KEYNOTE ADDRESS: ‘White Poison’: Public Health and the Pasteurization of Milk in Toronto, c. 1900-1929

David Wright

The first decade of the twentieth century constituted a paradox for public health officials in Toronto. Despite new medical knowledge revealing the origins and transmission of bacteriological disease, infant mortality in the city was steadily worsening. As Michael Piva has demonstrated, during the first decade of the twentieth century the city’s infant mortality rate rose from 141.4 (per 1,000 live births) in 1902 to 179.7 in 1909.^[1] Researchers across North America had identified milk as a culprit in the transmission of many potentially fatal diseases, from tuberculosis to typhoid. In addition, they recognized that social factors exacerbated this emerging public health crisis, including rapid urbanization, heightened immigration, pockets of intense poverty, and a reduction in breastfeeding. This lecture recounts the fascinating story of the creation of Canada’s first pasteurization plant, established in Toronto on the grounds of the Hospital for Sick Children. It will demonstrate the coordinated efforts of Dr Charles Hastings (Medical Officer of Health from 1908) and Dr Alan Brown (the Chief of Pediatrics at the Hospital for Sick Children) to provide clean drinking milk to the infants of Toronto through milk depots and well baby clinics. Accompanying the presentation will be stunning photographs, both from the archives of the Hospital for Sick Children and the city of Toronto.

^[1] Michael J Piva, The Condition of the Working Class in Toronto, 1900-1921 (Ottawa: University of Ottawa Press, 1979), 122-3.

[10:15] The Ontario Veterinary College and the Rise of Veterinary Public Health in Canada, 1873 – 1907

Lisa Cox

Recent and dramatic incidences of zoonotic diseases (disease that can pass between animals and humans) such as H1N1, avian flu, and even Ebola, have led many to focus on a growing relationship between veterinary medicine and human medicine. In fact, the two have been closely intertwined since the late nineteenth century. This paper focuses on that relationship and in particular, the integral role of veterinary medicine in early public health initiatives in Canada. This will largely be explored through the establishment of meat inspection legislation in the early twentieth century and the various events that led to its creation. Some of the earliest involvement of veterinarians in matters of public health involved meat. This began in the nineteenth century, however ensuring the quality and safety of meat was focused more on exported meat than what was consumed domestically. By 1907, however, quality and safety of domestically consumed meat became a priority. While meat inspection was a targeted activity, it does reflect the genesis of a larger animal health infrastructure in Canada that incorporated public health. Furthermore, while veterinarians contributed to public health by ensuring the quality and safety of meat, meat inspection as a public activity contributed greatly to the veterinary profession. As a very visible public service role, meat inspection aided greatly in the growing professionalization of veterinary medicine, which by the twentieth century was seeking to distance itself from its informal or lay practice of the past.

[10:40] Confusion, Rejection or Confidence? Torontonians’ Attitudes to H1N1 Immunization in 2009

Heather MacDougall

From Toronto’s official creation on March 6, 1834 to the present, controlling and preventing communicable diseases has been an essential component of municipal government. As vaccines against communicable diseases developed, the city health department engaged in public education and conducted immunization campaigns and regular clinics. The success of these efforts resulted in growing complacency about the dangers of communicable diseases until the SARS outbreak in 2003 revealed citizens’ vulnerability to external disease threats. This experience provided the impetus for the creation of the Ontario Agency for Health Protection and Promotion and led to pandemic planning. When the World Health Organization announced a pandemic of H1N1 influenza in 2009, Toronto Public Health once again faced the challenge of tracing the sick and their contacts and preparing for an immunization campaign. As Canadian, British and American scholars have demonstrated, vaccination has become a contested public policy since many of the childhood diseases which in Ontario require mandatory immunization are no longer seen as significant threats. Equally significant, research regarding the effectiveness of influenza vaccines has produced equivocal results which led many to question the value of the H1N1 vaccine. And controversies over its formulation and safety as well as the timing of its distribution enabled the anti-vaccination proponents to challenge the expertise of municipal and provincial officials. Using government records, press coverage, websites and scholarly studies, this paper will examine the extent of public support, resistance and hesitation regarding the H1N1 vaccine and the flawed campaign for its implementation in 2009.

