The theory and practice of medicine in Canada changed significantly from the 16th to the 20th century, with important developments in medical education and regulation, understanding of anatomy and disease, public health and immunization, and pharmacology. Physicians such as Sir William Osler, Norman Bethune, Robert McClure, Emily Howard Stowe, Jennie Kidd Trout and Maude Abbott worked in Canada and internationally to promote and improve human health. Canadian medical research led to advances in anesthesiology and neuroscience, and in the treatment of diabetes, polio, malaria, heart disease and tuberculosis.
Medicine in Canada began centuries before the French settled the shores of North America, but because the Aboriginal people passed on their traditions orally, the only written accounts of their practices and beliefs were recorded by white explorers and settlers. Aboriginal people generally sought cures from a shaman, or medicine man. They also treated illness with some highly effective plant remedies (e.g., oil of wintergreen, bloodroot, high bush cranberries; see Aboriginal Uses of Plants) and physical procedures such as sweat lodges and massages. It was from an Aboriginal person that Jacques Cartier learned of a cure (brewed from twigs and bark of white spruce or hemlock) for the scurvy that nearly wiped out his party of French explorers. Systems of Aboriginal medicine began to break down after prolonged contact with European settlers and their imported, often epidemic diseases (e.g., measles, typhoid, typhus, diphtheria and smallpox; see Health of Aboriginal People).
European medicine at the time of settlement was evolving into an identifiably scientific discipline, although theories and knowledge about disease developed very slowly. Most of the first medical practitioners from France were not trained physicians, but barber-surgeons, trained only by a rough and ready apprenticeship, or apothecaries who were theoretically limited to providing remedies ordered by a doctor but who usually functioned as semi-trained general practitioners. The practise of combining the offices of barber and surgeon may have derived from the almost universal custom of bleeding patients as a remedy for virtually every ill. All that was required was a sharp knife and knowledge of where to locate the major veins. Surgery was limited to operations on the arms, legs and the surface of the body and head. Internal operations usually resulted in the patient's death. The use of drastic measures to induce vomiting and purging were also commonplace.
Many of these men were of questionable character, but others — for example, Robert Giffard and Michel Sarrazin — dedicated their lives to serving the colonists. Giffard, a barber-surgeon who arrived in Québec in 1627, was the first physician at the Hôtel-Dieu, a hospital (four rooms, two closets) originally founded by a religious order from France (see Nursing). Sarrazin, who arrived in New France in the second half of the 17th century, was appointed surgeon-major of the French troops in Canada and later official physician of the Hôtel-Dieu. In that capacity, he became famous for helping hundreds of colonists recover from typhus. He was also an acclaimed botanist.
Despite the combined hazards of climate, disease, hunger and disputes with Aboriginal peoples, by 1763, when New France was ceded to the British, Montréal and Québec City were thriving small cities. The medical system imported by the British was similar to that used by the French. Military surgeons continued to dominate the practice and organization of the profession. However, there was a change in that the anglophone doctors took control of the cities, leaving the francophone doctors to serve the poorer areas.
Arriving in what was to become Ontario, Loyalists brought army surgeons with them as well as civilian physicians. These men usually had great difficulty making a living because the population was small, the fees low and the prestige of the medical profession very shaky. They often held other jobs, such as operating a farm or a store.
The settlers in Upper Canada were afflicted by acute infectious diseases, injuries of all kinds, periodic malnutrition and serious recurrent illnesses such as "fever and ague" (malaria). When they could obtain the services of a physician they often did, but frequently treated themselves with home remedies and botanic cures based on Aboriginal peoples' prescriptions. Midwives usually assisted at childbirth.
The situation was much the same in the Maritime colonies. Halifax, the largest city in the area, had a substantial medical population, including many military surgeons, and a number of hospitals. The poor could obtain some medical services from dispensaries or the workhouse. Many early Maritime doctors established successful second careers. Abraham Gesner, educated in London, was a doctor, geologist, mineralogist and the discoverer of kerosene. Dr. J. Webster was also an historian, Sir Andrew MacPhail a writer, Dr. Charles Tupper a politician. Another Maritime doctor, David Parker, who worked in the asylum for the poor in Halifax, was the first physician in Canada to operate with the help of anesthesia.
