patients treated each year, lays annually upon the municipal and private purse a burden of over six and one-half millions of dollars ; and where the problems relat- ing to this care are constantly becoming" more and more complex, it is obviously of the greatest importance that there should be some well-planned and well-regulated system of hospitals and a definite policy upon which new hospitals should be located. Yet, this city, with a length of over 35 miles and a breadth of over 10 miles and with a population of over 4,000,000, has nothing which can rightly be designated as a policy upon which it can base the location of its hospitals to meet either the needs of the present or those of the future. To establish such a policy, based upon a careful consideration of all the facts, an investigation of the present hospital situation in Greater New York has been made, in order that some scheme might be evolved, which should provide for the care of the sick needing hospital treatment both now and up to 1920 with the greatest degree of efficiency, and which at the same time should involve a minimum cost to the city. Two objects, or ends to be derived, were kept constantly in mind in this investigation. The first of these objects was to arrive at definitely proven conclusions, as to what additional general hospital accommodations are needed to meet the present needs of the city. The second object was to gain definite conclusions by which we might be able to foresee what new hospitals will be needed in 1920, and where they should be located to meet the needs of that date. The data on which this first question was decided included per- sonal visits to every one of the fifty-nine general hospitals in the city, a careful personal examination of the different districts in which these hospitals work, together with an analysis of the population, and the number of sick needing hospital treatment in each district. In determining the second question as to how many beds are needed for future needs, the. subject of population was carefully studied. Forecasts, based upon all the known factors, such as increased 22 transit facilities, were made. The various facts which will deter- mine the number of people needing hospital care in 1920 were sifted and weighed for their respective values in drawing conclusions. The results obtained upon this part of the investigation, it might be stated at the outset, are not blind guesses, nor superficial conclu- sions, but they are based upon a method, and upon principles which insure the most approximate exactness. These two conclusions, then, may be anticipated, that the city needs more hospitals now to fill the needs of to-day ; and that it will need many more hospitals in 1920. CHAPTER I. HOSPITAL POPULATION. Census and Capacity of Existing General Hospitals. In this report the word " hospital," unless otherwise qualified, means a general hospital, i. e., a hospital for the reception and treat- ment of all kinds of medical and surgical cases which are not sent to hospitals established for the care of particular diseases or class of diseases. This investigation has to do chiefly with the need for additional general hospitals. Hospitals for contagious diseases are excluded from the present inquiry because their extent, location, and management involve questions with which only the Department of Health is fitted to deal. Admission to them is on a wholly dif- ferent basis from the admission to general hospitals, and their ambu- lance service is wholly dissociated from the ordinary ambulance ser- vice of the city. Hospitals and sanitoria for the care of tuberculosis are also excluded from the present inquiry, partly because they are not a part of the general hospital system of the city, their location, number, and character being governed by special conditions, and partly because of the fact that a corresponding inquiry as to the number of additional hospital beds required for cases of tuber- culosis has been made by the Committee on the Prevention of Tuberculosis of the Charity Organization Society. We have sought to ascertain by all available sources of information the number of general hospital beds required for the proper care and treatment of the sick in this city at the present time and the number of additional beds that will be required by the year 1920. By " hospital population," as used here, is meant the number of people who are in the general hospitals of the city or locality on a given date. 23 This study of hospital population was made through personal canvass of every hospital in the city. At each hospital of Greater New York the census was taken for three different dates, January I, 1905, September 1, 1905, and March 1, 1906. The full bed capacity in use on March 1, 1906, was also taken. The reason for taking the census on these different dates was that the variations of seasons might be noted in their effect upon the hospital population. Thus it will be noted in Table XIII that the number of patients in the hospitals of the city on March 1, 1906, is nearly 800 in excess of what it was on January 1, 1905. This is due chiefly to the fact that the hospital population is usually smaller in January than in March. Needed Excess in Bed Capacity. In any investigation of hospital population which has for its end the determining of what is the proper bed capacity of the institu- tions, it should be noted first of all that this bed capacity in a given institution or in a given group of institutions should always exceed considerably the number of patients. There are various reasons for this. Medical cases should not be put in surgical wards or vice versa. Women, moreover, cannot be placed in male wards or the reverse. Adults cannot be put in children's wards, nor can the ordinary medical or surgical patients be placed in wards used for isolation of infectious and contagious diseases. Thus, though a hospital may show an excess of beds over patients on any given day, it may still be overcrowded in many of its de- partments. As seen in Table IX, for instance, the New York Post Graduate Hospital had on March 1st but 161 patients with a bed capacity of 216. There were on that day, however, seven cots in the surgical wards of the building and a waiting list of over 20 in the women's surgical ward. In Mount Sinai Hospital about one-tenth of the beds in the institution are kept constantly in reserve for emergency and isolation cases. It can thus be seen how any hospital or group of hospitals may speak of overcrowding and yet show from actual figures a considerable excess of beds over patients in the hospital on any given day. So in the city as a whole there may be a considerable excess of beds over patients, but this does not necessarily indicate that there is, then, no need for more hospital accommodations. It may indicate a needed excess, as above men- tioned, or it may indicate that there are more beds in one locality than are necessary and not enough in another. On the other hand it may indicate a certain marked preference on the part of the public for some hospitals as against others. Thus, it is a most conservative estimate to say, that in a city the size of Greater New York, at least one-tenth of the bed capacity must be constantly in reserve, and that about another tenth is very likely to be in reserve on account of poor location or for some other reason. 24 During visits to the hospitals the opinions of superintendents were solicited in regard to needs for hospitals in their own neighborhoods. With these preliminary remarks we take up a consideration of the hospital population of the city by boroughs : i. Manhattan. In Manhattan the total number of patients in all general hospitals, including those on Blackwell's Island, was 4,774 on January 1, 1905 ; on September 1, 1905, it was 4,608; and on March 1, 1906, it was 5,060. The number of beds in these same hospitals on March I, 1906, was 5,917. On December 1, 1907, the number of patients in the twenty-five general hospitals of Manhattan was 3,697, exclud- ing the Blackwell's Island hospitals, and including these two institu- tions, 4,750. The bed capacity of the Manhattan hospitals, exclud- ing Blackwell's Island, on the above date was 4,858, and including the island hospitals, 6,175. It will thus be seen at the outset that the excess of beds in Manhattan is only 9.3%, which is fully 10% under what ought, even under the most ordinary circumstances, to be allowed for emergency, poor location, or other reasons. Besides the beds now available, additions to the present bed capacity are contemplated, and some of them are already in course of construction. (See Table XX.) The Sydenham Hospital will soon build an entirely new institution of 200 beds somewhere in Harlem. The new Red Cross Hospital accommodates 52 patients. The New Harlem Hospital recently completed accommodates 150 patients. The plans for a " Greater Bellevue " with 2,000 beds have been approved and work is in progress on two pavilions, which will be completed in 1908. This will mean an addition of 1,000 beds to the present capacity. In all the definitely known increases for the next fifteen years will aggregate 1,460 beds. (See Table XX, p. 83.) The St. Francis Home and Hospital on 5th Street has recently been closed for general hospital purposes, and is used now only for a home for chronic and indigent aged patients. The Trinity Hospital has also closed its doors. Seven hundred eighty beds are being considered as additions to different hospitals, but no definite plans are as yet decided upon ; and these do not figure in this report. It will thus be seen that when all the definite additions to the bed capacity of Manhattan are completed there will be over 6,300 gen- eral hospital beds in the borough in 1920 excluding those on Black- well's Island. 2. The Bronx. In the Bronx there were on March 1, 1906, five hospitals with a bed capacity of 1,305. The number of patients on January 1, 1905, was 588. At a later season, March 1, 1906, the number had increased to 841. On December 1, 1907. there were 4 hospitals with 1,265 beds and 888 patients in the Bronx. The tendency on the 25 part of hospital managers to move northward in Manhattan and The Bronx is evidenced by the large number of hospital beds in the southern part of The Bronx. Two of the largest general hospitals in the city, the St. Francis and Lincoln, are situated here within a few blocks of one another, the former one being but recently opened. Another one of over 200 beds, the Lebanon, is a short distance away. The details of the different hospitals in this section may be found in Table IX, p. 80. 3. Brooklyn. The hospital situation of Brooklyn is considerably different from that in Manhattan. Of the 21 general hospitals in the city almost all are located in the older section of the city. A line two miles long drawn in a circle from a point on McDonough and Stuyve- sant Streets reaches 15 out of the 21 general hospitals now in opera- tion in the city, and within a two and a half mile radius every hospital except two will be included. It can thus be seen at a glance that the outlying sections of Brooklyn are practically without hos- pitals at all. On January 1, 1905, there were in the general hospitals of Brooklyn 2,045 patients; on September 1st there were 1,983; on March 1st there were 2,241. The bed capacity of the twenty gen- eral hospitals open on March 1st was 2,719. The new Jewish hos- pital, with a potential capacity of 200 beds, was opened December 7, 1906. On December 1, 1907, the number of patients was 2,276, and the number of beds in the 21 general hospitals then open was ;,882. Several additions to the present hospitals and more new hos- pitals are being planned in Brooklyn. At the Long Island College Tospital the work of remodelling the entire institution is under way, and when completed will add 125 beds to the present capacity. The new Bradford Street Hospital and the new Coney Island Hospital will accommodate 100 beds each. Altogether the definite additions to the general hospital bed capacity of Brooklyn within the next fifteen ^ears will aggregate 918 beds, with about 400 more as indefinitely ;onsidered. (See Table XXI, p. 83.) When all these known addi- tions are completed the bed capacity of Brooklyn should be 3,800. Table X, p. 81, gives details of the hospital population of Brooklyn. 4. Queens. There are five hospitals in the Borough of Queens, one in Long Island City, two in Jamaica, one in Flushing, and one in Far iRockaway. The total bed capacity of the five hospitals is 389, and 'they had 288 patients on March 1, 1906. The bed capacity of the five hospitals on December 1, 1907, was 395, and the number of patients was 314. (See Table XI, p. 82.) At present a wing to accommodate 125 beds is in building at the Long Island City Hos- pital. This will bring the bed capacity of Queens up to ove" 500. 26 5. Richmond. The Borough of Richmond has but two hospitals, both in the northern end of the island. These seem to be amply sufficient for all the present needs of the borough. The bed capacity of the two hospitals is 231, and the number of patients on March 1st was 159. The bed capacity of the hospitals was 227 on December 1, 1907, and the number of patients was 219. (See Table XII, p. 82.) No definite plans are being considered at present for additions in this borough. 6. Summary for the Hospital Population. Table XIII, which follows, gives a summary of the hospital popu- lation of Greater New York. It will be seen from this table that there are 59 general hospitals in Greater New York with a bed capacity of 10,926 in 1908. On March 1, 1906, there were 8,589 patients in the five boroughs, including Blackwell's Island, and on January 1, 1908, there were 8,447. The total proposed definite addi- tions to the bed capacity of Greater New York aggregate 2,853. When these additions are completed there will be in Greater New York nearly 13,800 general hospital beds. TABLE XIII. SUMMARY OF HOSPITAL POPULATION GREATER NEW YORK. Beds pro- posed in definitely Number of Number of Patients. Number known OF Borough. hospitals Jan. i, Jan. 1, 1905. 