Island Doctor: John Mackieson and Medicine in Nineteenth-Century Prince Edward Island 9780773570931

Table of contents :
Contents
Illustrations
Acknowledgments
Introduction
1 A Scotsman Settles in Prince Edward Island
2 Social, Family, and Professional Life in Charlottetown
3 Health and Illness in Nineteenth-Century Prince Edward Island: Mackieson's Practice in Medicine
4 A Nineteenth-Century Surgical Practice
5 The Perils of Childbearing in the Nineteenth Century: Mackieson and Obstetrical Care
6 Ministering to a "Mind Diseased": Mackieson, the Charlottetown Lunatic Asylum, and the Treatment of Mental Illness
7 Coda: Portrait of an Island Doctor
Appendix A: Chronological Outline of Mackieson's Career
Appendix B: The Formulary: Therapeutic Agents
Notes
Bibliography
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
Z

Citation preview

Island Doctor

McGill-Queen's/Associated Medical Services (Hannah Institute) Studies in the History of Medicine

1 Home Medicine John K. Crellin 2 A Long Way from Home The Tuberculosis Epidemic among the Inuit Pat Sandiford Grygier 3 Labrador Odyssey The Journal and Photographs of Eliot Curwen on the Second Voyage of Wilfred Grenfell, 1893 Edited by Ronald Rompkey 4 Architecture in the Family Way Doctors, Houses, and Women, 1870-1900 Annmarie Adams 5 Local Hospitals in Ancien Regime France Rationalization, Resistance, Renewal, 1530-1789 Daniel Hickey 6 Foisted upon the Government? State Responsibilities, Family Obligations, and the Care of the Dependant Aged in Nineteenth-Century Ontario Edgar-Andre Montigny

7 A Young Man's Benefit The Independent Order of Odd Fellows and Sickness Insurance in the United States and Canada, 1860-1919 George Emery and J. C. Herbert Emery 8 The Weariness, the Fever, and the Fret The Campaign against Tuberculosis in Canada, 1900-1950 Katherine McCuaig 9 The War Diary of Clare Gass, 1915-1918 Edited by Susan Mann 10 Committed to the Asylum Insanity and Society in Nineteenth-Century Quebec and Ontario James E. Moran 11 Jessie Luther at the Grenfell Mission Edited by Ronald Rompkey 12 Negotiating Disease Power and Cancer Care, 1900-1950 Barbara Clow

13 For Patients of Moderate Means A Social History of the Voluntary Public General Hospital in Canada, 1890-1950 David Gagan and Rosemary Gagan 14 Into the House of Old A History of Residential Care inBC Megan J. Davies 15 St Mary's The History of a London Teaching Hospital E.A. Heaman 16 Women, Health, and Nation Canada and the United States since 1945 Edited by Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson

17 The Labrador Memoir of Dr Henry Paddon, 191 z-1938 Edited by Ronald Rompkey 18 J.B. Collip A Life in Medical Research Alison Li 19 The Ontario Cancer Institute Successes and Reverses at Sherbourne Street E.A. McCulloch zo Island Doctor John Mackieson and Medicine in Nineteenth-Century Prince Edward Island David A.E. Shepard

Dr John Mackieson, 1874 (Courtesy Public Archives and Public Records Office of Prince Edward Island, ace. no. 23 98-8c)

Jsland ^Doctor John Jttackieson andjUedidne in ^ineteenth-Qentury ^Prince £dward Jsland

DAVID A . E . S H E P H A R D

McGill-Queen's University Press Montreal & Kingston • London • Ithaca

© McGill-Queen's University Press 2,003 ISBN 0-7735-2.52.4-6

Legal deposit second quarter 2003 Bibliotheque nationale du Quebec Printed in Canada on acid-free paper that is 100% ancient forest free (100% post-consumer recycled), processed chlorine free. This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada. McGill-Queen's University Press acknowledges the support of the Canada Council for the Arts for our publishing program. We also acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program (BPIDP) for our publishing activities.

National library of Canada Cataloguing in Publication Shephard, David A.E. Island doctor: John Mackieson and medicine in nineteenth-century Prince Edward Island / David A.E. Shephard. (McGill-Queen's/Associated Medical Services (Hannah Institute) studies in the history of medicine, health, and society; no. 20) Includes bibliographical references and index. ISBN 0-7735-2.52.4-6

i. Mackieson, John, 1795-1885. 2. Physicians - Prince Edward Island Biography. 3. Medicine, Rural - Prince Edward Island - History 19th century. I. Title R464.M245S46 2003 6io'.92 €2.003-900325-6

Typeset in Sabon 10/13, Centaur, and Adobe Wood Type Ornaments. Book design and typesetting by zijn digital.