[11:05] John G. FitzGerald & Robert D. Defries: The Lennon & McCartney of Canadian Public Health

Christopher Rutty

“They are a team as naturally suited to one another as Astaire and Rogers, Abbott and Costello, Rogers and Hart or Hammerstein, Hepburn and Tracey. They magnify this power not just because they are two, but because their combined chemistry is so much more that one plus one.” Such was the conclusion of a short article entitled, “The Music and Magic of Lennon-McCartney.” The personal elements it highlights and the comparisons it makes about the musical partnership between John Lennon and Paul McCartney of The Beatles are strikingly applicable to the most important partnership in the shaping of public health in Canada during the first half of the 20th century: Dr. John G. FitzGerald (1882-1940) and Dr. Robert D. Defries (1889-1975).

FitzGerald and Defries were the visionary and architect, respectively, of the uniquely structured and intimately connected Connaught Laboratories and the School of Hygiene of the University of Toronto, their common birth tracing back to 1913. Their partnership continued until 1940, when FitzGerald’s life (like Lennon’s) was cut short, albeit by his own hand, it’s spirit continuing until Defries retired as Director of both Connaught and the School in 1955. Their influence on infectious disease control, biotech innovation, and public health teaching, research and public service in Canada was fundamental, not unlike Lennon & McCartney’s was on the course of music.

This presentation will highlight the many and often quite polarizing elements shared between the Lennon-McCartney and FitzGerald-Defries partnerships, elements that proved so critical to how they respectively revolutionized popular music and public health.

[11:30] Germ Warfare: Charles J. Hastings, Arthur S. Goss, and the Use of Visual Media for Social Engineering

Dennis Duffy

“[O]ne of Toronto’s most influential and well-known Medical Health officers …” who “significantly changed the course of the Public Health Department,” Charles J. Hastings (1858-1931) knew exactly how the game of modern municipal government was played.

Hastings’s grasp of the new fundamentals of imaging power involved Arthur Goss, the city’s first official photographer, himself a protégé of Toronto’s leading civic modernizer, R.C. Harris, after whom the great waterworks plant is named.

The sources of Hastings’s power were varied, but modernity itself underwrote his prominence. He was a scientifically trained professional in a civic system that thrived on ethnic identification (Orange Protestantism) and cronyism for the selection of its elected leaders, men who could never possess those credentials. Public education had made his ministry the city’s most politically sensitive; electors now knew that people died when preventative measures were disregarded.

A spectre was haunting Toronto: the slum. The district known as “the Ward” diminished Toronto’s self-image. Religious and secular powers alike sought to reshape that image through a crusade that Hastings came to lead. His polemical 1916 M.O.H. annual report, entitled Report of the Medical Health Officer Dealing With the Recent Investigation of Slum Conditions in Toronto Embodying Recommendations for the Amelioration of Same appeared as a book, printed on magazine slick paper. Replete with Arthur Goss’s strong and evocative imagery. Hastings’ report demonstrated that Toronto’s shapers now understood how photography and the popular press could advance social engineering.

[1:00] ‘Mad’ history, heritage policy, and urban development: Forgetting and remembering Toronto’s Lakeshore Psychiatric Hospital Cemetery

Gregory Klages and Daniela Napoli

Growing attention to the public aspects of mental health history is offering unique insights into institutions and populations that have suffered marginalization in traditional history writing. Increased understanding, however, has served to add another complication to incorporating mental health institutions and sites associated with their history into community heritage efforts. This presentation studies recent negotiations involved in repurposing of a psychiatric hospital cemetery, exploring difficulties in integrating the site into larger community awareness and respect.

Between the 1890s and 1960s, over 1,500 Lakeshore Psychiatric Hospital patients were buried in an institutional cemetery in Etobicoke, Ontario. In 2000, the site was sold by the provincial government, and zoned for redevelopment by the local city council. Community advocates, heritage organizations, and scientific experts contributed to discussions regarding the redevelopment plan, and the Ontario Cabinet overturned the sale in 2007.