1908. Sept. 1, 1905. Mar. 1, 1906. Jan. t, 1908. to 1920. Remarks. Manhattan.. 25 3,477 3.499 3,815 4,858 1 ,460 The Bronx.. 4 588 55o 841 1,255 Brooklyn. . . 21 2,045 1,983 2 , 241 2,874 918 Queens 5 242 268 288 395 125 Richmond. . 2 124 121 159 227 Blackwell's Island , . 2 1,297 1 , 109 1,245 1,317 350 Totals.. 59 7,773 7,530 8,589 10,926 2,853 About 1,200 beds, in- definite additions. are being considered, but no plans com- pleted. 27 CHAPTER II. GENERAL POPULATION. The Index of Future Growth is Past and Present Growth. In considering the general population of Greater New York in its effect upon the problem of hospital location, it is of great impor- tance to note both the growth and the distribution of the great masses of people who have come into the city within the last 25 years. In order that a forecast of the population in 1920 may be made, it is necessary to ascertain both the past and the recent growth of the city in its different sections. To obtain an adequate idea of this growth the subject was approached in two ways. The actual increases for five, ten, fifteen, and twenty-five year periods with the percentages of increase were obtained for each ward in the entire city. Then these were summarized and the results tabulated bv boroughs. (See Tables I, III, IV, V, and VIII.) By this method the percentage of growth in every ward and district of the city was obtained. A second way of securing the same results was through a comparison of the density of population in the different wards for fifteen years back. This showed the increases in the number of people per acre in the different localities, denoting whether a district was being built up or not, or whether it was crowded beyond a proper limit. (See Tables II, VI, and VII, pp. 74-79-) 1. Manhattan. Approaching the subject of population of Manhattan from the standpoint of actual increase in numbers, we note that during the past twenty-five years the population of Manhattan has increased 75.1%. (See Table I, p. 74.) This figure, however, does not indi- cate the great movements and changes in population which have taken place in Manhattan during that period. Table I shows that, of the 22 wards in Manhattan, 13 decreased in population between 1880 and 1890, although the borough as a whole increased 25.6%. In the next decade 8 wards, including 6 of the 13 above mentioned, show a decrease,, while the city increased 22.9%. For the period between 1900 and 1905, there was an increase in all the wards but five, only one of them having decreased in the two preceding decades. The total increase for the borough was 14.2%. Con- sidering the twenty-five-year .period as a whole, we note that of the six wards which show a decrease, four are below Canal Street. The two others are just above Canal Street on the west side. All of these wards are in a section where business is rapidly driving out the resident population and where few people, except the janitors of blocks, now live. In fact, the section below Canal Street, com- prising wards 1, 2, 3, 4, 5, and 6, when taken as a whole shows an 28 almost steady decrease. The district just above this on the West Side, containing wards 8, 9, 14, and 15, has remained almost sta- tionary in population for 25 years. But on the East Side, between Canal and 14th Streets, the population has increased 59% in the past 25 years. The territory between 14th and 40th Streets has remained almost stationary*, increasing less than 5% for 25 years. This is due, also, to the growing business interests of the district. On the other hand, the up-town wards have shown phenomenal in- creases in the same period. From 1880-1905 wards 19 and 22, lying between 40th and 86th Streets, increased 87.8%, while the 12th ward, comprising all north of this district, multiplied its population seven times, increasing 627.2%. It will thus be seen that the whole tendency of the population of Manhattan, so far as it is moving within the borough itself, seems to be towards the northward, into Harlem and the Bronx sections. The lower East Side, comprising wards 7, 10, 11, 13, and 17, although it is increasing, and has to-day a very large population, is nevertheless, increasing at a decreasing ratio to the population of Manhattan as a whole. The up-town sections, above mentioned, are, however, increasing at an increasing ratio to the population of Manhattan as a whole. This is very obvious when we note that in 1880 the wards 7, 10, 11, 13, and 17, comprising the lower East Side, held 25.4% of the entire population of the city, while the three uptown wards, the 12th, 19th, and 22d, contained 29.1%. In 1905, however, the percentage of the entire population in the Lower East Side wards had decreased to 23.1%, while that in the uptown wards had almost doubled, increasing to 52.2%. Density and Population. The increase of the population of Manhattan is further noticed in Table II, p. 75, which shows the growth in density of the city by- wards from 1890 to 1905. The city as a whole increased 58.74 per- sons per acre in the 15 years, which seems all the more remarkable when it is considered that there are 10 wards of Brooklyn which to- day have a less density than 55 per acre, and that the density of the borough of Queens is less than 3 persons per acre. As is gen- erally known the Lower East Side is the most densely settled area of the city, some districts containing nearly 1,000 persons per acre. In every ward in this section, except the 10th and 13th, from which considerable area was taken out for the approach to the new Wil- liamsburgh bridge, there has been an increase of density within the last five years. Between 1900 and 1905 the nth ward increased 99 persons per acre. The 17th ward, adjoining it, increased 57 persons per acre. Although the growth in the uptown wards does not show so large increases per acre, the size of these wards is much larger than the downtown ones, and hence the density growth would 2 9 not be so marked. A growth of 26 persons per acre in the 12th ward in five years is a far larger growth proportionately than one of 50 on the Lower East Side, whos.e five wards have less than one- fifth of the area of the 12th ward. 2. The Bronx. Twenty-five years ago the Bronx was considered the " country." With a population of but little over 50,000 in 1890, it has increased 205.5% within the last fifteen years and had in 1905 a population of over 270,000. Between 1900 and 1905 the increase in the Bronx was 354%. As before stated, the population of Manhattan, moving northward, is finding relief from the over-crowded sections of the down-town districts in the suburban sections of the Bronx and Harlem. Table I shows the increase in the Bronx for the different periods from 1890 to 1905. 3. Brooklyn. The increase in Brooklyn from 1880 to 1905 was 125.9%, which is 50% greater than the increase in Manhattan for the same period. The most rapid growth in Brooklyn has been during the last five years, a growth which is going on at present. While several of the wards, as shown in Table III, p. 76, show decreases for the periods before 1900, only one shows a decrease for the period of 1900 to 1905, and this decrease of less than 2% was in the 13th ward, where a large number of buildings were destroyed to make way for the new bridge plaza. The most rapid growth in Brook- lyn has been in the territory annexed in the last fifteen years in the East New York, Flatlands and Bay Ridge sections. Within the five years from 1900 to 1905 the population increased 42.4% in the 26th ward, which comprises East New York and Brownsville ; 50.4% in the 30th ward, comprising Bay Ridge, Bath Beach, etc. ; 53.4% in the 31st ward, taking in a large area of Flatbush ; and 60.5% in the 32d ward, comprising the town of Flatlands. Among the other sections of Brooklyn showing rapid growth between 1900 and 1905 are the 24th and 29th wards, east and northeast of Pros- pect Park. The latter ward gained 58.4% in the five-year period. Density. • Unlike Manhattan, there are no wards in Brooklyn which have a very large density of population, and there are none which show within five years anything of an in- crease approaching to__ fifty persons per acre. The 16th \ward, which has 249.3 persons per acre (see Table VI, p. 78), increased 18 persons per acre during the past five years. I From this figure in the 16th ward, which presents the maximum I density in Brooklyn, the density of the different sections of Brook- lyn drops to less than three persons per acre in the 32d ward. The 3Q Borough of Brooklyn as a whole has a density of but 33.9 persons per acre, as compared with 187.3 persons per acre in Manhattan. There are 20 wards out of a total of 32 in Brooklyn which have a density under 100 per acre. It will thus be seen at a glance that there are large tracts of Brooklyn which are but sparsely settled and that the number of vacant lots, even in the most crowded sec- tion, is far in excess of what it is in Manhattan, a fact which means that Brooklyn has much more room than Manhattan to develop and grow. 4. Queens. The most rapid growth of population in any borough of Greater New York during the past twenty-five years has been in the Borough of Queens. From less than 60,000 in 1880, the Borough of Queens has increased to nearly 200,000 in 1905, or at the rate of 268.3%. This is more than double the rate of increase in Brooklyn and nearly four times that of Manhattan. Of the various sections of Queens, the 2d ward, comprising the town of Newtown, has had the most rapid increase within the past 25 years, while three of the four remaining wards have increased over 100%. (See Table IV, p. 76.) As before stated, the density of Manhattan is 187.3, an d that of Brooklyn 33.9 per acre. The density of Queens is but 2.4 per acre. When it is considered that the area of Queens (88,863 acres) is more than double that of Brooklyn, and is seven times that of Manhattan, it can be seen at once how large an area of Queens is sparsely settled, and what an opportunity is offered for- increase in population. 5. Richmond. Richmond is the only borough of Greater New York which is increasing at a decreasing ratio to the city as a whole. The increase in Richmond from 1880 to 1905 is 86.8. For the first two decades, from 1880 to 1890, the population of Richmond increased at a com- paratively rapid rate. But for the last five years it has not increased very rapidly, only 8.7%.' (See Table V.) The largest increases between 1900 and 1905 have been in wards 1,3, and 5, or the towns of Castleton, Northfield and Westfield. The eastern end of the island has had but slight increase, and in the 4th ward, Southfield, there was a slight decrease. 6. Estimate of Increase in Population of Greater New York to 1920. In 1905, according to the New York State census, Manhattar had a population of 2,112,380. The increase from 1900 to 1905 I was at the rate of 14.2%. Figures show that during the past fifteen ' years Manhattan has not only increased at the same rate as for 3i fifteen years before, but it has compounded its increment. Thus it seems a safe estimation for fifteen years to come to triple the actual increase of Manhattan from 1900 to 1905 and add besides 10% of the quinquennial increase, compounded each five years. Thus for example, the increase in population of Manhattan from 1900 to 1905 was 262,604. Ten per cent of this amount compounded each five years would be 31,774. By adding this figure to three times the above increase (786,812) we make the population of Manhattan in 1920 stand at 2,931,288, or an increase for the 15 years of 34.1% as compared with 39.4% from 1890 to 1905. The Bronx, with its rapid increase in population, will undoubtedly keep up its present rate of increase, and it is probably a safe esti- mate to say that a 20% increase will not be too much. This should make the population of the Bronx in fifteen years 445,449, an increase of 63.9% for the fifteen years, as compared with 205.5% from 1890 to 1905. On a most conservative estimate of increase for the next fifteen years Brooklyn should have 2,284,264 people in 1920, an increase of 68.6% for the fifteen years slightly larger than the increase 61.5% for 1890 to 1905. Queens, on a basis of 30% quinquennial increase, should have 406^676, an increase of 105.1% as compared with 127.7% from 1890 to 1905. Richmond, on a basis of 10%, should have 94,700, or a 30% increase, as compared with 40.9% from 1890 to 1905. Thus the population of Greater New York in 1920 would be 6,162,377. This is an increase of 53.5% for the next fifteen years, as compared with 55.5% increase from 1890 to 1905. This rate of growth for the next fifteen years is, perhaps, too conservative in crediting the city with a lesser migration from outside sources than before, in spite of the fact that this migration, especially that from country to town, is increasing. It is deemed well, however, to have a conservative estimate here, in order that due allowance may be made for any prevention of the city's growth, and for any false speculation on the future of New York. It is thought, there- fore, that 6,162,377 will be the population of the city at least by 1920. The above estimation of population in 1920 is taking into con- sideration the probable effect of the improved rapid transit facilities to Long Island and to the upper end of Manhattan and the Bronx. There is little doubt, when all the tunnels under the East River are completed and the transit facili- 'ties to the Bronx are made more adequate, that population \will flow in these directions. Brooklyn also will receive its share of the increase. Between 1900 and 1905 in both Brooklyn and Manhattan, although the population increased very rapidly, the percentage of the