Health Care in 1867

Dr. Jacalyn Duffin talks about the state of health care practices in Kingston in 1867.

I am a physician. I graduated from the University of Toronto, out of the old pre-med program. I went into medical school out of high school. I then specialized in internal medicine and hematology. In those days we could move around, so I am very happy that I was able to do part of my training in Sherbrooke Quebec. Then I found myself married to a Canadian diplomat. We got posted to Paris where I was not allowed to practice medicine because I was married to a diplomat, not because I was Canadian trained. So I used the time that we were there to pursue a doctorate in the history and philosophy of science.

My dissertation topic was on the invention of the stethoscope, which is an 1816 invention already invented by the time we had Confederation in Canada, and I had a great deal of fun doing that. When we came back to Canada I wanted to return to clinical medicine again but had a great deal of difficulty convincing the doctors that it wouldn’t be dangerous. So it was with great joy that I was able to accept the offer here at Queen’s in 1988 to occupy the Hannah and chair where I have been teaching history, and practicing medicine ever since then. I’ve been a very lucky person.

Healthcare is a bit of a misnomer because in 1867 we didn’t have the idea so much of maintaining health. It was all about treating whatever was wrong at any given time. So without much of a concept of health maintenance or health promotion, health care consisted of treating the diseases as they happened, and when they happened. In 1867, more than 80% of the Canadian population was rural, less than 20% lived in towns and cities. So what people needed, given that health care was treating diseases, they needed the doctor to come to their homes and look after them.

So many of the practitioners were on their own, and they could be called any time of day or night to rush out and help with a situation: a sick child, a woman in labor, person with a high fever, or especially accidents and injuries that occur on the jobs. We did have hospitals then some of them we went back a long way, especially those in cities: in Montreal, Quebec City, and in Toronto.

But since so many people live far away from the hospitals, in 1867, there wasn’t the opportunity to just drop in, and there wasn’t an emergency department like we know them today. So people who were admitted to hospital generally were urban people, often they were poor people who couldn’t afford to have the doctor come to their home and look after them.

So the hospital was a place that you didn’t really want to go if you could avoid it, and for the majority of people who live far away they never went to the hospital even if they needed an operation. Well the things that happen in hospitals today: surgeries, operations the delivery of babies. Those things actually could take place in the home.

Canada had an intent at vaccination before 1867. It didn’t really get institutionalized until a bit later, but we did know how to vaccinate. That would be done locally. Babies were delivered in the home, largely. Surgical operations could be done and the doctor I studied through practiced in Richmond Hill north of Toronto did a number of operations in patients homes. Some of them work emergencies, the setting of bones, amputations. When a limb could not be saved following trauma but he also did what we would call elective operations: where the procedure didn’t have to be done, but could be.

So under those circumstances he repaired the congenital deformities of cleft palate harelip, and he also repaired what we call clubfoot. He did those surgeries, he planned them,and he did them in the patient’s home. The staff of hospitals were usually employees of the hospital, in other words, the nursing staff.

But we didn’t have a formal nursing profession until a little bit later. The first nursing schools came through the hospital system and a lot of the nurses in the religious hospitals were nuns who had a vocation, and learned how to take care of sick people in that way. The lay nurses came along a little bit later although there were lay nursing schools in England, for example.

It’s hard to focus on one thing that a time traveler would find a difference in going into the hospital. Really most hospitals did not have private rooms for patients. Those came along a little bit later, there were large wards with beds in them. Patients were of course segregated by sex so there’d be a large ward of women and a large ward of men. In this time period there were people advocating for sanitation, but germ theory did not come along until the 1880s. So the things that we associate with hospital garb, the sterile clothing the masks and the gowns, all that was still yet to come. Doctors who were performing operations would dress up wearing their frock coats to do the procedure because they didn’t have the concept of aseptic technique. It just wasn’t there.

So at first blush what a time-traveler would see is a difference in the ambience, and the appearance at the hospital. I think it’s unfair to claim that they were dirty. We like to invoke draconian and horrible images of the past, but they understood about cleanliness they knew it was important and so the sheets would be clean, the floors would be swept, the walls would be probably whitewashed once a year perhaps, but our notions of this kind of crisp sterility would not be there.

The other thing is that the hospitals didn’t necessarily have a kitchen so that patients would have to have their family members or their friends bring them their meals, and the meals wouldn’t have been regimented in the way that meals are now in hospitals.

And I’m not convinced that that would be a bad thing to go back to that. The architecture would be different as well. In the early 19th century there were a number of theories about how the space could be a healing space; That too bares some looking at in our own time. Light and air were viewed as part and parcel of the therapeutic intervention, so you could for example be in a hospital space around 1867 where somebody in charge had the idea that the window should be opened for fresh air.This would not happen in an academic Health Center now.

The theory of disease causation up at 1867 was a little bit up for grabs. There had been many theories about why people got sick, going back to antiquity, some of them were to do with the humors of the body. We still think of the body as being made up of humors, a subset of the periodic table. The ancients had a periodic table with four elements in it: earth, air, fire, and water. Each of these elements had a cognate in the body, known as a humor. So their theory of disease was that you had too much or too little of one or another of these four elements. This kind of subtended theories where you might bleed people to remove blood if they had too much blood, or you might warm them up because they were seen as too cold, and how the therapeutic principles worked under those cases was to do the opposite of what you thought the cause of the disease was.

In addition, the perturbation or the disturbance of the humors that made up the body could be caused by changes in the atmosphere around the patient. So some of it could be inherited, your makeup and your temperament, but some of it could be caused by changes and this could extend even to the alignment of the stars in the heavens, or the climate that was going on at any given time, if it was cold and wet or hot and dry, and these these atmospheric disturbances could provoke what was called a miasma.

The miasma could provoke a disease, and it wasn’t just evil noxious humors like a poison gas, it was a way that the world was confronting its atmosphere. People would fall ill because of the change in the miasma, but it would only be certain people who would fall ill depending on their temperament, their makeup, and their composition of the humors.

So all of that said, without the germ theory which comes along in the 1880s, people were constantly striving to improve the atmosphere, improve the environment, or alter the environment.Some of the treatments would be fumigations, where a special plant or a resin would be put in a pot under which there was fire and the fumes would pervade the room. So some of them were physical treatments but some of them were also atmospheric treatments.