For Jan The heart speaks many ways

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Contents

Illustrations

ix

Acknowledgments Introduction 1 2 3

xi

xiii

A Scotsman Settles in Prince Edward Island

3

Social, Family, and Professional Life in Charlottetown

9

Health and Illness in Nineteenth-Century Prince Edward Island: Mackieson's Practice in Medicine 25 4 5

A Nineteenth-Century Surgical Practice

55

The Perils of Childbearing in the Nineteenth Century: Mackieson and Obstetrical Care 68 6 Ministering to a "Mind Diseased": Mackieson, the Charlottetown Lunatic Asylum, and the Treatment of Mental Illness 88 7

Coda: Portrait of an Island Doctor

117

Appendix A: Chronological Outline of Mackieson's Career Appendix B: The Formulary: Therapeutic Agents Notes

139

Bibliography Index

165

177

129

127

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Jllustrations

Dr John Mackieson

ii

Title page of Mackieson's casebook, "Sketches of Medical and Surgical Cases" xv Title page of Mackieson's "Codex Experientiae Medendi" Mackieson's medical diploma

5

Charlottetown harbour, c. 1830

10

Wright-Patterson Plan of Charlottetown, 1771

n

Round Market, Charlottetown, c. 1825

12

Queen Square, Charlottetown, c. 1860

13

Matilda Brecken Mackieson

14

The Mackieson house, 238 Pownal Street, Charlottetown Charlottetown Sleighing Club, c. 1840 Panoramic view of Charlottetown, 1849

18

Queen and Kent Streets, late nineteenth century Hillsborough and Fitzroy Streets, c. 1890 Case report: Hepatitis chronica 40

35

16

17

Margaretha Stevenson, Charlottetown Harbour, c. 1866

Case report: Bronchocele

xvii

22

21

20

Illustrations

Fracture box for immobilization of fractured leg George Coles

63

89

Title page of Mackieson's "Record of Cases of Insanity" Panoramic view of Charlottetown, 1878 Charlottetown Lunatic Asylum

96

Inmate, Falconwood Hospital, c. 1890 Dr John Mackieson

104

119

Gravestone of Dr John Mackieson Title page of Mackieson's "Formulary" Case report: Chronic rheumatism

Xll

95

izo 130 132

91

^Acknowledgmen ts

Writing a book is very much a collaborative effort, and it is a pleasure to thank the many individuals who have facilitated the research, the writing, or the preparation of this book. Their assistance is much appreciated. Dr Edward MacDonald, former editor of The Island Magazine and a member of the Department of History at the University of Prince Edward Island, first encouraged me to make a study of Mackieson's casebook, the "Sketches of Medical and Surgical Cases." I am grateful for his comments on the history of the Island when writing the book. Some of the Mackieson manuscripts came to light through the efforts of the late Dr Gordon Lea, and all who are interested in the history of medicine in Prince Edward Island are in his debt. Three of these manuscripts are held by the Medical Society of Prince Edward Island, whom I thank for making them available. Microfilms of the three manuscripts, the originals of two others, and other archival material are held in the Public Archives and Records Office of Prince Edward Island, and I am grateful to its staff for making documents available and for assisting me in ways large and small. Several individuals in Glasgow gave me valued assistance: Alastair Tough, Archivist, University of Glasgow; Carol Perry, Archivist, Royal College of Physicians and Surgeons of Glasgow; Dr Fiona Macdonald of the Wellcome Unit in the History of Medicine; and Sir Abraham Goldberg, Professor Emeritus, University of Glasgow. Coauthorship of papers on Mackieson's obstetric and surgical cases with Professor Thomas Baskett and Dr Basil Grogono, respectively, of Dalhousie University, enlarged my understanding of those aspects of Mackieson's