In the West, most of what was to become the Prairie Provinces and British Columbia were controlled by the Hudson's Bay Company (HBC), which employed its own doctors. William Fraser Tolmie, who immigrated to Vancouver as a surgeon and trader for the HBC, and for whom Mount Tolmie in British Columbia is named, was a botanist, geologist, and later, a member of the legislature. He may have performed one of the first modern operations on the West Coast when he removed a tumour from the breast of a sailor. Tolmie had brought stethoscopes from Scotland; surgical instruments provided to him on his arrival in British Columbia included "an Amputating, two trephining, two eye instruments, a lithotomy and a cupping case, beside two midwifery forceps, and a multitude of catheters, flexible and silver sound bougies, probangs, tooth forceps." A colleague of Tolmie's, Dr. John McLoughlin, born in Lower Canada, became representative of the HBC in the West after serving at Fort William on Lake Superior.
19th Century Medical Education
During the 19th century, immigration to Canada, particularly from Britain and the United States, increased dramatically. Among the immigrants were many notable physicians, such as Christopher Widmer (who became known in Upper Canada as the "Father of Surgery") and W. R. Beaumont, a prolific inventor of surgical instruments. Widmer practised at York Hospital (later the Toronto General).
The first medical schools in Canada were established in the 1820s. One of the first in Upper Canada, the Talbot Dispensary, was opened by the reformer Dr. Charles Duncombe, but closed when its benefactor, Thomas Talbot, withdrew his support, suspecting correctly that Duncombe was using the dispensary as a stepping stone into politics. Indeed, many of Canada's early doctors became actively involved in politics. A second medical school, which eventually became affiliated with Victoria College (now part of the University of Toronto), was founded by the reformer Dr. John Rolph. In late 1823, the Montreal Medical Institution, established by Dr. W. Caldwell and his associates and later absorbed by the medical faculty of McGill University, began to give classes.
The founding of medical schools in Canada was inspired by various motives, including the desire of doctors (who invariably founded the schools) to teach along lines of which they approved and to ensure a source of income for themselves. They were supported by those who felt that many Canadians who sought education in the United States were being inadequately trained and were being exposed to dangerous democratic principles. In the United States, many medical schools became commercial operations willing to lower standards to attract students, but in Canada the schools sought affiliation with universities and maintained high standards of entry, in order to discourage charlatans (or quacks) and to improve the public reputation of doctors.
By the 1850s, students in medical schools in Canada typically attended lectures on materia medica and therapeutics, anatomy and physiology, principles and practices and surgery, midwifery and the diseases of women and children, and medical jurisprudence. There was some dissection but little laboratory work (it was not until the mid-1870s, when William Osler took over the chair at McGill, that microscopes would be used in any extensive way). The dissecting rooms were known as "dead-houses." The one associated with the medical school established in London, Ontario, was probably typical. According to author Donald Jack, the dissecting room was located in the dining room of an old cottage and contained "two tables, a few chairs, a pile of sawdust, a shovel in the corner, old coats and aprons and hooks along the walls. A trapdoor in the floor led to the cellar, where two large vats, filled with ancient wood alcohol and other things, permeated the whole building with their odours."
New medical students were initiated into dissecting by being forced down to the cellar to retrieve the cadavers. Dr. D. C. MacCallum has left a record of the situation at McGill in the mid-19th century, where he prepared the dissections that were to be part of the anatomy professor's lectures the following day. He was compelled to pass several hours at night in the dissecting room, which was "dismal and foul-smelling." He wrote that his only company was "several partially dissected subjects and numerous rats which kept up a lively racket coursing over and below the floor and within the walls of the room."
