Health care in 19th century Upper Canada/Ontario : adaptation of a British model

Abstract

After having completed relevant coursework in health care in Britain and while researching late 19th century health care in Port Arthur, I became fascinated by the surprisingly advanced level of such services in Port Arthur during the last two decades of the nineteenth century. One would expect such an isolated community to have lagged far behind southern Ontario and Britain in terms of progress in health care services. Such, however, was not the case; Port Arthur, despite its obvious handicaps of size and relative isolation, managed to keep pace astonishingly veil. Yet advances in Ontario health care services did emanate from Britain. Therefore, it seemed logical to address first the conditions which stimulated innovative changes in Britain and the adaptation of these new ideas as they spread to southern Ontario before examining their effects in a more remote community. To fully appreciate the rapid spread of ideas and subsequent changes in services that occurred in Ontario — and specifically, in a frontier community one must first consider the stages in the development of the various fields of health care. Health care in Britain and Ontario underwent a dramatic change during the second half of the nineteent-h century: what had been during the first half of the century a rather primitive form of health care now developed into a highly scientific and well-organized service. Major discoveries in the science of medicine; public health awareness, with improved municipal cleanliness; clean water supplies and sewage removal; understanding and control of epidemics along with improved hospital facilities and nursing care had combined to bring about this revolution. To truly appreciate the impact of such advances and the remarkable dissemination of knowledge from Britain, to Ontario, and subsequently to Port Arthur, it is necessary to establish a frame of reference: the examination of conditions in existence during the first half of the nineteenth century which served as a catalyst to dramatic changes in health care. This thesis has consequently been divided into two parts: Part 1, consisting of Chapters 1 and 11, deals with the development of the various fields of health care in Britain and Upper Canada/Ontario during the nineteenth century. Part 11, consisting of Chapters 111, IV and V, examines the development of the Ontario Board of Health, public health in Port Arthur and St. Joseph's hospital. Chapter 1 traces the crisis in health care in Britain brought about by the Industrial revolution and its demographic changes. The sanitary reform movement was a direct response to the increase of disease in certain segments of the urban population and to the need for reform. The development of hospitals and nursing care is also outlined in Chapter I, as well as the impact of the Crimean War which served as a watershed in the improvement of medical services in Britain. Chapter 11 examines the conditions in Upper Canada and the response of the colony to demographic changes and the diseases brought by immigration. It also surveys the construction of the first hospitals in Upper Canada. Major discoveries in medical science, in the second half of the century, are discussed in Chapter 11 to emphasize the impact they had in the colony. In addition to these changes in the medical profession, improvements in hospital facilities and nursing care are also described. Finally, Chapter 11 outlines the advances in public health in Ontario brought about by legislation which enabled the province of Ontario to keep pace with developments taking place in Britain. Part 11 of the thesis moves on to illustrate the context in which change occurred. Chapter 111 deals with the specific problems of the Ontario Board of Health: apathy of the municipalities; why Ontario lagged behind Britain in the enforcement of public health legislation; what was wrong with this system, and what had to be done to improve public health. There was discussion of legislation throughout the 1880's, and progress was made by the turn of the century through public education. In Chapters IV andV,case studies of Port Arthur and its Board of Health and St. Joseph's Hospital and its Nursing School are presented to show how even a small, remote community responded quickly to advances made in southern Ontario and Britain. Although Canadian public health reformers were in contact with the American Public Health Association, the stronger influence was with the British experience. As Heather McDougall states in her essay Enlightening the Public, "Such close ties indicated clearly the extent to which the Canadians were emulating the British approach." (p.439.) Indeed, on looking at the American public health movement during the 1880*s it also indicates an indebtedness to the British experience.