Acknowledgmen ts

work. Dr Jock Murray of Dalhousie University advised me on a medical topic and Dr Robert Forsythe, of Charlottetown, on Mackieson's work in the Charlottetown Lunatic Asylum; Dr Tom Brown, of Mount Royal College, Calgary, read the chapter on the Charlottetown Lunatic Asylum; and Dr Allan Marble shared aspects of his knowledge of the history of medicine in Nova Scotia with me. Professor Heather MacDougall, of the Department of History, University of Waterloo, also made helpful comments. I thank Marion MacArthur, librarian at the Queen Elizabeth Hospital, Charlottetown, for her assistance on a number of occasions. I also thank the members of the Canadian Society for the History of Medicine and of the Dalhousie History of Medicine Society for the interest they showed when I presented papers on Mackieson. I am also indebted to the three readers of the manuscript; their diligence in that task and the comments they made are greatly appreciated. Also much appreciated is the assistance given me by Barb O'Handley when I needed to solve word-processing problems. I recognize especially Associated Medical Services, Inc., of Toronto for a grant-in-aid that made it possible for me to conduct research outside Prince Edward Island. In the publishing phase of this book, I have been fortunate for the interest and cooperation of the staff at McGillQueen's University Press; I also appreciate the able and helpful manuscript editing assistance of Jacqueline Larson. Finally, I am especially grateful to two individuals in particular. First, Dr Jacalyn Duffin, Hannah Professor of the History of Medicine at Queen's University, gave me invaluable advice at different stages of my research and read early drafts of the manuscript. Discussions with her about many aspects of medical history and historiography, and specifically on medicine in nineteenth-century Canada, were most helpful. Not least of the ways in which she helped was by sharing her own brand of enthusiasm for and interest in the history of medicine. Second, of immeasurable value to me was the ever-present and unfailing assistance of my wife, Jan. Her understanding, tolerance, and patience during all stages of the preparation of this book enabled me to carry the work of writing it to fruition. Without her support and interest, my task would have been arduous indeed.

xiv

Jntrod uction

For Dr John Mackieson, 4 December 1836 was a busy day. A general practitioner in Charlottetown, Prince Edward Island, he was summoned in the morning to see thirty-five-year-old Mrs Proctor, who was then in labour.1 She needed him urgently, "on account of a discharge of blood which she had observed for some hours from the vagina, and ... some obscure pains in the region of the womb." Finding the mouth of the uterus "not much dilated" - his patient thought she was about eight months pregnant - and preferring not to disturb the coagula that he had felt, he packed the vagina with a silk handkerchief and gave her "35 drops of Tincture of opii." He told her that she should remain "perfectly quiet" and that he would see her again later. At 4 P. the same day, Mackieson was asked to see Mr Pladwell, a sixty-eight-year-old man who had for some time noticed a small tumour the size of a pigeon's egg in his groin.z It had been painful since the morning and had made him retch. Mackieson immediately recognized the problem: an inguinal hernia had to be reduced and returned to the abdominal cavity. Mackieson described what he did to the patient in his case record: "he was retained by a stout man standing at his feet holding his thighs - I made him drop his right leg over the left knee & bend it a little (for the Hernia was on the right side) I then caught the neck of the Hernia with my left thumb & middle & fore fingers - & made gentle but constant pressure with the right." Mackieson was performing the manoeuvre known as taxis, and was evidently successful, for "in the course of half a minute, the tumor first became sensibly smaller - then gently rumbled & suddenly disappeared thro' the abdominal ring."

Introduction It was now time to see Mrs Proctor again. Mackieson renewed the vaginal plug and gave her more opium so that she could sleep. However, neither she nor Mackieson slept for long. The bleeding persisted, and, "anxious and fearful of the result," she had her doctor roused "at about 2 o'clock on the following morning." The os uteri was now dilated to the size of "half a crown," and, since a likely cause of the bleeding was placenta praevia, a life-threatening abnormality of the position of the placenta, Mackieson sought a second opinion. He and Dr Henry Conroy, "a brother surgeon," on making "a further and freer examination," confirmed the diagnosis and agreed on the necessary course of action.3 They decided, "since the placenta occupied such a dangerous position - the mischief going on - that artificial delivery must be some time used, and that she could not be left alone under such circumstances with safety [and] to dilate the os uteri & deliver." To deliver the baby would be dangerous because manipulation could bring on hemorrhage as the placenta separated from the uterus. Mackieson wrote that "it appeared the preferable mode of procedure to turn the child, rather than wait the doubtful chance of labour pains suddenly supervening and pressing the head against the placenta, and by that means putting an end to the haemorrhage." Because of the ever-present danger of exsanguination, Mackieson went ahead with the necessary manoeuvre and delivered the infant feet first. During the process of version, Mackieson "never observed any pulsation in the cord," and on being delivered the baby appeared to be "under 7 months"; death of the fetus was therefore no surprise. The mother recovered, and was soon able to return to looking after her six children. We know about these events, which occurred during just one day in Mackieson's long career in Charlottetown from 1821 to 1885, through a casebook titled "Sketches of Medical and Surgical Cases."4 Covering the period from 1826 to 1858, this casebook comprises 257 case histories of a variety of illnesses in his patients, which include two accounts of illness in himself, one in 1827 and a second in 1847.5 The cases Mackieson wrote up were of medical, surgical, obstetric, gynecologic, and mental disease. They tell us about the conditions in the patients Mackieson saw in his medical practice in this thirty-year period and how he diagnosed and treated them. Some of his patients were from Charlottetown, and he saw them in his office, which was located in his home there. But some of his patients lived in the country where he was