population of Greater New York was less in 1905 than in 1900 in both of these boroughs. In 1900 Brooklyn had 32 33-9% °f the population of Greater New York. In 1905 it had decreased to 33.8%. In Manhattan a larger decrease was noted, viz., from 53.8 to 52.6. In the Bronx and Queens, however, the percentage of population of Greater New York increased. This fact seems to indicate also that the population is moving to the suburbs. But, if present indications are of any value, Brooklyn, as the above estimation shows, should have a share of the population of the Greater City more nearly equal to that of Manhattan in 1920. These two movements then must be accounted for in the study of population, the filling up of the suburbs of Queens, the Bronx and Richmond, and the more rapid development of Brooklyn. CHAPTER III. SICKNESS AND HOSPITAL NEEDS. How Proper Bed Capacity is Computed. An investigation of hospital accommodations which entirely ignores the amount of sickness requiring hospital care in a city or a given locality must be incomplete. To attempt to locate new hospitals or to add to existing ones without some general idea at least of the number of sick in a district requiring hospital care, is obviously an anomaly. Yet such actually has been the method of location of hospitals heretofore in this city. If the casual observer should inquire of almost any hospital superintendent in New York how many sick people there were in his district who were requiring hospital attention he would receive from the hos- pital official an answer to the effect that he didn't know and had never thought of that phase of his work. While it is true that the present distribution of general population, as well as that of the hospital population, discussed in the two preceding chapters, may serve as a basis for calculating the number and distribution of those needing hospital care, it must be supplemented by a careful computation from all data available as to the exact number of sick persons in any given district. It is evident that, if the number of sick in any given locality who are in need of treatment in a general hospital can be obtained, we have here a comparatively safe and reliable index as to how many genera hospital beds are needed in this district. To find this index was tht ' main object of this part of the investigation. The scarcity of material at this point necessitated the working \ out of an entirely new method. Except for a few cursory studies \ of sickness in the writings of Dr. William Farr of London, for • forty years superintendent of the Statistical Department of the 33 Registrar General's office ; in those of Dr. Arthur Newsholme of the University of London, and a few other European writers, there was little data that could be found on this subject. More than twenty-five years ago Dr. Farr, who is considered the founder of the science of Vital Statistics, made the statement, " It has been found by experience that in England to one annual death two are on an average constantly suffering from sickness of some severity." ("Vital Statistics," page 498.) This statement has been accepted upon Farr's investigation without much unfavorable comment up to the present time. In Table XIV the attempt was made to verify Farr's figure, or to obtain some other figure which would give a fixed ratio between both mortality and sickness, and sickness and population. Dr. Farr and others who attempted to establish this ratio did so through a study of a large number of registered cases of sickness in different friendly societies. The difficulty with the result thus obtained, however, was that the rate, in the end became an estimation for a large population from a comparatively small number of cases. The method employed in this report is not an estimate, but is a deduction, the conclusions of which are derived from well founded premises. Method of Computing Number of Sick. The premises from which the conclusions in Table XIV are derived are, that in every disease there is an average rate of mor- tality which can be computed for any given period ; that there is an average duration for each disease which at any given period can be calculated approximately ; and that with these two facts and the number of deaths during a year or other period in the dis- ease given, the daily average number of sick can be computed. The first column in Table XIV gives the name of each disease from which death occurred in Greater New York in 1905, the notation being that of the Department of Health. The second has the num- ber of deaths for the year as taken from the Department of Health reports. Column three gives the percentage of fatalities, which has been found from best medical sources available to be the average in each disease. The facts here are taken from standard works on Vital Statistics, and from experience and testimony where it was of the highest standard. Among some of the physicians :onsulted were Drs. Hitchcock, Dana, and Jacobi. That an exact nortality rate and average duration of illness from each disease can- ot be obtained, owing to the many variations of age, sex, climate .nd housing conditions, etc., is admitted, but, considering New 7ork, with its 4,000,000 people as a whole, the averages here will ;e found in the main "correct. 34 TABLE XIV— SHOWING AMOUNT OF SICKNESS IN GREATER NEW YORK IN 1905. Percentage Number of deaths Number of deaths or mortal- of cases Total days in each ity rate occurring Average sickness Average disease in each in each duration in each daily for disease in disease in days disease in sickness year year in of each year during Name of Disease. 1905. 1905. 1905. disease. 1905. 1905. Acute diseases excluding contagious: Typhoid fever 649 1.15 4,333 40 173,320 475 Meningitis, simple and cerebrospinal 2,584 2.75 3,445 3 i4 48,230 132 Tubercular meningitis. ... 644 4 .7S 859 5 6o 41,540 114 Congestion, hemorrhage & softening of the brain . . 2,891 4 -75 3,855 4 3o 115,650 317 Pneumonia, excluding broncho-pneumonia.... 5,657 4 .2o 28,285 4 30 848,550 2,325 Broncho-pneumonia 4,126 4 -3o 13, 753 4 6o 825,180 2,261 Diarrhea and enteritis, (largely under 2 years) . 5,877 6 .3o 19,590 7 137,130 376 Acute bronchitis 1,417 4 0=; 28,340 7 i4 396,760 1,087 Puerperal diseases, includ- ing septicaemia 815 8 .2o 4,075 8 i4 57,050 157 Malarial fever 53 5 .oi 5,300 5 6o 318,000 871 Influenza 311 4 .oi 31,100 4 io 311,000 852 Diseases of stomach (most- ly acute) 512 9 20 2,560 9 3o 76,800 212 Hernia and intestinal ob- structions (acute stage) 570 '.50 1,140 'io 11,400 32 Violent deaths, including ing suicides, etc 4,476 10 .025 179,040 u 5o 8,952,000 24,526 All other diseases, unclas- sified & including mostly those of acute nature . . 9,500 9 .oi 950,000 9 io 9,500,000 26,025 Totals for acute diseases . . 40,082 .032 1,275,675 17.1 21,812,610 59,763 Totals for chronic diseases 21,664 .193 111,824 98-7 11,044,980 30,216 Chronic diseases excluding tuberculosis: Cancer 2,875 5 -75 3,887 5 30o 1,116,100 3,195 Brights disease 5,944 5 -3o 19,813 5 ioo 1,981,300 5,255 Congenital debility and malformation 4,341 V50 8,682 '90 771,380 2,113 Cirrhosis of the liver 907 '.50 1,814 5 ioo 181,400 497 Senile debility 723 10 -75 964 10 6oo 578,400 1,584 Organic heart disease 5,140 4 -5o 10,280 ?ioo 1,028,000 2,843 Chronic bronchitis 315 4 .oi 31,500 5 6o 1,890,000 5,J78 Non-cancerous tumors and other female genital dis- eases (chronic) 327 9 .oi 32,700 9 ioo 3,270,000 8,953 Ill-defined causes, chiefly marasmus 1,092 l -S° 2,184 'ioo 218,400 598 Total acute and chronic excluding contagious and tuberculosis 61,746 043 1,387,499 23.8 32,857,590 89,979 Contagious diseases exclud- *• ing typhoid fever: Diphtheria i,544 1 .ii3 13,673 7 . 2 25 341,825 936 Smallpox 9 1 . 195 46 2 4o 1 , 840 5 Measles 520 4 , 2 .oi 52,000 2 io 520,000 1,425 Scarlet fever 473 1 .os8 8,071 4 35 282,485 774 Whooping cough 408 4 , 9 .oi 40,800 5 , 9 io 408,000 1,118 Totals contagious diseases. 2,954 .026 114,590 135 1, 554, 150 4,258 Tuberculosis, excluding tubercular meningitis.. 9,014 12 .3o 30,046 12 5oo 15,023,000 41,1.19 Total, all diseases 73,714 -048 1,532,135 32.2 49,434,740 135, 3*6 department of Health reports. 2 0sler, Practice of Medicine. 3 Owing to high death rate, duration is short. Osier and Gould both agree with above figur ■;. Dr. Hitchcock of New York says this is usual duration. 4 Gould & Pyle, Encyc. of Med. and Surg. 5 Estimated from Gould & Pyle. 6 The rate is estimated from Gould and Pyle and is taken lower than might be expected be- cause summer of 1905 was not very hot. 7 Pepper, System of Medicine. 8 Estimated from Pepper. 9 Estimated from general medical reading and testimony, together with information from Department of Health. 12 Records of Homes for Aged and Infirm, B. I. 10 Mayo-Smith, Statistics and Sociology, pp. 159 and 160. u Mayo-Smith, p. 157. 13 C. Easton in Report on Tuberculosis in N. Y. 35 Column four shows the number of cases arising in the disease during the year, including both the fatal ones and all others which were in existence during the year 1905. These figures are obtained by dividing the number of deaths in column two by the death rate in column three. For instance, if, as in typhoid fever, there were 649 deaths in 1905, and 15% of all the cases were fatal, the number of cases of typhoid would be obtained by dividing the percentage, 649, by the rate,^, giving 4-333-* Column five gives the average duration in days of each disease. These figures are obtained from sources similar to those in column three. Here again the variations which would effect the fatality rate would be evident. This column, therefore, does not profess to give an exact prognosis as to the length of each disease that would fit all conditions, but to show as nearly as possible what, during 1905, might be considered as the average duration of the different diseases. The length of sickness, moreover, is somewhat shorter in all diseases, perhaps, than might be expected. This is due to the fact that by sickness here we have meant only bedfast sickness, or such a disease as would keep an individual in bed, and would possibly require hospital treatment. On this account the table shows only the more serious sickness of the city, leaving out the ills which bother for a day or two and are never in them- selves a cause of death. The average duration given in the chronic diseases is that which, from the best medical testimony, is judged to be the average amount of incapacitation during the year. Column six shows the number of days sickness in Greater New York from all fatal diseases during the year T.905. The figures are obtained by multiplying the number of cases in column four by the average duration in days. Then by dividing the total number of days of sickness by 365 (days in a year) the average daily sick- ness in Greater New York in 1905 is computed as 135,396. We reach a conclusion, therefore, by data based on wide observation and by vital statistics, which closely approximates exactness. This conclusion is that the average number of persons sick daily in Greater New York is 135,396. To show how closely the results of this table come to those of Farr and others, some comparisons are here given. The total number of daily sick (135,396) shows that for every annual death in New York during 1905 there were on an average 1.83 persons constantly sick, thus practically verifying Dr. Farr's figure, given above, that for every annual death there are two people sick. From further figures given by Farr and Newsholme it is found that in English and Scotch Benefit Societies from 1.4 to 4.5 men are constantly sick in *For demonstration, let x equal the number of cases in a disease during a year. Then, as in ty:''.ioid fever, 15% of x equals 649, the number of deaths. Then 649 divided by 15% equals x, -juals 4,333, 36 every ioo members. The result of Table XIV gives the sick rate of New York as 3.3, which seems to be a fair mean, inasmuch as the above societies take only men for membership and are, besides, very careful in the selection of these members. The Hospital Rate. Having found the total number of sick, it remains to find out what percentage of the sick are in need of treatment in the general hospitals of the city. For the purpose of securing this ratio the amount of sickness in acute and chronic cases only (excluding tuberculosis and contagious diseases) was used. Manifestly those who are sick with contagious diseases cannot be treated in general hospitals on account of the danger of infection. We are now com- ing to see that a like reason should exclude from general hospitals those sick with tuberculosis, and have, in fact, excluded this class from all the regular wards. Both the ordinary contagious diseases and tuberculosis demand special kinds of hospital treatment other than what can be furnished by a general hospital. The number of sick, then, of acute and chronic diseases, excluding contagious and tuberculosis, is seen to be 88,669. We find from this figure that 2.21 persons out of even- 100 of population in Greater New York are constantly sick of these acute or chronic diseases. From Table XIII it will be seen that on January 1, 1905, there were 7,773 patients in the general hospitals of Greater New York. Taking this figure for a basis it will be found that of the 88,669 persons daily sick of acute and chronic diseases in Greater New York in 1905 8.4% actually were in general hospitals of the city. The testimony of hospital superintendents and those who have to do with hospitals is that there are always in the community a large number of sick people who ought to be in hospitals, but who are not there, and this, too, in spite of the increase of home treatment. The head workers of the largest district nursing system in this city assert confidently that they find from their varied experience that there are large numbers of sick people who are receiving improper or insufficient treatment