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In the eighteenth and nineteenth centuries, Elmhurst was mostly large tracts of land used for farming. Streets constructed along present-day Douglas Ave, Eaton Street, and Chalkstone Avenue allowed for transit of produce to the city. The neighborhood remained sparsely settled for most of the nineteenth century. A streetcar line connecting Elmhurst to the city was opened in 1882. In 1909, the city acquired a piece of land on either side of a stream flowing from Academy Avenue, parallel to Chalkstone, and created Pleasant Valley Parkway, a landscaped boulevard similar in design to Blackstone Boulevard in the Blackstone neighborhood of Providence, though the residents attracted to the area were not as wealthy as their Blackstone counterparts.
In the early 1900s, Irish and Italian immigrants making their way out of crowded closer neighborhoods displaced the initial middle and upperclass residents. Institutional growth came over the next few decades in the form of the founding of the Charles V. Chapin Hospital, the Providence Lying-In Hospital (now Women and Infants Hospital), and the Homeopathic Hospital of Rhode Island (now Roger Williams Medical Center). Providence College and La Salle Academy moved to the area in 1917 and 1925 respectively.