Surveying the history of the Lakeshore Psychiatric Hospital Cemetery from creation (1891) to last burial (1974), the presenters will consider how the cemetery came to be slated for development. Particular attention will be paid to what forces emerged as ‘community voices’ regarding the development, and how these forces characterized the site and its value. The authors will assess what role the cemetery’s close association with a psychiatric hospital might have played in complicating community memorialization of the site, and briefly place the struggle over the LSPHC’s fate within the context of efforts to preserve, commemorate, and protect similar sites in the United States, England, and Australia.

[1:25] Capitation Financing of Medical Care of an immigrant population . . . An early Toronto Experience

Irving Rosen

The turn of the century witnessed a progressive massive Eastern European immigration to Canada. Many such immigrants located in Toronto’s “Ward” district after coming to the city.The predominantly, penurious, immigrants formed multiple associations known as Mutual Benefit Societies (MBS) which provided socialization opportunities, but more importantly such social benefits as sick benefit, and unemployment allowances, interest free loans, burial arrangements and most significantly, low cost medical care (e.g. $2.00/family/year on a 24 hour basis), provided by newly graduated MD’s who vied for MBS panel inclusion. This was essentially a much vaunted capitation scheme, which lasted from 1900 to 1948 and the advent of prepaid, and government health insurance. Despite the extensive population involved, this unique non-governmental experience has never been reported upon, or critically examined. The scheme was characterized by acrimonious relations between doctors (who felt exploited and denigrated) and patients (who felt underserviced and neglected). Organized representatives of both groups were adversarial. While the scheme did provide low cost medical care, and assured some MD practice viability, it was considered unsatisfactory by all participants. That early capitation scheme deserves historical recognition, and discussion. Albeit, it is interesting to note that currently there is widening acceptance of capitation financing of medical care in Ontario, funded by adequate MOH rewards, illustrating the signal role such rewards play in the success of innovative health care delivery economic plans.

[1:50] Sanitarianism in British North American Indian Departments in the mid-19th century

Elsbeth Heaman

Social history of medicine emerged, to no small degree, from the reflections on epidemic experiences of early to mid-nineteenth-century Europeans, as governments began to reflect more profoundly on the deep undercurrents of political life, grounded in urban living spaces, understood both environmentally and socially. Sanitarianism came more slowly to British North America, in part because people conceived of the colonies as a healthy suburb for Britain. But sanitarian research paradigms did infiltrate British North American Indian Departments during the 1840s, as seen in the work of the Bart’s-trained Nova Scotia Indian Agent, Abraham Gesner, or the work of the Bagot Commission with its investigations of comparative adult and infant mortality. Such investigations have been overshadowed by later assimilation projects aimed at removing indigenous children from their families and comparable social influences. During the 1840s and 1850s, by contrast, the “civilizing” project insisted on the importance of those social influences, and it aimed primarily at settling “Indians” in villages, which were understood, from the sanitarian point of view, as the proper foundation for constituting healthy environments and social relationships. This paper will shed light on the sanitarian thinking around civilization projects of mid-nineteenth-century Indian Departments. It pays particular attention to the gendered dimension of the interaction between public and private indigenous spaces.

[2:15] Inequalities in Canadian Dental Health

Catherine Carstairs and Lauren Lewitsky

In the forty years that followed World War II, Canadians saw significant improvements in their dental health. Children’s cavities plummeted, thanks in part to water fluoridation, while middle-aged people were less likely to have to wear dentures or bridges to make up for lost teeth. Dental hygiene improved while the number of people visiting dentists regularly increased significantly. But not everyone enjoyed better dental health. People on low-incomes, rural residents, the disabled, the aboriginal and the elderly continued to suffer from tooth decay, tooth loss and periodontal disease, with significant implications for their overall health. Although a number of provinces developed denticare programs for children and for welfare recipients, dental care remained private, making it difficult for marginalized individuals to access care. (Indeed, many welfare recipients found it difficult to access care since dentists were often reimbursed at lower rates than they could charge on the open market, making them reluctant to accept patients on welfare.) This paper will outline the inequalities that continued to exist in dental health among Canadians, and explore the reasons why it was difficult for these people to access care.