at home, and who should rightly be cared for in hospitals. ' Various reasons may be assigned for this condition. Many people, for instance, would go to hospitals if they could pay for their maintenance there, but being unable to pay, they endure the inadequate treatment at home rather than receive hospital treatment as a gift of charity. Others refuse abso- lutely to go to hospitals, because of the lack of confidence in the management of all such institutions. This horror of the hospital, which has been created largely by the yellow press, is, however, decreasing and more people are going to-day than ever before. Still another reason why many people stay at home when sick instead of going to a hospital is because they hate to be separated from 37 their families. Probably, however, one of the weightiest reasons why there are people who need hospital care but do not get it is because the general hospitals of the city cannot accommodate them. Many hospitals, because of lack of money, are obliged to close wards of their hospital even in the busiest time of the year. The Presby- terian Hospital, for example, has ioo beds lying idle for this reason, and this, too, when patients are being refused admission constantly for lack of room. Again in some sections the general hospital accommodations are so woefully inadequate that people are obliged to stay at home, even if they desired to go to a hospital. These reasons here given, for the fact that more people ought to be in general hospitals, are but a few of the many which might be given. In view of these facts, it is safe to assume that the present rate of hospital attendance, 8.4%, is lower than what it ought to be. Since, however, it is impossible to obtain data upon which to base a definite estimate as to how much this percentage should be increased to include the number who ought to be in hospitals and are not there, the percentage of actual hospital attendance, 8.4, has been used as the percentage of those needing hospital treatment in Tables XV to XVIII. It can thus be seen that the computations as to the present number of people needing hospital treatment are very conservative. With this percentage as a basis, the attempt was first made in Manhattan to determine what is the actual proper bed capacity or how many persons there are actually in each hospital district need- ing hospital care. The other boroughs of the city were subdivided, where necessary, with similar districts and the same method applied as in Manhattan. Hospitals in Their Own Neighborhoods. A fundamental principle upon which the report is based is that hospitals should be built in the neighborhoods from which their patients come. Two conflicting theories of hospital location here deserve attention. The first of these is the principle just stated, that hospitals should be built where the people who will use them reside, regardless of all other influences. The second theory goes on the assumption that, as fresh country air is the most vital essen- tial in modern medical practice, new hospitals should be built in the suburbs and rural districts about the city. While conceding the high scientific value of this latter view, it must be borne in mind that there are difficulties in the way which render it imprac- ticable in Greater New York. This theory has had a partial vogue in some of the European cities, notably Paris and Berlin, but the conditions there are quite different from those in New York. The phlegmatic German of Berlin or the ease-loving Frenchman of Paris do not value their time as does their kinsman of New York. Here 38 " time is money," and the loss of time to most people means a loss of money in a more real sense than it does to the European. It is mainly for this reason that the New Yorker would object to being sent out of the city or at a distance from home if he were sick. It would mean to him not alone the separation from loved ones, but a considerable loss and expense to his family in visiting him. If, after all, the hospital is to care for the sick, then it seems reason- able to suppose that it should be built where it will be easily accessible to the sick. Home Treatment. If only 8.4% of the sick go to hospitals, it is evident that at least 90% must be treated at home. The advantages of home treatment for most of the ordinary diseases are evident, provided the proper sanitary arrangements and medical facilities can be procured at home. The number of diseases which demand hospital treatment is limited. This being the case, it is manifestly the duty of the municipal hospital, as well as of the private one, to co-operate in every way with organizations who are engaged in trying to improve the standard of living in the home. In this field, the municipal hos- pital has a very definite work. Through its dispensary, by its nurses and doctors, and by the general atmosphere which goes out through the discharged patients, the hospital can radiate an influ- ence which should go far to lift up the health of the entire com- munity. Thus, with the hospital near at hand as a center not only for the cure, but also for the prevention of disease, the health of the community will be benefited at the lowest possible cost to the patient and to the city. Method. In computing the number of sick in a given area needing hos- pital care, the population of that district is multiplied by .0221, since it was found from Table XIV that in every 100 population 2.21% of the population are constantly sick of some form of disease which might be treated in a general hospital. Thus the number of sick in each district (excluding tuberculosis and contagious) may be obtained. Of that number, 8.4% is taken as the number of sick needing treatment in general hospitals. By this method, it will be seen that as accurate account as it is possible to obtain of the number of sick needing hospital care in any given district is obtained. 39 CHAPTER IV. CONCLUSIONS. New Hospitals and Their Distribution. The three studies of hospital population, general population, and sickness lead to the general conclusion that we need in Greater New York 500 additional beds for present emergencies, and that by 1920 we will need 2,900 more. These three lines of data do more, however, than give us this general conclusion. They show how, according to the needs of the different districts, this large number of beds should be distributed. We consider the conclusions in two parts, first, present needs, and second, future needs, taking up under each head the needs for the various boroughs and districts separately. I. PRESENT NEEDS. 1. Manhattan. Considering the Borough of Manhattan as a whole, it will be seen that there was in 1905 an excess of 609 beds over what was computed as the proper bed capacity. If we only had this fact for consideration we should at once say there is certainly at present no need for hospitals in Manhattan. And this would be true, if people would go from all over Manhattan to where the excesses in beds are, and would stay away from where there was a marked lack of beds, and if no more beds were needed in a hospital than there were patients at any given time. (See Table XV which follows.) But since hospitals are built chiefly for the care of the sick, and since the sick cannot go in all cases for miles to a hospital, the excess of 609 beds in Manhattan may de- note a need for more hospital accommodations. It does not indicate by any means that no more hospitals are needed in Man- hattan. It does indicate, however, that if all the hospitals in the borough had been built and distributed originally according to the needs of the population of the various districts, our present bed capacity in Manhattan would then be in excess of what would be needed. But since hospitals have been built in Manhattan, fre- quently, wherever a philanthropic donor happened to have an unused site, or where a site could be acquired cheaply and with no regard to the needs of the people who were to use the institutions, the result has been, as before stated, that we have large districts over- supplied with hospitals, while others lack their proper capacity. Hence the needs of this, or any other borough, will be best found by looking at the needs of the various districts where a lack of beds is seen to be manifest, rather than by studying the needs of the 40 Table XV. — Showing Present Bed Capacity, Man Name of Ambulance District. Names of general hospitals in district. ( St. Gregory's House of Relief 4 House of Relief ( Trinityf Gouverneur I Gouverneur I Beth Israel St. Vincent's St. Vincent's New York New York Hospital f Columbus New York Post Graduate Bellevue I Bellevue I St. Mark's I St, Francis* [ Polyclinic Flower Flower* ( German Presbyterian 4 Presbyterian ' Hahnemann ( St. Elizabeth's Roosevelt ■< Roosevelt ( French Benevolent I St. Luke's ) J. Hood Wright ■< J. Hood Wright J- ( Washington Heights ) I Mt. Sinai ) Harlem •< Harlem > ( Sydenham ) Totals, Manhattan. . 26 hospitals. Lincoln.. . . Lincoln and Lebanon. . . 4 Lebanon. . . St. Francis. Fordham I Philtnthropini Totals, The Bronx. .5 hospitals. 'opulation of district, Computed number daily sick Computed number needing hospitals 1905. in district. care, 1905. 65.936 1.457 122 265,343 5.864 493 153.354 3.389 284 127 ,065 2,808 235 316,19s 271 , 600 6,988 6 , 002 *Flower Hospital at 63d St. and Avenue A, outside its own ambulance district. t Hospital closed in 1907: JNo longer, in 1908, used for general hospital. §This hospital now (in 1908) belongs in Harlem district. 587 III , 187 2.457 206 182,252 4,028 338 293,638 6,489 549 330.337 7.300 613 239.238 5,287 444 2, 112,380 46,43 7 3.871 THE 168,517 3.724 313 103,083 2, 278 191 41 Proper Bed Capacity, and hattan. Beds Needed in 1920. Present Number B District, Mar. i, EDS IN I906. Excess or lack of beds in i9°5-* By hospitals. Total. 20 ) 35 f 28) 83 39 90 1 210 283 120 j 125 216 980 79 50 96 245 214 81 65) 244 > 150 J 261 58 40 480 53 65 BRONX. 500 235 500 56 14 3»o 205 1,546 100 540 459 359 598 1,235 70 Population 96 30 959 106 202 90 254 154 609 922 in 1,305 801 *Excess denoted in black face type; 65,936 146 321,065 710 171,756 165,183 380 366 411,052 90S 164,532 364 268,354 593 Known number of Number beds in of beds 1920, needed in including 1920. all known additions. 82 35° 425 217 180 652 381,727 844 547,921 1,211 396,660 877 ,931,288 6,399 244,348 540 195,858 433 440,206 973 lack in ordinary type 6,318 1,235 150 1,385 iixcess or lack of beds in 1920.* 64 360 45 149 1,614 59 292 781 29 81 665 283 412 4 2 borough as a whole. On account of this fact of poor distribution of hospitals, it is certainly a conservative estimate, as before stated, to allow that one-tenth of the entire bed capacity of the city would be more used if it were better located. Again, it must be noted that the figures at this point are com- puted on the actual number of sick needing hospital treatment in the various districts of the city. No allowance is made for any needed excess in bed capacity, such as would be required in any individual hospital or group of hospitals. The reason for this has been discussed on page 23, Chapter I. Allowance must always be made for extra beds that cannot be used on account of differ- ences in sex, disease, age, etc. It is estimated on a most conserva- tive basis that one-tenth of the bed capacity of any hospital, or group of hospitals, is always kept in reserve, or in excess of the number of patients. The computations in this table and the tables for the other bor- oughs are based on the population of 1905. It is impracticable to attempt to distribute the population of the city by small districts for so short a period as three years. Consequently the figures of 1905 are used with corrections where necessary, on account of change in hospital conditions, up to January 1, 1908. Thus, by taking in account these two factors, from which it will be seen that at least one-fifth of the bed capacity of the city might be in excess of the number of patients, it will be seen that a com- puted excess of 609 beds for the Borough of Manhattan is not indicative at all of no need for more beds. It indicates rather that about 200 beds are needed, a conclusion which is verified by a closer study of the various districts of the city. Methods of Hospital Distribution. But before taking up a detailed study of the needs of the bor- ough, we must consider how the bed capacity of any given section,, district, or borough can best be distributed. Manifestly there are but two ways in which this can be done : (1) By building local hospitals of the size, ascertained by com- putation, required to meet the needs of the district. This is the method, so far as any policy at all has been pursued, upon which both municipal and private hospitals have hitherto proceeded. If a given district was seen to be in need of hospital accommodations, a hospital of from 50 to 200 beds was at once erected. This method has its advantages, but it has also certain disadvantages over against the other method of distribution. Before considering the relative merits of this method, let us consider the other way of distributing the needed bed capacity of the borough. (2) A second method is by establishing ambulance stations in the district where a lack of bed capacity is shown ;" and then by 43 building the additional beds required, not in the immediate neigh- borhood in which the lack of beds is indicated, but to one large general hospital which should supply the needs of the entire bor- ough. By an ambulance station, as opposed to a local hospital on the one hand, or a general hospital on the other, we mean a small hospital of not more than ten beds. The Bradford Street Hospital in East New York is a fair illustration of this type of in- stitution. The House of Relief on Hudson Street, while consider- ably larger than the above suggested figures, is also a type of this institution. The ambulance station has peculiar