xvi

Introduction

Title page of Mackieson's casebook, "Sketches of Medical and Surgical Cases." Mackieson began this in 1826; his last case reports were entered in 1858. (Courtesy Medical Society of Prince Edward Island)

frequently called out to attend them in their homes, often far from Charlottetown and difficult to reach in the hard winters. Although he was not a rural doctor, his practice covered many parts of the Island, and he became very well known, both to his patients and his colleagues. In this sense he was indeed an Island doctor. The "Sketches" are, however, only part of what Mackieson wrote, just as his daily general practice made up only part of what he did on the Island. Mrs Proctor and Mr Pladwell, for example, represented the obstetric and surgical aspects of Mackieson's practice. But he was, in fact, engaged in all aspects of medicine, both clinical and administraxvii

Introductio n

tive. In his clinical work, Mackieson was nominally a general practitioner, so he saw the gamut of clinical cases a general practitioner would see. Although specialization had not yet begun to fragment medical care, he was a specialist as well as a generalist. This is evident in many ways besides his surgical and obstetric work. In a second casebook, for example, he recorded the clinical details of 115 patients with mental illness whom he looked after from 1868 to 1874, as medical superintendent of the Charlottetown Lunatic Asylum.6 He held this state appointment from 1847 to 1874. Another state appointment was the port health officer for Charlottetown, which he held from 1833 to 1847. This made Mackieson familiar with the problems of public health as they were understood in the first half of the nineteenth century, particularly in relation to the major communicable diseases of smallpox, cholera, and typhus. Overall, then, Mackieson's work covered a wide range of activities. Two other medical manuscripts that Mackieson wrote illustrate yet other aspects of his practice. One manuscript was the "Code of Medical Experience" (Codex Experientiae Medendi).7 Dated 1855, this eightyfive-page manuscript summarizes the features of medical, surgical, and obstetric conditions that Mackieson considered important. The "Codex" connects Mackieson's own practice as a doctor to medicine beyond Prince Edward Island. Because it is made up of synopses he wrote based on his reading of the general medical literature, it gives us an idea of the clinical conditions that concerned physicians outside Prince Edward Island. The "Codex" also indicates that Mackieson kept abreast of medical progress by reading journals and textbooks. The other manuscript is the "Formulary," in which Mackieson described fifty-nine classes of therapeutic agents and listed thousands of prescriptions culled from various authorities.8 From this four-hundredpage manuscript, which indicates his familiarity with everyday aspects of therapeutics, we can form an idea of the types of therapeutic agents that doctors used in Mackieson's day. From 1847 to just before his death in 1885, Mackieson also kept a diary.9 The entries are in the form of notes and comments rather than extensive observations on the subjects of the entries. Many of his entries concern the weather, particularly daily recordings of the temperature, and many concern his family or social events. Some are about political events that he considered worthy of notice. However, some entries are of medical interest, and while they are not accounts of cases, they do augment the information about Mackieson's life as a doctor. xviii

Introduction

Title page of Mackieson's "Codex Experientiae Medendi," dated 1855. In the "Codex," he wrote up synopses of conditions of interest, based on his reading of the medical literature. (Courtesy Medical Society of Prince Edward Island)

Mackieson's manuscripts, therefore, are a rich primary source of information about medicine in the nineteenth century, as well as about Mackieson himself, his practice, and his life in Charlottetown and the Island. Written in considerable detail by Mackieson himself, these documents are unique. For example, census data for the nineteenth century provide details of population only, rather than longevity, and vital statistics for the province, which would tell us about the nature and prevalence of diseases in the community, are not available before 1907. Artifacts such as tombstones do not provide adequate or objective information that might complement that in Mackieson's manuscripts. xix