The procuring of cadavers used for anatomical studies and medical research was often risky. The demand for bodies led to a thriving trade in body-snatching. Some students in Québec even paid their medical fees by taking bodies from the cemetery near Côte des Neiges. Such incidents led the Legislative Assembly of the Province of Canada to pass an Act to Regulate and Facilitate the Study of Anatomy in 1843 (amended in 1883). The Anatomy Act allowed medical schools to legally procure unclaimed bodies from government institutions.
Regulation of the Medical Profession
From the late 1700s, efforts to regulate the medical profession had provoked controversy between universities and boards of examiners over whether a medical degree constituted a licence to practise. The number of charlatans and incompetents practising medicine had proliferated, partly because the public preferred them, having no social or scientific reason to choose regular doctors. In both Upper and Lower Canada, licensing bodies had existed since the late 1800s. In Lower Canada, a board appointed by the governor had been formed under the authority of a British Act of Parliament to prevent unlicensed persons from practising medicine. Later attempts to define the profession in Lower Canada produced tension between French- and English-speaking doctors until the College of Physicians and Surgeons of Lower Canada was finally created in 1847.
In 1849, the Act creating the corporation was amended to provide automatic membership in the college to those engaged in practice in 1847. In 1839, a group of Toronto physicians, many of them trained in Britain, were incorporated as the College of Physicians and Surgeons of Upper Canada, but its incorporating act was disallowed in 1840. In 1869, the Ontario Medical Act incorporated a new College of Physicians and Surgeons of Ontario, empowered to examine would-be practitioners and university graduates. In 1867, the Canadian Medical Association was formed. Overall, the mid-19th century was a turbulent period in the Canadian medical profession, which was torn by divisions between English- and French-speaking doctors, and between those trained in Canada and those trained elsewhere.
Epidemics and Public Health
As the population of British North America increased, so did its susceptibility to epidemics. In 1832, 1834, 1849, and during the 1850s, cholera epidemics ravaged the country. In 1832, the disease spread from Québec City to most of the towns and cities in Upper Canada in only three weeks. During the cholera years in Canada, doctors disagreed over whether the disease was contagious. There was a tendency to see it as a disease of the blood; treatments included bleeding, massive doses of calomel and opium, and cauterizing.
In 1854, an Italian, Filippo Pacini, identified the Vibrio cholera (the bacteria that causes cholera), visible through a microscope. However, his discovery was largely ignored at the time. It was not until the germ theory, established by Louis Pasteur, was reluctantly accepted later in the century that the cause of cholera was isolated. In the 1880s, Robert Koch, a German researcher, independently discovered the cholera bacillus as well as the bacillus that caused tuberculosis.
While the link between micro-organisms and disease was not fully understood in the 19th century, officials in Canada passed sanitary laws to protect the health of the public. As early as 1834, William Kelly, a surgeon of the Royal Navy, had suggested there was a relationship between diseases and sanitation, particularly clean water. Local boards of health were established to enforce quarantine and sanitary laws. By the end of the 19th century, public health was being promoted through a variety of enactments regarding immigration restrictions, protection against the sale of tainted food, and provision of adequate sanitation.
Public resistance to these measures was intense, as it was to compulsory vaccination. For example, although a smallpox vaccine was introduced into Canada in the early 1800s by a Nova Scotia doctor, smallpox epidemics ravaged the country until the 1900s, when the value of the vaccination was finally accepted.
Anesthetics and Antisepsis
Two other major discoveries in medicine also occurred in the mid-1800s. The first was the discovery, in the 1840s, of anesthetic, which rendered surgery painless. Two Canadian doctors later made major contributions to developments in anesthesiology. In 1923, W. E. Brown of the University of Toronto established the value of ethylene as an anesthetic, and in 1942, Dr. Harold Griffith advanced the science of anesthesia by his use of curare (commercially, Intocostrin), a plant extract used by South Americans as an arrow poison.
The second discovery, by the Englishman Joseph Lister, derived from Pasteur's work. Lister proved that the recovery rate of patients suffering wounds could be drastically improved if the wounds were disinfected (Lister first used carbolic acid for this purpose).