advantages over the local hos- pital, as a means of distributing the bed capacity of the city in the districts where it is needed. Among its advantages may be classed : (a) The economy with which such an institution can be run is evident. The ambulance station is not an independent hospital. It is part of its parent, the general hospital. As such, it serves only to relieve the emergency needs of the community in which it is located. The average length of stay in such an institution is from four to five days. Cases which would require longer treat- ment would be transferred to the general hospital of which the ambulance station is a part. Thus it will be seen that the ambu- lance station, while having in itself a limited bed capacity, is never- theless allied with the best resources which hospital management can procure. (b) A second advantage of the ambulance station is the ease with which it can be moved or abandoned. It is comparatively inexpen- sive to fit up an existing building or build a small new one for these purposes; and when such station should have outlived its usefulness, it can either be moved or abandoned with little loss. (c) A third advantage of the ambulance station is that in neigh- borhoods where it is not sure that a local hospital would be required, an ambulance station would soon find out whether there was definite need for a larger institution. The ambulance station thus becomes a local hospital in embryo. (d) The ambulance station has a further advantage as above indicated, in that it affords quick relief in case of sickness or acci- dent to the neighborhood in which it is located, and at the same time gives direct connection with the medical staff and with the medical appliances of the general hospital. The advantages of the general hospital of 1,000 beds over against the small local hospital of from ioo to 300 beds are apparent. It is only in the larger institution, where sufficient numbers and varie- ties of cases are received, that advanced methods of treatment can be afforded. In a small local hospital, where the cases of any par- ticular disease are few in number, the attraction to specialists is comparatively small. Consequently the advantages which the larger institutions give are apparent. 44 In the distribution, then, of the hospital accommodations both for the present and for the future we shall use both methods above mentioned. The particular character of the district needing hos- pital accommodations will determine whether an ambulance station or a local hospital is required, i. e., whether it is an advantage to build the required number of beds in the neighborhood where the lack is shown, or whether, on the other hand it is an advantage to build simply a relief station there and place the additional number of beds needed in some large central institution. This principle will govern us in the distribution of hospitals and hospital accommoda- tions throughout this report. St. Vincent's. — Of the ten ambulance districts in Manhattan, four show an excess on March i, 1906, over the proper bed capacity on that date, as indicated by Table XV. In the St. Vin- cent's hospital district, while there is only this one hospital, it is computed to have an excess of 96 beds over what is needed for the district. On March 1, 1906, the St. Vincent's Hospital had 275 patients and 380 beds, an excess of 95 beds. (See Table IX, p. 80.) This hospital stands in a neighborhood whose population is stationary. If it did not draw very largely from the city as a whole through its religious affiliations, it would have many more vacant beds than now. Middle and Upper East Side. — In the Bellevue ambulance district an excess of 959 beds is given. In this district, whose actual popu- lation is very large, there are in 1908, five general hospitals, con- taining in all over 1,500 beds. In fact, more than one-third of the bed capacity of Manhattan is centered in this district. Of course the use of Bellevue Hospital as a receiving station for all cases considered unsuitable by the private hospitals makes it necessary for this institution to have a large enough capacity for the work. But, even with Bellevue omitted from the hospitals of the district, the other four would leave but a very slight lack of bed capacity. And this is more marked when we consider that Bellevue Hospital has a very active ambu- lance service, covering its own large territory, and that thus it gets about 30% of its patients. An excess of 202 beds is shown in the Presbyterian Hospital district. The three large hospitals of this district, together with Flower Hospital, just south of this territory, easily fill all the needs of the Upper East Side. The hospital needs of the East Side in Harlem are also met, as here an excess of 154 beds is computed. The hospitals of this dis- trict and the Presbyterian and Bellevue districts contain 60% of the bed capacity of the Borough of Manhattan. It would seem, therefore, in view of these facts, that no more hospitals are needed for present needs on the East Side above Houston street. 45 Two sections of the city, however, are in need of hospital accommodations at once. Lower Manhattan. — The first of these is the lower end of the island of Manhattan, including the first six wards of the city, or the House of Relief ambulance district, and also a portion of the lower East Side, or the Gouverneur ambulance district. According to Table XV a lack of 39 beds is shown in the first-mentioned section and 283 in the second, which adjoins the House of Relief's territory on the north. The needs of the first-named district are increased in 1908 by the closing of the Trinity Hospital. Considering then, first of all, the territory in the House of Relief's district, it seems as if there is need here for an ambulance station of at least 8 beds to meet the immediate needs of the district. The territory in this district is that below Canal and Catherine streets, or the extreme lower end of the island of Manhattan. This territory has a resident population of but 65,000, which seems to be about stationary. The daytime population, however, is very large and numbers at least a half million. This population is constantly on the increase. Every year sees more clerks, more business men, more mechanics, more business and traffic of every kind within this territory. There are in 1908 but two small general hospitals located in this district, the House of Relief, with a capacity of 42 beds, and the St. Gregory's, with 40, making altogether 82 beds. There are more accidents here than in any other district in Greater New York, and the hospital work of this district is largely of an ambulance character. In the year 1905 the House of Relief ambulance answered 5,164 calls, or a daily average of 14.1. This hospital alone had 11.6%, or nearly one-eighth of the total ambulance calls of Manhattan for 1905, i. e., a hospital with .7 of 1% of the hospital beds of the borough was called upon to answer 11.8% of the ambulance calls. The St. Gregory's Hospital, without a regularly assigned district, answered over 1,000 private calls. The three ambulance district hospitals below 14th street, the House of Relief, St. Vincent's, and Gouverneur, answered in 1905 40% of all the ambulance calls in the borough for 1905. When it is considered that below Canal street there is resident but 3.1% of the popula- tion of Manhattan, and below 14th street but 31.5%, it can be seen how largely this business papulation needs hospital service. Of the calls answered by the House of Relief ambulance, 1,334, or about one-quarter, were transferred to Bellevue without being brought to the hospital. One thousand four hundred and forty-three of the 3,387 patients treated in the wards in 1905 were patients admitted with surgical injuries. Eighty-four per cent, of the entire work done in the wards of this hospital was for cases brought in on emergency calls by the ambulances. When it is considered that the average stay of the patients in this hospital for 1905 was but 46 44 days, it can be seen at once what the character of the work done here is. It will be seen then that there are at present 67 additional beds required for the present needs of this district according to the methods of computation. The needs of the House of Relief's territory are emphasized when considered in connection with those of the Gouverneur district on the northeast. In this district a lack of 283 beds is shown. (See Table XV, p. 41.) With the completion of the additions now in progress on the Gouverneur Hospital and those about to be made on the Beth Israel, this figure will be reduced to about 200 or less. During the past two years repeated efforts have been made by private charity to start new hospitals in this section. The State Board of Charities, while admitting the evident need for additional hospital accommoda- tions in this neighborhood, has refused charters to all applicants, because of insufficient financial backing. The new Mt. Moriah Hospital, now in building is not yet incorporated. This demand for more hospitals here is impressed upon one who sees the constantly crowded condition of the two general hospitals here. It is further stated by the social workers of this district that many more people would go to a hospital if there were another one nearby, and they would not run the likelihood of being transferred to Bellevue. Accordingly, the needs of the House of Relief ambulance district, together with those of the Gouverneur district, point to the immedi- ate necessity for an ambulance station of 8 beds, the remaining beds needed in this district to be centered in Bellevue Hospital. A station here would be easily accessible to the eastern waterfront as well as to the great manufacturing establishments and newspaper offices of this district. The largest percentage of the calls of the House of Relief come from the Chinatown section in the 6th ward, to which a hospital located as suggested would be easily accessible. Such a station, moreover, would furnish sufficient relief to the Gouverneur district so as to meet all the present needs of this com- munity. Within a five minutes run. an ambulance from this sug- gested station could reach the crowded residential districts on the north as well as the packed business-filled canons of Nassau and Wall streets on the south. These many reasons urge the immediate erection of an ambulance station in the lower end of Manhattan. Middle West Side. — Another section of the city, also, is in need of additional hospital accommodations to meet present needs. This is the Middle West Side, comprising chiefly the Roosevelt ambulance district, or the territory between 20th and 86th streets west of Sixth avenue. A lack of 90 beds is computed for this district (see Table XV), which lack would be increased by at least 60 more when it is noted that the St. Elizabeth's Hospital is really a private hospital for pay patients only. As in the lower Manhattan section, so in the Middle West Side, the work of the large hospital of the 47 district (the Roosevelt) is chiefly that brought in by the ambulance. In fact 88% of the entire work done in the Roosevelt Hospital in 1905 was brought in by the ambulances. This hospital is without doubt one of the busiest hospitals in the city. Hundreds of patients are turned away every year for lack of room. This is true even when, as in 1905, nearly 2,000 cases were transferred to Bellevue Hospital, many of them because of insufficient hospital accommo- dations in the Roosevelt Hospital. Some of the needs of the Roosevelt ambulance district might be met by a redisricting of this territory on the West Side, but even then there would still remain the fact that there are in this district at least 550 sick needing general hospital care, with less than 400 beds that can be depended upon to care for them. The fact that the Roosevelt district contains what will be when completed the largest railway terminal in the world, gives additional force to the argument for a new hospital in this vicinity. Although there is little probability of a rapid increase in resident population on the Middle West Side, there is every indication that the business popu- lation who throng the streets in the daytime will show a large increase over the present condition. With all these facts emphasizing the need for more hospital beds on the Middle West Side, it is suggested that an ambulance station of 8 beds be built in the vicinity of 40th or 45th streets and 9th and 10th avenues. An institution here would supply all the needs of the middle district and would leave the Roosevelt Hospital free to do a larger work in the growing population to the north. Upper West Side. — One further section of Manhattan demands special attention here. That is the Upper West Side, comprising largely the J. Hood Wright and Washington Heights districts. It wili be noted that, in Table XV, a lack of 254 beds is shown. About 60 beds from this number should be deducted on account of the new Red Cross Hospital which opened October 1, 1907, at 99th street and Central Park West. St. Luke's Hospital has increased its capacity to 298 since 1905. The needs of this large territory have been more than met by the opening of the new Harlem Hos- pital, with 100 additional beds, on the boundaries at the corner of 136th street and Lenox avenue. The moving of the Philanthropin Hospital into this district from the Upper Bronx has added 18 beds. Thus the apparent needs of this district are met, and it does not seem as if more hospitals are needed here for present use. Summary. — The present needs for Manhattan may be summed up, then, by stating the need for an ambulance station of 8 beds in the Lower Manhattan Section near Chambers street and Park Row ; and for another of similar size in the Middle West Side section, be- tween 40th and 45th streets and 9th and 10th avenues. 