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Health and the Health Care Delivery System: The Micmac in Nova Scotia c. Peter L. Twohig, 1991 A thesis submitted by Peter L. Twohig in partial fulfillment of the Requirements for the Master of Arts Degree in A tlantic Canada Studies at Saint Mary's University April, 1991 THESIS APPROVED BY: Dr. Colin D / (Supervisor liAVtoi Dr. Harold F. McGee (Reader) Dr. /John| l(j. fiT Reid (Coordinator) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 ^ 1 National Library Bibliotheque nationale of Canada du Canada Canadian Theses Service Service des theses canadic oes Ottawa, Canada K1A0N4 The author has granted an irrevocable non- L'auteur a accord* une licence irrevocable et . exclusive licence allowing the National library non exclusive permettant * la BMothOqoe na of Canada to reproduce, loan, distribute or sell tionale du Canada de reproduce, prater, dis- copies of his/her thesis by any means and In any tribuer ou vendre des copies de sa these de form or format, making this thesis available to in quelque mani*re et sous quelque forme que ce terested persons. soit pour mettre des exempiaires de cette these * la disposition des personnes int*ress*es. The author retains ownership of the copyright L’auteur conserve la proprtttd du droit d'auteur in his/her thesis. Neither the thesis nor substan qui protege sa these. Ni la these ni des extraits tial extracts from it may be printed or otherwise substantiels de celie-ci ne doivent etre imprimes reproduced without his/her permission. ou autrement reproduits sans son autorisation. ISBN 0-313-63134-6 CanadS Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Abstract Health and the Health Care Delivery System: The Micmac. in Nova Scotia This thesis examines the history of medical.care and the development of the health care delivery system among the Micmac in Nova Scotia during the nineteenth and twentieth centuries. It examines the relationship of the medical profession to the state and, through this examination, the relationship of the Micmac to the state. This thesis examines a broad range of topics, including the struggle of medical orthodoxy to profes sionalize, the role of the Micmac in this struggle and the role of the state and philanthropic capitalism in advancing the status of orthodoxy. The thesis then examines the response of the medical profession to later challenges to its authority. These interrelationships grow out of an analysis of varied source materials. Petitions reveal much about the extent and nature of nineteenth century medical attendance. At the same time, these petitions offer numer ous insights into the dynamics within the medical marketplace. Tremendous use is made of government reports and publications because of the pervasive concern with the role of the state. As well, newspaper accounts have been utilized to give voice to some of the arguments presented and add colour. This thesis makes a contribution to our collective understanding of the medical profession in Nova Scotia and adds‘another dimension to the history of the Micmac and their relationship with the state. In doing so, it demonstrates how change within the medical profession and the provision of medical care to the Micmac was a negotiated process and how the Micmac were active participants in their own history. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Acknowledgements This thesis would not have been possible if not for the support and help of a number of generous people. My th esis advisor, Dr. Colin Howell, who's assistance and guidance reminds one of that famous des cription of a general's authority: "More than advice but less than a command. An advice which cannot be safely ignored." Dr. Howell's con stant interest in, and criticism of, this thesis has been invaluable. My colleagues in the Atlantic Canada Studies, Tony P itt, Carol Goodine, Brenda Sanderson and Marilyn Dwyer, all criticized portions of this work, and were most helpful. Equally generous in their time were Dr. Harold McGee and Dr. John Reid. The staff of the Public Archives of Nova Scotia, the Killam and Kellogg libraries at Dalhousie, Health and Welfare Canada and St. Mary's University offered their assistance at every turn, and T am deeply in debted to them a l l . Special thanks must go to-Gerry H ill, of Health and Welfare Canada in H alifax, Cara LaRocque of Health and Welfare Canada in Ottawa, Terry Knockwood of the Confederacy of Mainland Micmac, and Peter Christmas, all of whom were instrumental in securing information for me and took an early interest in my research. Finally, my personal relations, especially my wife Beverly and my parents Ron and Dolly Twohig, are to be acknowledged, for the love and support they provided throughout this and earlier endeavours. This work could not have been completed without their support. i i Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents A bstract................................................................................................................. i Acknowledgements ................................................................................................ i i Introduction ......................................................................................................... 1 Chapter I - The Aboriginal World and European In tru sio n ................ 9 I - The Aboriginal Population II - The Micmac Economy III - European Intrusion IV - Disease V - Dietary Change VI - Traditional Health Care VII - Colonization VIII - Hostilities IX - Administration X - Conclusion Chapter II - 'among us, yet not of u s ': The Early Nineteenth Century ............................................. 53 I - Early Indian Administration II - Disease in the Early Nineteenth Century III - Practitioners IV - Doctors and Disease: The IRAOs V - The Micmac at Mid-Century VI - Doctors, Disease and Medical Attendance: The 1850s VII - The Struggle to Professionalize . VIII - Hospitals IX - Therapeutics X - Medical Schools and Medical Societies XI - Conclusion Chapter III - The Micmac in Canada: Medical Specialization and Bureaucratization 116 I - The National Context II - Doctors, Disease and Micmac III - Health Care Delivery IV - The Micmac Context V - Continued Professional Struggles and Physician Preeminence VI - A Sensitive Profession VII - Conclusion Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter IV - The 'Cultural Gap of Centuries': Micmac Health 1942-1968 ....................... I - C en tralization II - The Indian Health Bureaucracy I I I '- Communicable Disease IV - Immunization. V - Tuberculosis VI - Maternal Health VII - Specialty Services VIII - Mortality IX - The Provincial Context X - Conclusion Chapter V - The Just Society Reconsidered .......... I - Hospital and Medical Insurance II - The 1969 Statement III - Health Care Delivery: The Early 1970s IV - Administration and Delivery 1977-1980 V - Infant Health VI - Substance Abuse VII - Suicide VIII - Indigenous A ttitudes Toward Health IX - Challenging the Medical Monopoly X - Mortality XI - Towards A New Strategy? XII - Conclusion Conclusion .......................................................................... Bibliography...................................................................... Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Introduction *■ Perhaps no other field of historical inquiry has sho«m the growth and diversity in the past decade as that of medical history. A late comer to the realm of social history, the "new social history of med icine"* investigates the nexus at which the private world - the tradi tional concern of social historians which includes the history of the family, chilhood and other such pursuits - and the public world inter sect. David Gagan recently wrote that the "social history of medicine seeks to understand society's historical response to disease, especially in relation to the interaction between those in need of health care and those who provided it, as a microcosm, perhaps even a paradigm, of modern society." The history of medicine, Sir William Osier is said to have observed, "is the history of mankind". Therefore "virtually all 3 human activity has some implication for the social history of medicine". It is this perspective that lies at the foundation of the body of scholarship that has been generated in the area of medical history. Given the large scope of inquiry that could be placed under the rubric of medical history, it is not surprising that there are several neglected areas, including questions pertaining to medical research, the medical care provided to prisoners or members of the military, or other such topics.^ One other such area is the provision of medical cafe to native peoples. This thesis, it is hoped, will further our under standing of medical h isto ry in Canada and in Nova S cotia. Through an Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2. examination of the historical provision of medical services to the Micmac in Nova Scotia, the interface between the social history of medicine and native history may be illuminated. This analysis of medical care in Mic mac communities will integrate various approaches and orientations in the writing of medical