[3:15] From Marketplace to Monopoly: The Role of the Legal System in Advancing the Interests of Physicians in Early Twentieth Century Ontario

Elizabeth Koester

The usual analysis of “public health” involves consideration of the relationship between the public and the state: for example, measures taken by the latter to assure, control or enhance the health of the former. If we adjust the eyepiece of our viewfinder, however, a different question comes into focus: what types of practitioners provide healthcare to the public? At the turn of the twentieth century, the medical marketplace in Ontario was vibrant, and healthcare was provided, in the words of Premier James Whitney, by “all sorts of ‘pathies’ and faiths.” Yet today, at the turn of the twenty-first century, medical care rests almost exclusively in the hands of physicians. A number of factors resulted in this change, and, in particular, in the ascendancy of the medical profession, rather than osteopathy, chiropractic, Christian Science, or other groups who had been engaged in providing health care to the public. This paper examines one aspect of the quest by physicians in Ontario for social, political and legal dominance by looking at the role played by the legal system, including legislation governing “the practice of medicine,” court decisions adjudicating the meaning of that phrase and an Ontario Royal Commission appointed in 1915 to study medical education in Ontario. This scrutiny allows us to see what issues faced the government of the day regarding the provision of health care to its public and provides insight into the relationship between the government, the medical profession and the public at the time.

[3:40] East of Eden: Origins of the Public Health Movement in New Brunswick

Jane Jenkins

In the spring of 1918, medical professionals in New Brunswick campaigned for centralized government oversight of public health. The Public Health Act proposed sweeping powers for a Minister of Health and his department to regulate everything from food production to butcher shops and boarding houses. Widespread opposition suggested the only thing not controlled by the new Act would be the solar system! The eventual passage of the Act by a narrow margin was a precarious victory and within days the nascent Department faced its first challenge when the unprecedented influenza epidemic hit. Using his sweeping powers, the Minister of Health issued province-wide closures and rallied volunteers to fight the epidemic. In the end, the perceived effectiveness of epidemic management legitimized the new Department thereby sealing government involvement in the health of its citizens.

My study of the institutionalization of public health in early 20th-century New Brunswick reveals several distinct features beyond the role of the influenza epidemic. These include its emergence from within the medical profession, its close ties to the ideology of progressivism, and its leveraging of economic justifications. In particular, I examine the formative influence on New Brunswick physicians of medical schools and professors in New York and Montreal. Standard accounts of the emergence of public health in Canada identify Ontario as the model for other provinces and highlights pioneers trained at Toronto medical schools. My study adds nuance to this narrative by identifying different sources of influence in establishing New Brunswick’s public health agenda.

[4:05] Scientific-Medical Practices in Toronto Forest and Open Air Schools

Patty Kelly

During the early twentieth century, Forest and Open Air schools were on the rise in North America and Europe. From the early 1900s and continuing through the 1960s, the Toronto Board of Education and the Department of Public Health collaborated in the establishment of forest and open air schools for pre-tubercular and underweight elementary school children. The first forest school in Toronto opened in 1913 in Victoria Park, followed by the High Park Forest School in 1914, and the Orde Street Open Air School in 1915. At this time, the architectural design of these educational spaces intersected with and drew on prevailing scientific ideas about the organization and categorization of human subjects in medical spaces (e.g., hospitals and tuberculosis sanatoriums). The Toronto schools took the tuberculosis sanatorium as their architectural and medical model, espousing the Canadian National Sanatorium Association’s core values of fresh air, rest, and good nutrition. In so doing, public health officials position elementary schools as sites of medical practices and scientific experimentation on children. While working in educational spaces that children occupy, medical professionals and educators adopt practices that align with the institutional and professional commitments of scientific experimentation and research. Scientific-medical practices that take children as their research subjects raise ethical questions about the treatment of children in educational spaces—practices that sought to correct not only nutritional deficits but also social deficits. This paper seeks to identify some of these ethical considerations and provide a narrative account of this little-known history of Toronto forest and open air schools.