At that time, surgeons at the Toronto General, like surgeons everywhere, operated in frock coats, usually holding their knives, when not in use, in their mouths. Instruments were washed in a cursory fashion or wiped on a towel. Lister's antiseptic treatment was described in Canadian journals within a few months of his experiments and was being used — though often incompletely — in operating rooms of the Toronto and Montreal General Hospitals by 1869. However, most Canadian physicians initially resisted the technique and the attempts by Archibald Malloch, an Ontario surgeon who had worked with Lister in Glasgow, to teach Lister's principles of antisepsis. Thomas Roddick is credited with being the first doctor to base procedures at the Montreal General on these principles.
Female Physicians in the 19th Century
By the 1850s, Canadian women had begun to demand access to medical schools, but until the 1880s, virtually all female physicians practising in Canada (e.g., Emily Howard Stowe, Jennie Kidd Trout) had trained in schools or with doctors outside Canada. In 1883, the Women's Medical College, affiliated with Queen's, and the Woman's Medical College, affiliated with University of Toronto and the University of Trinity College, opened. Both institutions offered the required coursework but did not grant degrees. However, after 1895, students of the Ontario Medical College for Women, successor to the Toronto school, could take the exams of the medical school of their choice. Medical training for women was subsequently offered at Dalhousie (1890), University of Western Ontario (1890s) and University of Manitoba (1891), but McGill University and the universities of Laval and Montréal did not open their doors to women until much later. Early female practitioners, such as Elizabeth Matheson (noted for her work in the Northwest Territories) and Maude Abbott (whose accomplishments included her work on congenital heart disease), made significant contributions to Canadian medicine.
Of the 19th-century doctors who contributed to the prestige of Canadian medicine abroad, the most eminent was William Osler. Educated at the Toronto School of Medicine and at McGill, over time he was professor of medicine at University of Pennsylvania, was appointed to Johns Hopkins Hospital and Medical School and became Regius Professor of Medicine at Oxford. Author, in 1892, of The Principles and Practice of Medicine (which indirectly helped inspire the foundation of the Rockefeller Institute of Medical Research), he contributed to science through his discovery of blood platelets and his investigations into heart disease, malaria and tuberculosis. His emphasis on the study of anatomy and on bedside teaching transformed medical teaching in North America. His colleague, Dr. Francis Shepherd, introduced new scientific methods of teaching at McGill and, like Osler, emphasized the importance of a grounding in anatomy to understanding medicine.
Many Canadian doctors (for example, John Schultz, John Sebastian Helmcken, Clarence Hincks and John Richardson) helped influence the development of their own country not only as physicians but as politicians, inventors, explorers, writers, soldiers and community leaders. Many others, including Robert McClure (whose work was described in W. H. Auden and Christopher Isherwood's Journey to War), Florence Murray, Davidson Black and Norman Bethune, became known for their work outside Canada in countries such as China and India.
20th Century Advances
Tentative advances in medical research in Canada were accelerated by the discovery (1922) and clinical application of insulin by Frederick Banting, Charles Best and J.J.R. MacLeod. Because of their success and the increased interest in medical research, the government became involved in financing and more studies and institutes of medical research were established. For example, in 1934, Wilder Penfield, funded by the Rockefeller Foundation, founded the Montreal Neurological Institute, which drew together the disciplines of neurosurgery, neuropathology, neurology and related basic sciences, and consequently transformed the study of the brain.
As the Second World War approached, medical practice was changing slowly, influenced by the discovery that a number of serious diseases could be controlled by immunization. Health in general was improving, largely because of better diet and nutrition and more effective public-health measures. Hospitals had become safer places for the sick, and surgical procedures were more sophisticated and more likely to achieve satisfactory results. The discovery of sulfa drugs (synthetic antibiotics) in the 1930s and the mass production of penicillin in the 1940s vastly improved the treatment and prevention of bacterial infections. In the early 1950s, a vaccine, which Aventis Pasteur Limited at University of Toronto had helped develop, defeated the feared disease of polio.