4 8 2. The Bronx. The present (1908) bed capacity of the Bronx, 1,265 beds, is now well in excess of what is needed to meet all the existing needs. With three of the largest hospitals in the city in the southern Bronx, and a fine new city institution (Fordham Hospital) in the northern Bronx, all the present needs seem to be met. According to the method of computing the hospital needs, only 504 persons are found to be actually needing hospital care, showing an excess of 801 beds. This excess is due largely to the fact that far-sighted hospital managers are already beginning to build for the future needs of this section, and for a second reason, because the hospitals in the Bronx are accommodating a large number of patients from Manhattan. 3. Brooklyn. As mentioned in the discussion of the hospital population in Brooklyn, most of the hospitals here are located in the old town, while the outlying sections of East New York, Flatbush, Flatlands, Bushwick, and Bay Ridge have inadequate accommodations. The city of Brooklyn is about twelve miles long from north to south, and about seven miles broad from east to west. Within this area the hospital population centers inside of a circle with a two and a half mile radius. It will thus be seen that there are many sections from which patients are obliged to travel in an ambulance or other- wise from three to six miles to a hospital. It is partly because of this congestion of hospitals that the Borough of Brooklyn as a whole shows an excess of 410 beds (see Table XVI which follows), while some sections of the city are in immediate need of additional hospitals. The same reasons which account for the excess in Man- hattan have added weight also here. Heights and Red Hook. — Considering the three districts in which excess of bed capacity is computed, we note that in the Heights and Red Hook district there are now 571 beds, while the number of sick in that district needing them is but 384, making an excess of 187 beds. This district claims the two largest private hospitals in Brooklyn, and will have an increased number of beds when the remodelling of the Long Island College Hospital, now in progress, is completed. It is one of the few sections of Brooklyn where population is about stationary, comprising as it does much of the very oldest residential section of the city. While some increase in laboring population has been felt in the southern part of Red Hook, this has been very slight in the past fifteen years. So there seems to be no immediate need here for more hospital accommodations. Flatbush. — The excess of beds in the Flatbush section of Brooklyn (829) is due largely to the fact that this district, on January 1, 1908, contained six hospitals aggregating over 1,200 beds, or nearly 50% of the entire capacity of the city, while the sick population calls 49 for but 414 beds. This district, however, like the Bellevue district of Manhattan, has a large general hospital which receives patients from all over the borough. But even when the bed capacity of the Kings County Hospital is deducted, there will still be found an excess of about 200 beds in the district. It is, then, no assumption to say that Flatbush has far more hospital beds than it needs for present purposes in its own district. North Brooklyn. — Considering now some of the sections of Brooklyn where there is a present need for more hospital accom- modations, we note that the two districts of Bedford and Williams- burg and Bushwick combined give a lack of over 550 beds. It will also be noted that the district in which the Cumberland Street Hospital is located shows an excess of 121 beds. (See Table XVI.) If, however, the Cumberland Street Hospital, which supplies the need of Bedford largely, were taken from this Prospect Heights district, we would. have an excess here also. There are, thus, without doubt a large number of sick in the northern part of Brooklyn who do not go to a hospital because there is none convenient. This territory is fast developing a tenement-house population such as that of the lower East Side of New York. Across the Wil- liamsburg bridge have come within the last three years a large num- ber of Jews who have settled in this territory in Brooklyn, bringing with them their habits and customs of the lower East Side of Man- hattan. As noted in Chapter II, page 29, in the study of popula- tion, this territory contains the only section of Brooklyn (Ward 16) which has a density of over two hundred persons per acre. There is little doubt but the whole district will increase in population and in density. In this North Brooklyn territory is centered now nearly one-half the entire population of the borough, with less than one- third of the entire number of hospital beds. North of Flushing avenue and Broadway is a territory which has an area equal to more than one-third of the entire area of the Borough of Manhattan. It has a population equal to more than one-fifth of that of the entire Borough of Manhattan. Yet it has but five hospitals, with an aggregate capacity of 464 beds, or equal to less than one-tenth of the bed capacity of Manhattan. These facts speak loudly the need for more hospital accommodations here. On March 1, 1906, the eight hospitals of this district were crowded to within about one-tenth of their capacity, and two of them had more patients than beds. (See Table X.) The Cumber- land Street Hospital conducts one of the most exacting services of any hospital in the city, and yet it is frequently the case that from one to twenty-five or more patients are compelled to sleep on the floor and many more refuse to go to the hospital at all because of lack of room. That the Cumberland Street Hospital is overcrowded, is evidenced by the figures shown in Table X, where on March 1st the number of patients was 205, while the bed capacity was but 200. 5° Name of District with Ward Equivalents. Table XVI. — Showing Present Bed Capacity, Brook Names of general hospitals in district. The Heights (Wards i, J Long Island College. . . 2, 3, 4, 5, 6), and Red I St. Peter's Hook (Wards io, 12). Bedford (Wards 7, 13, j Brooklyn, E. D 19, 21) I Williamsburgh Prospect Heights (Wards I Cumberland Street. . . . 9, 11, 20, 22) -\ Brooklyn ( Methodist Williamsburgh (Wards 14, i5 ; 16, 17), and I St. Catherine's J Bushwick (Wards 18, -< German > 27, 28) f Bethany ) East New York (Ward I Bradford Street. . „ I 26) 1 Lutheran ". f f St. John's ] i St. Mary's I Flatbush (Wards 23, 24, I Bushwick ! 25, 29, 32) I Kings County ! I Swedish I L Jewish* J Bay Ridge (Wards 8, j Norwegian^. ....... . 3 °' 3 / Samaritan Totals 21 General hospitals. Population of district, Computed number daily sick Computed number needing hospital 1905. in district. care in 1905. 206, 929 4.572 384 174,922 3,865 356,439 7.877 94,149 2 ,080 223,053 4.93o *The Jewish Hospital, though opened December, 1906, is counted in present capacity. 5i Proper Bed Capacity, and Beds Needed in 1920. lyn. Present Number Gen- eral Hospital Beds in District. Excess or lack of beds in i9°5-t Population in 1920. Number of beds needed in 1920. Known number of beds in 1920, including all known additions. Excess or lack of beds in 1920. t By hospitals. Total. 250 1 321 1 57i 187 267, 216 59i. 641 50 38 \ 75 1 113 213 327,974 725 170 555 200 ) 165 \ 100 ) 196 120 > 35 ) 465 35i 101 310 243,348 521,320 538 1,152 655 502 117 650 54 1 62 112 170,810 378 135 243 84l 230 1 38 631 1 1,243 829 464,799 1 ,026 1,480 454 60 | - 200 J 94) 25) 127 102 289,797 641 217 424 2,932 410 2 , 284, 264 5,051 3,800 1,251 tExcess denoted in black face type; lack in ordinary type. 52 The reports of the New York City Visiting Committee also, as well as the reports of the superintendent of the Cumberland Street Hospital, have constantly spoken of the overcrowding of this insti- tution and have consistently recommended an addition. The present investigation, however, leads to the conclusion that it would be a better policy to build the proposed addition to the Cumberland Street Hospital in the form of an ambulance station of 8 beds somewhere to the north of that institution in the northern part of the 21st ward, or the southern part of the 18th or 19th wards. A station located here would serve not only as a relief to the Cum- berland Street institution, but would be located in such a manner as to be easily accessible to the population to the north and to the more immediate neighborhood. It will, moreover, be advantageously located when this district has so increased in population that the Cumberland Street Hospital will be almost inaccessible to the resi- dents of the 16th, 18th, and 19th wards. The present growing needs of this North Brooklyn district, how- ever, demand more than one ambulance station of eight beds. As indicated above, this section shows a lack of over 500 beds. Rather than distribute this number of beds in several small hospitals, it seems a better plan to erect in this territory a large general hos- pital, and distribute the bed capacity, so far as is needed, in ambu- lance stations. It is accordingly suggested that a general hospital of 500 beds be built in the eastern end of North Brooklyn district, preferably in the 28th ward, near Decatur and Irving avenue. Such a hospital, together with an ambulance station as indicated above, would meet all the present needs of this growing district, and provide as well a way for the enlarging of hospital accommoda- tions for future needs. South Brooklyn. — Another district of Brooklyn which is now in need of more hospitals is South Brooklyn, or the territory south of Prospect Park and Greenwood Cemetery, comprising the Bay Ridge Local Improvement District. As will be noted in Table XVI, 102 additional beds are needed here. A word as to the distances between hospitals in the district will show that this is not an extravagant number of beds. Between the Norwegian Hospital, on Fourth avenue and 46th street, and the proposed Coney Island Hospital on Ocean Parkway, there is a distance of about five miles. Westward and northward the nearest hospital is between three and four miles. The ambulances of the Norwegian Hospital often make runs of six miles south to Bath Beach, Gravesend and Bensonhurst. To the east and to the northeast of Coney Island Hospital there is no hos- pital until the Bradford Street is reached, "a distance of about seven miles. The Kings County Hospital, almost north of the new Coney Island Hospital, is about five miles away. Bearing in mind that this district, including the 30th, 31st, and 32d wards, is the most rapidly growing section of Brooklyn, -the need for 53 additional hospital accommodations here can be seen at once. The superintendent of the Norwegian Hospital, Rev. E. C. Tollefsen, gave as his opinion that a hospital between their institution and the Coney Island Hospital with ioo beds should be built almost imme- diately. He said that he thought such a hospital would be full within a year. Taking into consideration the fact that the new subway terminal in Brooklyn is to be at the lower end of Prospect Park, there is little doubt that the territory adjoining, known as Kensington and the Borough Park district, will increase very rapidly within the next fifteen years. Already real estate is rising at a very rapid rate and many buildings are going up in this territory. An ambulance station located here would serve as a relief to the overcrowded Kings County Hospital on the east end, and to the growing population of this territory on the south and west. This station should be located preferably in the Borough Park section south of Greenwood Ceme- tery. It should be built at once for 8 beds, although land should be secured now when it can be done at a reasonable price for the building of a local hospital of two or three hundred beds. East New York. — In the East New York district 112 beds are computed as necessary. This need is amply met by the provision of the Department of Charities to build a new hospital of 100 beds on Dumont street, facing Linton Park, which it is urged be started at once. Summary for Brookyn. Summarizing the situation for Brooklyn's present needs, we find, then, that two ambulance stations, one in North and one in South Brooklyn are needed, and besides these, a general hospital in North Brooklyn. This makes on all a little over 500 beds required to meet the present needs of Brooklyn. 4. Queens. The bed capacity of Queens Borough is at present amply ade- quate for the hospital needs. (See Table XVII which follows.) The distribution of hospitals seems to be wide enough also to meet all the needs of the day. 5. Richmond. In the Borough of Richmond it is computed that for present needs 135 hospital beds are needed, which gives an excess now of 96 beds. (See Table XVII.) With the comparatively unsettled portions of large parts of this borough and the low rate of increase in population throughout, there does not seem to be at present a need for any additional hospital beds. 54 6. Summary of Present Needs. Summarizing the present hospital needs of the city, we suggest that immediate steps be taken to erect two ambulance stations in Manhattan of 8 beds each, one on the lower end of the island, and the other in the middle West Side ; and two more in Brooklyn, one Table XVII. — Showing Present Bed Capacity, Queens and Name of Borough. [ St. John's, L. I. City } I Flushing f Q ueens ?t. Mary's I Jamaica \ Jamaica. . \ J I [St. Joseph's, Far Rock'y. J Richmond j S. R. Smith Infirmary. . . I I St. Vincent's f Names of General hospitals in borough. Population of borough. Computed number daily sick Computed number needing hospital 1905. m district. care in 1905. 72,845 1 ,609 55 in North, and one in South Brooklyn ; and also a general hospital of 500 beds in North Brooklyn. The proposed Bradford Street Hospital should also be built at once. This makes in all 632 addi- tional beds for Greater New York required to meet the present acute needs in Manhattan and Brooklyn. Proper Bed Capacity, and Beds Needed in 1920. Richmond. Present Number Gen- eral Hospital Beds in Borough. Excess or lack . of beds in 1905.