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Research project offers new look at pre-Confederation health care

From left: Drs. Jim Connor, Maria Mathews, Monica Kidd and Jennifer Connor.

By Sharon Gray

Medical records in the basement of the Curtis Memorial Hospital in St. Anthony are proving a treasure-trove for historians at Memorial’s Faculty of Medicine.

First noticed in 2006 by Dr. Monica Kidd during a rural family medicine placement, the detailed admission casebooks from the 1900s to the 1930s will be a focus for a history of remote medicine and health care in pre-Confederation Newfoundland.

Dr. Jennifer Connor, associate professor of medical humanities, and Dr. Jim Connor, John Clinch Professor of Medical Humanities and History of Medicine, were successful in obtaining funding from the Canadian Institutes of Health Research (CIHR) to research medicine in pre-confederation Newfoundland in three rural areas – St. Anthony, Twillingate and the Norris Point/Bonne Bay area.
The research team includes Dr. Monica Kidd, who will help to analyze the casebooks and provide medical knowledge, and Dr. Maria Mathews, associate professor of health policy/health care delivery, who will help to analyze the data.
“There may be lessons we can learn from this study that have relevance to health care policy. It is useful to know what happened in Newfoundland before 1949,” said Dr. Mathews.

Dr. Jennifer Connor explained that the study will examine unexplored archival materials and publications for three themes – hospital practice, health care delivery, and public health, particularly nutrition. She emphasized the partnering role of Labrador-Grenfell Health in the research related to St. Anthony. With approval and IT support from the health authority, the casebooks held by the Curtis Memorial Hospital are being digitized by the team’s research assistant John Matchim, who has spent the past four months in St. Anthony photographing the 5,000 records. The digitized files will provide the health authority with back up for their paper records, in an effort that both researchers and staff at Labrador-Grenfell Health view as a key preservation effort. For the research project itself, files have been anonymized.

The medical historians postulate that remote medicine in pre-Confederation Newfoundland was relatively effective and was suitable to the place and its population in the 1930s and 1940s.

“During this period, despite high rates of infectious diseases such as tuberculosis, the gulf between urban and rural practice was not as pronounced as later,” said Dr. Jennifer Connor. “Medicine was neither as specialized nor as dependent on technology as later and there was a distributed network of primary care throughout the island that was accessible to most people at the local level including the cottage hospital system and the seven government hospital ships.”

Dr. Jim Connor pointed out that the hospital system was augmented by the vital help of lay and trained midwives along with other missionaries with basic medical training.

The medical historians describe this as a primary care “ecosystem” in which a fragile balance existed between the expectations of people and the availability and competency of the medical personnel who worked within their geographical and cultural conditions.

In addition to analyzing the casebooks from the Curtis Memorial Hospital, the researchers will look at materials held at Yale University and the Columbia University, New York, related to the practice of medicine in pre-Confederation Newfoundland.

“Our research will also examine the intensive use of Newfoundland in this period for nutrition surveys, conducted and published by leading British, American and Canadian biomedical scientists,” said Dr. Jim Connor.

Overall this information from this research project will be placed in the context of rural and remote medicine around the world. “Analysts are increasingly calling for study of primary health care delivery in the North and rural regions globally,” said Dr. Jennifer Connor. “Issues in Canada today focus on scope of practice, on access to care and to diagnostic technology, and on public versus private funding – all have earlier counterparts in pre-Confederation Newfoundland that are relevant to today’s discussions.”