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Medical Superintendents and the Early Professionalization of Asylum Management and Insanity Treatment in Upper Canada, 1840-1865

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Medical Superintendents and the Early Professionalization of Asylum Management and Insanity Treatment in Upper Canada, 1840-1865 Public Servants or Professional Alienists?: Medical Superintendents and the Early Professionalization of Asylum Management and Insanity Treatment in Upper Canada, 1840-1865 by Danielle Alana Terbenche A thesis presented to the University of Waterloo in fulfillment of the thesis requirement for the degree of Doctor of Philosophy in History Waterloo, Ontario, Canada, 2011 © Danielle Alana Terbenche 2011 Author’s Declaration I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I understand that my thesis may be made electronically available to the public. ii Abstract In nineteenth-century Upper Canada (Ontario), professional work was a primary means by which men could improve their social status and class position. As increasing numbers of men sought entry into these learned occupations, current practitioners sought new ways of securing prominent positions in their chosen professions and asserting themselves as having expertise. This dissertation studies the activities and experiences of the five physicians who, as the first medical superintendents (head physicians) at the Provincial Lunatic Asylum, Toronto from 1840 to 1865, sought such enhanced professional status. Opened in January 1841 as a public welfare institution, the Toronto asylum was housed initially in a former jail; in 1850 it was relocated to a permanent building on Queen Street West. During the asylum‘s first twenty-five years of operation physicians Drs. William Rees, Walter Telfer, George Hamilton Park, John Scott, and Joseph Workman successively held the position of medical superintendent at the institution. Given the often insecure status of physicians working in private practice, these doctors hoped that government employment at the asylum would bring greater stability and prestige by establishing them as experts in the treatment of insanity. Yet professional growth in Upper Canada during the Union period (1840-1867) occurred within the context of the colony‘s rapidly changing socio-political culture and processes of state development, factors that contributed to the ability of these doctors to ―professionalize‖ as medical superintendents. Rees, Telfer, Park, and Scott would never realize enhanced status largely due to the constraints of Upper Canada‘s Georgian social culture in the 1840s and early 1850s. During the 1850s, however, demographic, political, and religious changes in the colony brought about a cultural transition, introducing social values that were more characteristically Victorian. For Joseph Workman, whose beliefs more reflected the new Victorian culture, this cultural shift initially involved him in professional conflicts brought about by the social tensions occurring as part of the transition. Nevertheless, by the 1860s, changes in government led to the development of new legislation and departmentalization of welfare and the public service that led him to gain recognition as a medical expert in a unique field. iii Acknowledgements Many people contributed to the production of this dissertation and helped to make my experience as a Ph.D. student a positive one. My advisor, Dr. Wendy Mitchinson, encouraged my pursuit of this topic even as it diverged from my original plans regarding subject and time period. I am grateful for her understanding, generosity, and humour, which provided support and balance throughout my years in the program. Dr. Heather MacDougall provided similar support during the writing of this thesis. Her willingness over the past two years to engage in frequent discussions about Upper Canadian medicine and politics has been much appreciated. I am also thankful to Dr. MacDougall for supporting my teaching interests during two teaching assistantships with her as I completed the university‘s teaching certificate program. I wish to thank Dr. Douglas McCalla for agreeing to join my dissertation committee. His helpful comments (and corrections!) about Upper Canadian politics, economics, and culture have been invaluable to my critical thinking about the professional lives of the doctors studied here. Thanks also to Dr. Norman Smith for both his initial role as my gender field instructor early in the program, but more importantly for his ongoing support and friendship as I completed the dissertation. The Tri-University History Program and the University of Waterloo proved to be friendly and stimulating environments in which to study history and grow professionally. I appreciate the interest of faculty in my work and the many words of encouragement, often simply offered in passing. Special thanks to graduate assistants