* Population in 1920. Number of beds needed in 1920. Known number of beds in 1920, including all known additions. Excess or lack of beds in 1920.* By hospitals. Total. 150] 60 72 \ 70 | 40 J 392 24 406,676 899 520 370 161 1 70 f «3 1 96 94,700 210 231 21 *Black face type denotes excess in bed capacity; ordinary type denotes lack. 5^ II. FUTURE NEEDS. In determining the hospital needs of Greater New York in 1920, five factors of particular importance must be mentioned. Willingness to Go to Hospitals. (1) The first of these factors which will act as a determinant of the number whG will need hospital treatment in 1920 is the increased willingness on the part of the public to go to hospitals. It is a well noted fact that hospitals are being used much more largely by the general public to-day than they were a decade or a decade and a half ago. Even within the last fifteen years the reputation of the hospital has changed in the public mind from an institution of ill repute, where paupers were the principal patients, to a place where to-day the rich and the poor alike seek relief and health. From an institution with a stigma attached to its name and in which the public had little or no confidence, the hospital has developed into an institution of very high repute, and one in which universal confi- dence is placed. This increased willingness on the part of the people to use hospitals has not ceased, and is to-day increasing. Every year more people are seeking relief in hospitals. There is hardly a general hospital in Greater New York which does not report an increase in patients in 1905 over 1904. That this popular use of hospitals will continue to grow is beyond question. The rapid development of Greater New York into a city of apartment and tenement houses, together with the modern " bachelor move- ment," if it may be so called, on the part of both sexes, is preparing a class of people who will in years to come be more and more dependent on the hospital as a place of last resort in case of sick- ness. The increasing favor of the hospitals, due also to their great success in caring for the sick, will likewise tend to increase the number of applicants to these institutions. On October 1. 1890, there were in the general hospitals of Greater New York 4,045 patients. In 1905 the number of patients had increased 85%, or to 7,504 patients. The general population of Greater New York increased during the same period 64%. It will thus be seen that the hospital population, in the general hospitals alone of Greater New York, increased 20% more rapidly than did the general population during the same period. Another figure will show more clearly the use of hospitals in the last fifteen years. ->■. ■■•. ^ ->> V. >z- Q EUSTWG HOSPITALS O PROPOSED HDSP1 TAL D PfiOPOXD mBULMKE ST/] n "t ^ — W//M) B0tfH£H/?/£S ^-S// ^ U to >> "- 1 u, a g'gffi ^©{rjis g 1> ^ c*rr| 5 P/S (12"^ ra rf t* 3 ortotooo^o P.^? O 00000 « M M N CS rf g CD _c ^ .-s p. p, 2 3 *» 1— 1 O fin £"3(3 -■s ,_ p.+» : -i- — — -± oi5 vi in ^3 00 1-2 I 8 1 •- u cd s K «-. "o -a 2 to to +i 3 a SaSa CD SO .? Si c 3 c ^ 1 ° s rt if P- js g CD Jl 2 cS s^ cSPP a ^ 3 <* CD CD c c ccS m T3 CD CO g cd CD CD c £ cd 00 co P a H •z Z B to a « CM O O.tJ t3 "" cd | 9. P ^5 ,2 >.^-« S-s • p. 'ci'S 2 ' ° oZ 0^ o . o to c 5 tS.O 5 cd ^ +j < fco *s pq -c a to >> +J g ^ n 2 cd t3 *3 -^ a •£ CD CO H 5 CD > A! < 3 S >> r- 2; - c '■£ cd CD CD a _cd "3 e cd ' m C cd cd n) _>> "3 •- PQ CO c CD CD a *d c CD 2 rti— ( s "3 73 the price will be doubled or tripled. Dr. S. S. Goldwater, Super- intendent of the Mt. Sinai Hospital, in an address before the Medical Society of the County of New York, printed in the New York Medical Journal for April, 1906, arraigns hospital managers for their lack of foresight in not securing hospital sites in the out- lying sections of the city where they will be needed without doubt in the years to come. He says : " What far-sighted hospital cor- poration is there that will take steps to secure, at the existing low land valuation, desirable hospital sites for the hospitals which the future population of Queens must have? None that I know of, and probably nobody will invest a dollar in the reservation of a hospital site in that territory, until the population of the district has increased five-fold, until values have multiplied and until the scandal of carrying sick people many weary miles to the hospitals of Manhattan and Brooklyn begins to weigh heavily on the public conscience." This statement should explain what immediate action should be taken with reference to the future hospital needs of Greater New York. In conclusion, I wish to acknowledge my indebtedness to Mr. Homer Folks and other members of the Hospital Committee for their many timely suggestions in this investigation. I wish also to express my appreciation for the aid and suggestions given me by Miss Lilian Brandt, Mr. Frederick Hoffman, Mr. Archibald A. Hill, Miss Florence L. Lattimore, Drs. Hitchcock, Jacobi, and Dana, and for the uniform courtesy and assistance given me by the many hos- pital superintendents of the city. Respectfully submitted, PHIL P. JACOBS. 74 APPEN TABLE I— SHOWING POPULATION OF MANHATTAN Population. Ward. 1880. 1 17.939 2 1 , 608 3 • 3.582 4 20, 996 5 iS,84S 6 20, 196 7 50, 066 8 35,879 9 54.596 10 47,554 11 66, 778 12 81 ,800 13 37,797 14 30,171 15 31,882 16 52,188 17 104,837 18 66,611 19 158, 191 20 86, 051 21 66,536 22 in, 606 Totals for Manhattan. . . 1 , 206 , 299 1890. 189S. 1900. 1905. II, 122 12 , 508 9,5i6 io,595 929 1,038 1,488 673 3,765 4,OI4 1,797 3, 160 17 , 809 l8 , 404 19,554 22,793 12,385 IO , 603 8,298 7,871 23.119 22 , 897 20, 004 20,944 57.366 74,227 89,237 97.158 31 . 220 3L374 29,059 31. 117 54,425 60, 987 59,65o 60 , 232 57,596 70,l68 71,879 67,149 75,426 86, 722 99,144 n6,333 245,046 364,412 476 , 602 594,856 45,884 58,802 64,117 58,304 28 , O94 31.904 34,035 34.485 25,399 26,216 24, 066 27.520 49,134 57,43o 52,808 58,558 I03, 158 144,727 130,796 149.324 63,270 67,469 61,325 67 ,622 234,846 267 , 076 257.448 283,455 84.327 94,969 89,798 87.342 63 ,OI9 72, 144 60, 211 7L738 153,877 194,893 1,742,985 189, 261 1,850,093 220, 692 1,515,301 +2, 091 , 921 23 and 24. 88,908 POPULATION OF 125,075 200,507 271,630 J Health Department Census. POPULATION OF MAN Wards 1,2,3, 4, 5,6 70, 166 69, 129 69,464 Wards 7, 10, 11, 13, 17 307, 022 339, 43 o 404, 626 Wards 8, 9, 14, 15 152,528 139,138 150,481 Wards 18 and 21 133,147 126,289 I 39,6i3 Wards 16 and 20 138,239 133,461 152,399 60,657 455,173 146 , 810 121,536 142 , 606 65 , 936 488,268 153,354 139,360 145,900 DICES AND THE BRONX, i? 75 5o-igos, BY WARDS. *Increase per Cent. Total. ti88o-i8go. 1890- 1900. 1890— 1895. 1895— 1900. 1 900-1905. 1880-1905 .387 .144 • 137 .239 • "3 .409 .422 . 602 .116 • 433 .547 .581 ■ °Si .523 .066 .502 .758 .117 .151 .098 ■ °3S . 062 .165 .086 .218 .329 .144 .217 .051 .503 .095 .141 .009 .127 .047 .037 -I4S 555 .294 . 202 .088 .938 .120 .069 .005 .073 . 071 .132 .003 . 096 . 121 .022 .011 ■ 103 .211 .248 .218 .024 .065 .412 .128 • 314 • 149 . 164 ■ 173 • 742 1-995 .986 .487 .308 .248 6. 272 ■ 2M • 395 .281 .091 .091 ■ 542 .068 .245 ■134 .066 .013 .143 .203 055 . 032 .082 ■ 143 .136 .058 ■ °75 . 169 .081 .108 . 122 .016 .268 .112 . 140 .141 .424 .054 .031 .066 .091 . 102 .016 .484 . 096 .136 .036 . IOI .792 .020 .065 .112 .054 .027 .015 .053 .044 .161 .165 .191 .078 .378 . 223 . 229 • 273 .029 .166 • 977 . 256 .150 .061 .142 • 751 THE BRONX 1890 -1905 1 • 255 .407 .603 • 354 2. OSS HATTAN BY SECTIONS. .014 .125 .^05 .131 .087 .060 .105 .341 .191 .125 .072 .590 .087 . 127 .081 .024 .044 .005 .052 .038 .105 .129 . 146 .046 .035 .068 • 142 .064 .023 .056 *Black face type denotes decrease. tCensus of 1895, made by police department, is of little comparative value on account of its great inaccuracy. Comparisons from 1890 to 1900 are much more valuable. TABLE II- Ward. -SHOWING DENSITY OF POPULATION AND DEATH-RATE MANHATTAN, 1905, BY WARDS. Area in acres, excluding parks. 1 I3I-57 2 81. 3 95- 4 83. 5 168. 6 ' 74-89 7 186.65 8 183. 9 31987 10 106. 11 .■". 192.4 12 4,719.58 13 106.3 14 96. IS 189.88 16 349. 17 320.49 18 435-45 19 1,317.76 20 444. 21 408.05 22 1, 176.81 Totals 11,184.7 Population. 1905. io.595 673 3,160 22,793 7,871 20,944 97-IS8 31. "7 60, 232 67,149 n6,333 594,856 58,304 34,485 27,520 58,558 149,324 67,622 283-, 4SS 87,342 71,738 220, 692 Number of Persons per Acre. 1890. 84.53 11.47 30.63 214.57 73-72 297-73 289.73 170. 60 170.15 523.60 384.83 51-73 428.82 292.65 I33-78 140.79 321.87 145.30 178. 21 18993 153-33 129.95 1900 . 72.31 18.37 18 . 92 235-59 49-39 267 . 11 478. 10 158.79 186.48 653-45 515-3° 100.95 599-22 354-53 126.73 151-31 408. 10 140.83 195-37 202 . 24 146. 50 160.83 128.29 165.32 1905. 80. S3 8.31 32.26 274.49 46.86 279.66 520.53 170 . 04 188.31 633-48 604. 64 126 .04 549-39 348.8o 144-93 167.78 46S-92 155-29 215-13 176.44 I73-05 196.88 187.03 IN Death- rate 1905. 46.8 40. 1 20. 6 26.7 36.2 25. 14.9 17.8 27.4 14.6 13-6 16. 2 12.8 22 . 21 . 20.8 15-4 2S-7 22 . 1 24.1 23-7 20. 2 18.2 76 TABLE III— SHOWING POPULATION Population. Ward number. i 2 3 4 5 6 7 8 9 io II 13 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 3° 31 32 Totals — Brooklyn 1880. 1890. 1900. 1905. 18,729 20,040 20,327 22,838 9,254 8,986 8,565 9,026 18,271 i8,754 17,940 19,484 12 ,819 12,324 12,688 12,951 18,517 20,175 18,862 19, 807 35,437 37,693 42,485 48,547 31,663 35,726 40,471 45,358 17,388 31,239 52,414 63,912 15,044 17 , 696 42,876 47,955 27 , 140 34,031 39,100 42,854 21,680 22,693 22 ,608 25,090 , ' 22,201 27,368 30,354 31,432 21,029 21,628 24, 029 23,567 25,559 27 , 246 31,483 33,298 23,654 27,630 34,269 32,982 42,712 45,720 56,550 61 , 136 30,088 41,424 57.309 66,268 23,926 74,960 25.133 27,931 27,661 36,244 37,645 41,704 24,188 24,136 35,446 27,303 3L956 50, 118 58,957 65,176 25,473 50,250 66,575 74,974 14,396 29,348 61,813 67,966 8,823 16, 771 31,767 43,583 19,055 44,638 48,328 55,211 29.505 66,086 94,149 47,521 . 87,303 43.961 77,912 Included Included 27,188 43,o6l in m 24, 700 37,l63 total. total. 14, 609 22,358 8,243 13,232 599,495 838,547 1 , 166,582 1,358,686 Ward number. 1 2 3 4 5 Totals — Queens TABLE IV— SHOWING POPULATION Population. 1880. 1890. 19 00. IQ 05. 17, , 129 30 : ,506 48. , 272 55 ,020 9 ,804 17 .549 40 : 903 60 ,559 15. , 906 19 ,803 25, ,870 29 ,505 10 ,088 14 .441 30 : , 761 42 ,817 t 3 . .632 539 U .751 7, 193 9 ,926 56, 87, 050 152, 999 198, 240 Ward number. 1 2 3 4 5 Totals — Richmond TABLE V— SHOWING POPULATION Population. 1880. 1890. 1900. 1905. 12,679 16,423 21,441 23,659 9,029 10,557 13 , 200 14,035 7,014 4,980 5,289 9,811 6,644 8.258 13,701 9,516 9,163 15,347 9.480 10, 198 38,991 t Estimated on present area of ward by U. S. Census. 51,693 67,021 72,845 77 OF BROOKLYN, 50-1905, BY WARDS. *Increase per Cent. 1880— 1890. 1890— 1900. 1900—1905. 1880— 1900. 1880-1905. 1890— 1905. .070 .013 .139 .085 . 207 • 144 029 .049 .051 .080 .024 ,004 .026 .045 .085 .019 .062 .039 .019 .032 .019 .010 ■ 058 .082 .069 .050 .018 .069 .018 .063 . 127 •143 .198 .369 .288 .128 .130 . 121 • 275 .432 . 269 .796 .678 . 219 2 .014 2.675 1.043 .176 1.428 . 109 1.850 2. 161 1.687 .254 .119 .096. .441 ■ 579 • 259 .047 .004 109 .043 .157 • 105 • 235 . 109 • 035 • 367 .866 .148 .028 . in .019 .142 . 121 .089 .066 .144 .058 .232 • 3°3 .221 .077 .096 .079 • 237 • 394 .197 .071 • 237 .081 • 324 • 431 -341 • 375 .383 .156 ■ 9°5 1. 202 • 599 2.133 1.982 . in .051 . 167 .631 • 310 .038 .108 .361 .508 ■ 151 .002 • °S4 .052 .052 1.698 • 131 .568 ■ 177 .105 .845 I.039 .301 • 973 • 324 . 126 1 . 610 1.938 • 492 1.039 1 . 106 . 009 3-3o6 3-65I 1. 316 .901 .894 -353 2.600 3-939 1-598 1.342 .082 .142 1.530 J .8 9 7 • 237 1.239 2. 191 .081 .121 .584 .504 • 534 .605 .946 .615 OF QUEENS, 1880-1905, BY WARDS. ♦Increase per Cent. 1880-1890. 1890 -1900. 1900- -1903. 1880— 1900. 188c -1905. 1890 -1905. .781 .582 -139 1. 821 2.194 .803 .790 1-343 .480 3-172 5-177 2.451 .245 .306 .141 .626 .852 .489 .431 1. 130 • 392 2.049 3-244 1.965 .300 • 514 .241 1 . 256 1-733 1 .089 2.683 OF RICHMOND, 1880-1905. BY WARDS. ♦Increase per Cent. 188 3—1890. 1890— J 900. 1900- -1905. 1900- -1905. 1880- -1905. 1890- -1905. .295 • 305 .103 .691 .866 -441 .169 ■ 251 .063 461 • 554 ■ 329 .256 .396 . 120 953 1. 189 .564 .334 • 432 .003 911 .903 .425 .561 --.336 . 109 .112 732 ■ 932 .868 • 235 .296 .087 .718 .409 *Black face type denotes decrease. 78 TABLE VI— SHOWING DENSITY OF POPULATION AND DEATH RATE— BROOKLYN —BY WARDS. Ward. 13. 14. 15. 16. 17. 18. 19. 23. 24. 25. 26. 27. 28. 29. 3°. 31- 32. Area in Acres. 233. 97-7 161 . 4 in. 3 119. 4 302.9 458. 5 1,843-2 623.0 318.7 252.6 663.1 230.3 282.6 244.8 244.8 823.3 873. 413.8 461. 5 483.2 1,361.6 736. 1,198.5 567.8 3.S90.2 400.7 884.4 3,800. 5,404-1 6,312.3 5,479-5 Population. 1800. 20, 040 8,986 18,754 12,324 20,175 37,693 35,726 31,239 17 , 696 34,031 22 , 6g3 27,368 21,628 27 , 246 27,630 45,720 41,424 74,96o 30,244 24,136 50,118 50,250 29,348 16,771 44,638 25,905 Number of Persons per Acre. 1890. 1900. 1905. 20,327 8,565 17,940 12,688 18,862 42,485 40,471 52,414 42,876 39,100 22 , 608 30,354 24, 029 31,483 34,269 56,550 57,309 25,133 37,645 35,446 58,957 66,575 61,813 31,767 48,328 66,086 43,961 77,912 27,188 24, 700 14,609 8,243 9 , 026 19,484 12,951 19, 807 48,547 45,358 63,912 47,955 42,854 25 ,090 31,432 23,567 33,298 32,982 61,136 66,268 27,931 41,704 27,303 65,176 74,974 67,966 43,583 55,211 94, 149 47,521 87,303 43,o6i 37,i63 22,358 13,232 86.0 91.9 116. 2 no. 7 168. .9 124.4 77-9 16. 9 28.3 106. 7 89.8 41.3 93-3 96.5 112 .9 50.3 85.5 73-1 52.3 I03-7 36. I 39-9 13-9 87.2 87.7 III . 2 112 . 9 158.0 140. 2 88.3 28.4 68.8 122.7 89.5 45.8 104.3 in. 4 123.6 231.0 69.6 28.8 91 . o 74-i 122 . 48.9 84. 26.5 85.1 18.4 109.7 97-9 92.4 120. 9 116. 3 165 . 