Manitoba History: Review: Ian Carr and Robert Beamish, Manitoba Medicine: A Brief History
by Esyllt Jones
The history of medicine has changed a great deal in the last twenty years. There was a time when physicians wrote their own history, to be read predominantly by each other. To some degree, this was because no one else—least of all academic historians—showed much interest. But it was also because physicians “jealously guarded” their own history, in the words of American medical historian Charles Rosenberg. More recently, however, social historians influenced by critics of modem medicine—such as Michel Foucault, Ivan Illich, and feminists Barbara Ehrenreich and Deirdre English—have picked apart any previously existing consensus about the linear progress of medical science and practice. Historians tend now to write about medicine as a social phenomenon, or as a mechanism of social control, certainly not as pure science or simple altruism. As a result of the growth of what is referred to as the social history of medicine, the physician historian has lost both authority and prominence; his field has been bombarded from outside.
However, despite the fact that medical history is currently in vogue with social historians, literary theorists and sociologists, a tremendous amount of ground remains uncovered. Particularly in a field as small as Canadian social history, let alone Manitoba social history, there’s more than enough of the past to go around. Manitoba Medicine, written by two physicians, both retired members of the University of Manitoba medical faculty, is the first comprehensive survey of the development of physician practice, training, and research in Manitoba, from the fur trade and colonial expansion to the present. It’s a heavy range to cover in a book of manageable length, but Manitoba Medicine is accessible and readable.
The book often has the feel of an official history of the Manitoba medical profession, but at its best is a self-aware treatment. As someone who has written official history, I know that even within the genre, there are standards; good and bad insider versions. Medical history written by practitioners can be vulnerable to criticisms of hagiography, or perhaps more importantly, of an insularity that focuses attention on important people and events in an ahistorical way, out of place and time. Clearly, the authors took these potential criticisms seriously, and worked to write a book that sets medicine in context, evaluating where Manitoba medicine fit in the life of the province, and its relationship to national and international developments. There is considerable archival research behind the work, and a careful collection of disparate previous writing. Some of what the book says will be entirely new to readers, whether they are physicians or just those with an interest in the subject.
History is made by people, and this book is rich in short biographical sketches of leading (mostly male) figures in the profession. These sketches are the strengths of the book, in my view. While balancing the attention paid to professional intrigues and infighting, the contributions and weaknesses of Manitoba’s medical men are evaluated, albeit very gently. This is obviously a potential minefield for the authors, particularly when writing about those still living. Not surprisingly, Manitoba’s landscape, both physical and political, is littered with physicians who made their mark. They are all in this book: James Kerr, first dean of the Manitoba Medical College, founded in 1883; Manitoba’s first registered female physicians, Amelia Yeomans and her daughter Lillian; Canadian Shield pioneer doctor, Charlotte Whitehead Ross; Harry Chown, early dean of the Manitoba Medical College, elected president of the Canadian Medical Association in 1901; pathologist Gordon Bell; David Stewart, founder of the Ninette tuberculosis sanitorium; A. J. Douglas, medical officer of health for Winnipeg for the first forty years of the twentieth century; and many more. One of the appealing aspects of the authors’ work is their evenhanded attention to both influential figures, and those who were less publicly visible. While the focus is largely upon the medical faculty and the Winnipeg General Hospital (later Health Sciences Centre), rural medicine gets an amount of reasonable attention, as do the health conditions and treatment of aboriginal peoples, and public health.
To situate the general reader, biographies are put in context through basic information in the historical evolution of medical science and therapeutics, so that we can understand what kind of medicine these physicians were practicing and why. The book is basically organized chronologically, and the state of medicine is explained at various historical junctures: during Manitoba’s period of industrialization; during and after the two world wars; and in the contemporary post-war period. This is not to say, however, that the book is completely free of medical jargon. I was easily lost in the terminology of medical fields, specialties, and subspecialties. To a physician, of course, the differences between pathology, immunology, physiology, and so on, are clear enough: they are bewildering for those educated in the humanities, bereft of scientific training.
But is this a shortcoming? The fact that even a social historian with some training in medical history can find the terrain quite unfamiliar at times raises an important issue. Social historians write about the social and cultural aspects of medicine, and where possible, explore medicine from the patient’s point of view. But we tend not to explore in any detail the intellectual-scientific content of medicine. The intellectual history of medicine is still largely written by physicians themselves. This may well be a serious shortcoming in social history. It may be that not having a real grasp on the science tends to make social historians dismissive of the appeal and accomplishment of scientific research and medical therapeutics, and too prone to historicizing.
As I read Manitoba Medicine, I was struck by how extremely narrow a view I have on the medical world. Some months ago, I contacted Ian Carr and asked him to show me around the medical library on the Bannatyne campus. We discussed my thesis, and he patiently tolerated my struggle to communicate the medical aspects of the influenza epidemic I am studying. Carr lovingly showed me the rare books room in the library, where there are some wonderful gems, and it was clear that he had a relationship with the past of his profession to which I could barely even begin to relate. It is the outsider’s blessing and curse.
I mined this book for hints at future research that others might find fruitful. There are many. One is the 1933 doctors’ strike, fought over the demands made upon physicians to treat poor patients. The authors are careful to note that many physicians had always given care without payment for those who could not afford it. However, the issue of service to the outdoor clinic (an outpatient clinic for the city’s sick poor) had been one of longstanding tension at Winnipeg General. Faced with the terrible hardships and demands of the Depression, the Winnipeg Medical Society doctors fought against having td provide free services to the unemployed who were receiving municipal unemployment relief. They would continue to care for the indigent not receiving relief, and attend to emergency cases. But for those on assistance, doctors wanted to get paid by the City of Winnipeg. They won the right to payment at a rate of half the fee schedule.
Winnipeg, we learn, had the worst polio epidemic of any North American city in 1953, and its impact changed much about rehabilitation and care for the chronically ill in the province. Its aftermath stimulated patient organization and advocacy. In Winnipeg alone, nearly 1300 polio victims were admitted to hospital in the summer and fall of 1953. Polio, with its medieval-seeming treatment in the iron lung (the precursor to the ventilator), has a macabre appeal for historians. The disease was extremely frightening for parents, often leaving their children disabled for life. According to Carr and Beamish, what doctors learned in keeping patients alive during the viral infection phase of the illness led to significant improvements in intensive care procedures in Winnipeg. The authors draw on the oral testimonies of polio victims, collected as part of a symposium held in 1989.
The effectiveness of the book in pointing the way for researchers would have been much improved with citations. The index has some mistakes. These are not unusual problems in a book written mainly for a popular audience, but Carr, Beamish and their publisher should have provided better source information for what will probably be a small, but potentially quite important, academic readership.
For the most part, this book avoids controversy; it is miles away from current scholarly debates about medicine and the political anatomy of the body. But there are issues on which the authors are firm in their viewpoints. As one might expect from two physicians, Manitoba Medicine is clear regarding the efficacy of medical treatment in promoting modern longevity and quality of life. If we don’t think medicine saves lives, they challenge us, “throw away the penicillin” and read another book.
Page revised: 14 October 2012