Irene Majer and Donna Lang for helping me navigate the many administrative tasks of the Ph.D. and for moral support during my studies. I am grateful for the friendship of other Tri-University graduate students. Two deserve special recognition: Kim Anderson was a much-needed ―study buddy‖ during my reading fields at the beginning of the program. Jane Whalen‘s enthusiasm during our efforts to develop a student association (TUGSA) in 2008 and her support throughout the writing of this dissertation has been much appreciated. I thank both of them for these experiences and much laughter. iv This project was funded by the Ontario Graduate Scholarships program, the Social Sciences and Humanities Research Council of Canada‘s Doctoral Fellowships, the University of Waterloo President‘s Graduate Scholarships, and the Friends of the Archives at the Centre for Addiction and Mental Health (Hewton Memorial Bursary). I wish to thank these organizations for this practical aspect of support. Sources of academic support outside my university life have also been appreciated. Thanks to John Court, archivist at the Centre for Addiction and Mental Health, and to Dr. Roy Merrens for their interest in various aspects of this study. Thanks also to Rev. Ron Scott, former rector of St. Margaret-in-the-Pines Anglican Church (Scarborough) for his interest in my work, and for allowing me to be a ―drop in‖ participant in his Bible study class whenever I was in Toronto. His discussions on the history of Anglicanism provided insights that helped to shape the religious aspect of this thesis. I have been fortunate to have the love and support of many friends and family. Thanks especially to Kimberley Basso who has been by my side for thirty-one years from my first day of school to my last. My grandmother, Anne Coffin, is a wonderful listener who has always taken an interest in my work. My parents, Dan and Toni Terbenche, have made my many years of studentship possible. I am grateful for their constant encouragement and engagement with my research. Last, but not least, I wish to thank Bella, a long-haired calico cat who came into my life just as I was beginning this dissertation. Thank-you for the many cuddles and distractions and for always being the ―sweet girl‖ initially indicated on your humane society ID tag. v Dedication In memory of my grandfather, Allan Emery Stewart, LLB (1922-1996) A professional gentleman who was not here for this project, but I know would have appreciated it. And also of my step-grandmother, Isabel Lillian Ellen Stewart (1929-2010) Who saw the beginning of this project, but sadly not the end. vi Table of Contents Author‘s Declaration……………………………………………………………………………….... ii Abstract ............................................................................................................................................... iii Acknowledgements………………………………………………………………………………….. iv Dedication…………………………………………………………………………………………… vi Table of Contents…………………………………………………………………………………… vii List of Abbreviations……………………………………………………………………………….. viii Introduction ………………………………………………………………………………………….. 1 1. Medical Warders of the Insane: Professional Disempowerment in the Era of the Temporary Asylum, 1840-1848…………………………………………………………………. 31 2. Agents of Medical and Professional Reform: Drs. George Park, John Rolph, and Joseph Workman at the Toronto Asylum, 1848-1854 ........................................................... 84 3. ―Mr. Brown – you are a gentleman!‖: Joseph Workman‘s Professional Conflicts in Toronto during the Georgian-Victorian Transition, 1854-1857 ………………………............. 139 4. A New Medical Field Emerges: Medical Superintendents‘ Professional Advancement during the Expansion of Canadian Welfare Institutions, 1853-1865 …………... 191 Conclusion ………………………………………………………………………………………… 246 Appendices 1. Hafferty & Castellani‘s Complex Systems Levels of Analysis ............................................ 259 2. Hafferty & Castellani‘s Seven Types of Medical Professionalism ...................................... 260 3. Capital Locations, Province of Canada, 1841-1867 ............................................................. 261 4. Population Statistics, 1831-1871 .......................................................................................... 262 5. Salaries of Medical Superintendents, Toronto Temporary Asylum, 1841-1848 ................. 263 6. Salaries of Selected Employees, Kingston Penitentiary, 1836-1848 ................................... 264 7. Medical Superintendents‘ Salaries Compared – Government-Run Asylums, British North America, c.1852-1854 ………………………………………………….. 265 8. Architectural Plans for Lunatic Asylum, Toronto (John Howard, c. 1845) ........................ 266 9. Patient Populations of Upper Canadian Lunatic Asylums, 1860 & 1862 ………………... 267 10. Salaries of Head Administrators of Upper Canadian
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