9 160.3 34 76 134 99 47 102 117 134.7 249-3 80.5 31-9 IOO. 7 59-2 134.9 55-1 92.3 36.3 97-2 26. 2 118. 5 98.7 11. 3 6.87 3-54 1905 Death Rate. 16.4 26.5 13-7 19. 6 18.3 28.2 15-7 16.5 14-9 19. I 29.4 17-5 23.7 - 16.6 16.5 II. 4 14-4 31-3 12.0 25.2 14.3 24-3 13 9 12 . 1 14-5 14. 2 45 -7§ 13.6 15-5 10.5 Totals — Brook- lyn 39,977-8 1838,547 1,166,582 1.358,686 20. tPresent area of borough. §The presence of Kings County Hospital, Home for Aged, Contagious Hospital, and several other institutions accounts for abnormally high death rate. TABLE VII— SHOWING DENSITY OF POPULATION AND DEATH RATE— QUEENS —BY WARDS. 1 4,650. 30,506 48,272 55,020 6.1 10.3 11. 8 18.7 2 14,700. 17,549 40,903 60,559 1.2 2.7 4.12 13.4 3 22,000. 19,803 25,870 29,505 0.9 1.1 1.34 10.6 4 36,600. 14,441 30,761 42,817 0.39 0.81 1.17 16.6 5 4,933- *4,75I 7,193 9,926 0.97 1.4 2.10 15.2 Totals — Queens 82,863 87,050 152,099 198,240 1.1 1.8 2.4 16.04 *Estimated on present area of ward, by U. S. census. TABLE VIII— SHOWING SUMMARY OF POPULATION OF GREATER NEW YORK- 1880-1905— BY BOROUGHS. Population. Increase per Cent. Name of Borough. 1890. 1900. 1905- Manhattan 1,206,299 1,515,301 1,850,093 2,091,921 The Bronx 88,908 200,507 271,630 Brooklyn 599,495 838,547 1,166,582 1,358,686 Queens 56,539 87,050 152,999 198,240 Richmond 38,991 51,693 67,021 72,845 Totals — Greater New York. . . 1,901,324 2,580,599 3,437,202 4,014,187 1880 1890 1900 1880 to to to to 1890. 1900. 1905- 1905. .256 . 229 .142 ■751 1-255 •354 2.055 •399 • 391 .161 1259 • 539 • 757 .289 2.683 ■ 326 . 296 .087 .868 .362 .332 .168 I. Ill 79 TABLE IX— SHOWING HOSPITAL POPULATION OF MANHATTAN AND THE BRONX 9- German Hospital, 77th street and Parle avenue. Hahnemann ?Iospital, 68th street and Park avenue. Flower Hospital, 63d street and Avenue A. French Benevolent Hos- pital, 450-58 W. 34th street, between gth and 10th avenues. 258 Name and Address of Hos- pitals in Order of Wards in which Located. Ward number. 4. St. Gregory's Hospital, 03 Gold Street, near Frank- fort. 5. House of Relief, 63 Hud- son, corner Jay. 5. Trinity Hospital, 50 Var- ick street, near Canal. 7. Gouverneur Hospital, Gov- verneur Slip and East River. 7. Beth Israel Hospital, Jef- ferson, corner Cherry. St. Vincent's Hospital, nth and 12th streets and 7th avenue. St. Francis Home, 609 5th street, near Avenue B. Mt. Sinai Hospital, 100 291 101st street, Madison and Fifth avenues. Sydenham Hospital, 339— 30 341 E. 116th street, near 1st avenue. St. Luke's Hospital, 113th 190 street and Amsterdam 12. J. Hood Wright Memorial Hospital, 131st street and Amsterdam avenue. 12. Washington Heights Hos- pital. 554 W. 165th street. 12. Harlem Hospital, 136th street and Lenox ave. • Philanthropin Hospital Fifth ave.. and 128th street. St. Mark's Hospital, 177 2d avenue, near nth St. New York Hospital, 15 and 1 6th street, between 5th and 6th avenues. New York Postgraduate Hospital, 2d Avenue and 20th street. Columbus Hospital, 226 E. 20th street, between 3d avenue and Gramercy Park. Presbyterian Hospital, 70th street and Madison Ave. Number of Patients. Jan. 1, Sept. 1 1905. 1905. Mar. 1 1906. 67 165 65 176 196 65 83 87 49 170 *37 38 7 362 335 20 37 207 213 43 37 4 39 35 65 190 161 Number of beds, Mar. 1, 1906. Remarks. 20 Hospital opened Jan. 1, 1905. Bed capacity Dec. 1, 1907 was 40 beds. 35 Census estimated on first two dates. 28 Hospital closed Aug. 31 1907. 90 Remodelled hospital now ac- commodates 160. 120 Some additions to bed ca- pacity recently made. 380 New wing of 125 beds re- cently opened. 275 Closed as a general hospital. Receives chronic cases only. 480 35 beds of the 480 are kept constantly in reserve for emergency and isolation cases. 65 New hospital for 200 beds to be started somewhere near present one soon. 261 Have plans to enlarge to ca- pacity of 600, but nothing definite as to time. Bed capacity on Dec. 1, 1907 was 298. 58 Expect to build hospital of 200 beds.. 40 Bed capacity Jan. 20 1908 was 23. Will build a new hospital soon. 5 53 New hospital at 136th street and Lenox avenue now open with 150 beds. 79 Will add 6 beds during 1908. 205 Plans for 10 more private rooms. 216 Hope to build adjoining an addition for 150 beds. 125 New addition on 19th street recently completed. 214 Top floor with 100 beds closed for lack of funds. Proper capacity, 315. 160 203 245 40 62 76 57' 72 76 81 Has large number of private patients. 100 An addition for 80 beds con- templated. 150 1 Census on April 25, 1906 2 Housecleaning and renovating made low census. 3 Carried forward from Jan. 1, 1905. 4 Census on Jan. 1, 1906. Hospital Sept. 1,-1905. 5 Bed capacity includes 9 cribs for infants. 9 Census January 1, 1908. Hospital moved from Williambridge. 8o TABLE IX— SHOWING HOSPITAL POPULATION OF MANHATTAN AND THE BRONX — Continued. Number of Patients. 755 72 8161 Name and Address of Hos pitals in Order of Wards . ■ — in which Located. Jan. 1, Sept. 1, Ward 1905. 1805, number. 2i. Bellevue Hospital, 26th street and East River 31. New York Polyclinic Hos- pital, 214—20 E. 34th street, between 2d and 3d avenues. 22. Roosevelt Hospital, 58th and 59th streets, 9th and 10th avenues. 22. St. Elizabeth's Hospital, 415 W. 51st street, be- tween 9th and iothAves. 13. Lebanon Hospital, E. 150th street and Cauldwell avenue. 23. St. Francis Hospital, i42d street, St. Ann's and Brook avenues. 23. Lincoln Hospital and Home, E. 141st street, Concord avenue and Southern Boulevard. 24. Fordham Hospital, Croton avenue near Pelham avenue. Totals (excluding Black- Mar. 1, 1906. 811 66 171 60 145 400 43 40 123 377 5o '69 215 60 165 9 I2 5 10 47 8 61 Number of beds, Mar. 1, 1906. Remarks. 6980 "Greater Bellevue" to ac- commodate 2,000. 96 Bed capacity on Dec. 1, 1907 was 105. 244 Bed capacity on Dec. 1, 1907 was 337. 65 Takes private patients only. 205 Bed capacity on Jan. 20, 1908 was 230. 500 New hospital for acute cases opened March 15, 1906. 500 About cases. are not hospital 56 New hospital Southern Boule- vard and Croton avenue, near Pelham avenue, now open with 150 beds. well's Island hospitals) . 4,065 4,049 4,651 BLACKWELL'S ISLAND HOSPITALS. City Hospital, Southern end 700 645 654 689 Had bed capacity of 705 on BlackweH's Island Oct. 1, 1907. Metropolitan Hospital, Northern end Blackwell's Island 12 S97 12 4^4 12 5gi 533 Had 612 beds onOct. 1, 1907. Totals — Manhattan, Bronx and Blackwell's Island Hospitals 5.362 5,158 5,901 7,202 6 Bed capacity reduced by about 100, because of work on new pavilions. 'Census has reached since Mar. 1 as high as 90. Most of cases are surgical. 8 Housecleaning and renovating made low census. On Nov. 1, had 219. 9 Census January 1, 1908. Hospital moved from Williamsbridge. 10 Most of cases (about 75 per cent.) are chronic. Hospital acts as relief for City Home for Aged and Infirm. v n The new Mt. Moriah hospital now being built at 138-140 2nd street will accommodate about 40 patients. "Census and bed capacity excludes tuberculosis. Bed capacity Oct. 1, 1905. 8i TABLE X— SHOWING HOSPITAL POPULATION OP BROOKLYN. Names and Addresses of Number op Patients. Hospitals in Order of . ■ Ward in which Jan i, Sept. i, Mar. i, Ward Located. i9°5- 1905. 1906. number. 6. Long Island College Hos- pital, corner Henry, Pa- cific and Amity streets. 6. St. Peter's Hospital, Henry street, between Congress and Warren. 8. Norwegian Lutheran Dea- coness Home and Hos- pital, corner 46th street and 4th avenue (Bay Ridge). 8. Samaritan Hospital, cor- ner 4th avenue and 17th street. 9. The Jewish Hospital, cor. Classon and St, Marks avenues. Number of beds, Mar. 1, 1906. Remarks 166 250 45 11. The Brooklyn Hospital, corner Raymond street and De Kalb avenue. 13. Brooklyn E. D. Hospital, 106 S. Third street, be- tween Bedford avenue and Berry street. 13. Williamsburgh Hospital, corner Bedford avenue, and S. Third street. 18. St. Catherine's Hospital, Bushwick, Ten Eyck and Maujer streets. 20. Cumberland street Hospi- tal, Cumberland street, near Myrtle avenue. 22. Methodist Episcopal Hos- pital, 7th avenue and 6th street. 24. St. John's Hospital, corner Atlantic and Albany avenues. 24. St. Mary's Hospital, corner St. Marks and Rochester avenues. 24. Swedish Hospital, corner Sterling Place and Rog- ers avenue. 25. Bushwick Hospital, How- ard avenue and Monroe street, near Broadway. 26. Bradford Street Hospital, 109 Bradford street, near Atlantic avenue. 26. Lutheran Hospital, New York avenue, between Powell and Junius streets. 28. German Hospital of Brook- lyn, St. Nicholas av- enue and Stockholm St. 28. Bethany Deaconess Hos- pital, St. Nicholas av- enue and Bleecker street. 29. Kings County Hospital, Clarkson street and Al- bany avenue. 31. Coney Island Reception Hospital, Surf avenue, near Ocean avenue, Coney Island. 107 185 651 164 252 66 113 198 203 238 75 139 34 58 164 205 70 73 36 S85 250 New hospital, replacing old one, to hold, when finished 37S beds. 321 Over 30 per cent, of work is for consumptives. 94 12 Plans now ready to double capacity within few months. Hospital opened in Dec. 1906, and had bed capacity of 160 on Dec. 1, 1907, with 83 patients. 165 Bed capacity on Dec. 1, 1907. was 175. 38 Will add 40 beds within a year. 196 Wing of 7s beds used for convent to be fitted for hospital purposes. 100 When all additions in pro- gress and contemplated are completed, hospital will accommodate 200. 230 Expect to add 50 beds in near future. 50 Opened July 1, 1906. for patients. Had census of 32, on Dec. 1, 1907. 38 Hope within 5 years to build hospital of 100 beds in Bushwick. 8 Plans now ready for new hospital nearby of about 100 beds. 54 Expect to build new hospital of 80 beds within 2 years, but not decided as to lo- cation. 120 Will add another wing of 100 beds soon. 35 631 Census omits neurological cases and 121 neurological beds. 8 New hospital of about 100 beds to be built nearby Total — 21 hospitals 2,045 1,983 2,241 2,719 2 Census June 1, hospital opened March 7, 1906. 4 Serves as receiving station for Kings County Hospit 'Census Jan. 1, 1906. 3 Census Sept. 30. ^Serves as receiving station for Kings County Hospital. 'Hospital usually open only 6 months of year, April to Oct. Hospital open all winter in 1908. TABLE XI— SHOWING HOSPITAL POPULATION OF QUEENS. Number of Patients Names and Addresses of Hospitals in Order of Ward in which Jan. i, Sept. i, Mar. i, Ward Located. i9°5- i9°5- 1906. number. 1. St. John's Hospital corner 139 Jackson and 12th streets, Long Island City. 3. Flushing Hospital, Parsons and Forest avenues, Flushing, L. I. 4. St. Mary's Hospital, Ray and Shelton avenues, Ja- maica. 4. Jamaica Hospital, New- York avenue, near Atlan- tic, Jamaica. 5. St. Joseph's Hospital, Cen- tral avenue, near Lock- wood street, Far Rocka- way. Totals — Queens (5 hospitals) 242 130 Number of beds Mar. 1, 1906. ; 147 Remarks. New wing of 125 beds in course of erection. Pres- ent bed capacity slightly reduced by building oper- ations. 35 36 32 60 37 41 52 72 31 26 29 70 hs 39 40 Will build addition soon, but can not tell how large or when. 'Hospital opened June 25, 1905. TABLE XII— SHOWING HOSPITAL POPULATION, RICHMOND. Names and Addresses of Number of Patients. Number Hospitals in Order of - Ward in Which Ward Located. number. 1. S. R. Smith Infirmary, Cas- tleton avenue, New Brigh- ton, Staten Island. 1. St. Vincent's Hospital, West New Brighton, Staten Island. Totals — Richmond (2 hospitals) 124 Jan. 1, Sept. 1, Mar. 1, Mar. 1, 1905. 1905- 1906. 1906. 79 75 96 161 45 46 63 70 Remarks. 70 This hospital has also 80 beds for consumptives. §3 TABLE XX. SHOWING KNOWN ADDITIONS TO BED CAPACITY UP TO 1920, BY HOSPITALS. MANHATTAN. Names of Hospitals Bed Capacity Additions Known bed Remarks in Jan. 1, 1908 definitely capacity Alphabetical order known (beds)* in 1920 Bellevue 1050 950 2 , 000 Two pavilions of new hospi- tal will be opened in 1908. Beth Israel 146 4 150 Expect to_ build entirely new hospital. Flower 100 80 180 _ French Benevolent. .. . 115 35 150 Has accommodations for 150. German 234 7 241 Isolation ward to be added. Harlem. . .' 120 30 150 Can accommodate 150. Mount Moriah .... .... 40 In building. New York 207 10 217 Additions to be in private rooms. Presbyterian 225 100 325 100 beds closed for lack of funds. Red Cross 52 3° 82 St. Luke's 298 68 366 Will eventually have 600 beds. St. Mark's 89 6 95 St. Vincent's 400 25 425 May add more beds but not known. Sydenham 85 115 200 Site purchased for new hospital. Totals Manhattan.. 4.858 1,460 6,318 (all hospitals) BLACKWELL'S ISLAND. Metropolitan 612 150 762 Capacity and additions ex- clude Tuberculosis Infir- mary. City 705 200 905 Totals Blackwell's Island 1,317 35o 1,667 * Hospitals to which no additions are to be made are omitted. Only definitely known additions are considered. TABLE XXI. SHOWING KNOWN ADDITIONS TO BED CAPACITY UP TO 1920, BY HOSPITALS. BROOKLYN. Names of Hospitals Bed capacity Known Bed capacity in Jan. 1, 1908 additions up in 1920 Remarks Alphabetical order -to i92o(beds)* Bradford Street 8 92 100 City will build new hospital. Brooklyn E. D 37 43 80 Work will be commenced this year. Bushwick 39 61 100 Will build new hospital. Coney Island 8 92 100 New hospital to be erected by city. Cumberland Street. . . . 200 80 280 German 122 100 222 Kings County 591 200 791 Improvements at new an- nex building will give in- crease. Long Is. College 200 12s 32s Additions in building. Methodist._ 150 50 • 200 St. Catherine's 190 50 240 St. Mary's 230 25 255 Totals for Brooklyn (all hospitals) .. 2,882 918 3,800 QUEENS. St. John's 150 12s 375 New wing soon to be opened Total for Queens (all hospitals) .. . 395 ■ 125 520 * Hospitals to which no additions are to be made are omitted. Only definitely known additions are considered. j V of fn£ * 7 COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special arrange- ment with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE /d 1 A"> /Sd )D-n-5p f t t / 4 "^ C2b(i14i)m100 RA.982.K48 St22 ' State charities aid association, New York. Committee on hospitals.