Introduction

Nor do newspapers provide reliable data on health and disease, though they do tell us about the public's reactions to health threats and how they were dealt with, and about the multiplicity of patent medicines that claimed to cure all sorts of conditions. The uniqueness of these manuscripts as a primary source on nineteenth-century medicine in Prince Edward Island, written by a doctor in practice, is the main strength of the Mackieson archive. Mackieson's manuscripts also augment the few primary sources on medicine in Canada as a whole.10 Of particular note are the daybooks of James Langstaff, who practised in Richmond Hill, Ontario.11 A comparison of the Mackieson material with Langstaff's reveals similarities to the clinical experience of a doctor outside Prince Edward Island. This lends credibility to Mackieson's Island experience and relates the manuscripts to studies of nineteenth-century medicine in Canada. Little has been written about Mackieson. Gordon Lea, the Charlottetown physician who ensured that Mackieson's manuscripts became accessible, wrote on Mackieson in the context of the history of medicine in Prince Edward Island, though without historiographic rigour.IZ Douglas Baldwin edited Mackieson's obstetric case records, and his commentary on the life and times of the physician is of particular interest,13 though his editing of the case records is incomplete and in some parts erroneous.14 Other accounts of Mackieson and his work include my own.15 It is because little has been written about Mackieson and his texts that this book seems warranted. The Mackieson archive itself provides an entree to the growing literature of microhistory that deals with the lives and careers of "ordinary" doctors. They are ordinary in the sense that they are neither well known nor among those who are admired as heroes of medicine, but they are certainly not ordinary in their achievements. Though these ordinary doctors have not generated the laudatory, sometimes weighty, and frequently hagiographic prose given to such physicians in Canada as William Osier, Frederick Banting, and Wilder Penfield, the study of minor figures is nevertheless rewarding. As Harold Cook has pointed out, it generates "detailed accounts of the lives previously hardly known to historians, people who by the very fact that good evidence about their lives survives are neither average nor typical, presenting us with lively stories that illuminate little corners of humanity which could have hardly been imagined before."16 Jacalyn Duffin's study of xx

Introductio n

Langstaff, based on his daybooks, is one example of work in this genre;17 Harold Cook's account of the practice of Joannes Groenvelt in London in the seventeenth century is another;18 and Katherine Mandusic McDonell's edited version of the journals of William Lindsay, a nineteenth-century Indiana physician, is a third.19 This study, then, introduces another "ordinary" doctor. It is only through what he wrote that we are able to learn about Mackieson and his practice. But why did Mackieson write during virtually all of his career in Charlottetown? Although it was customary for physicians in the nineteenth century to write up their own case records, it appears that he had a larger purpose in mind.zo The title pages of his "Sketches," his "Codex," and his "Formulary" indicate that he wrote in part to communicate information to other physicians. Moreover, he dedicated the "Formulary" to the medical students of his own alma mater, the University of Glasgow. Mackieson likely wrote with a view to publishing at least some of it, and his diary does tell us that he had correspondence with publishers at one point/1 However, despite his desire to communicate with others, there is no evidence that he published anything in the medical literature. This is one of a number of ways in which he differed from Langstaff, who published one article in Canada Lancet in 1880." The Mackieson material, particularly the casebooks, also differs from the Langstaff material in the extent of case reporting. The Mackieson casebooks are primarily records that give an often detailed account of the diagnosis, the treatment, and the course of a disease in his patients. They are casebooks rather than daybooks or account books. In contrast, Langstaff's daybooks provide much information about his daily accounts, while most of his entries on clinical aspects of the cases are in point form only; he wrote up few cases at any length/3 The Mackieson material also lacks the chronological continuity of Langstaff's daybooks. The "Sketches," for example, cover the years from 1826 to 1858, and the lunatic asylum casebook, from 1868 to 1874. It also lacks information about his fees and income, which must be estimated in other ways. (For a discussion on Mackieson's earnings, see chapter 2,.) An additional weakness of the Mackieson material is the absence of material, either in his casebooks or his diary, that enables us to reconstruct what we can be sure was a typical day in Mackieson's life. But then, there is no such material that gives a complete account of all the activities in the life of any nineteenth-century Canadian doctor. xxi

Introduction

Franca lacovetta and Wendy Mitchinson have observed that case files constitute research material that deserves wider interest as historiographic tools, and certainly Mackieson's manuscripts fit into that category.24 Mitchinson has also discussed some general issues in the historiography of medicine. She points out that physician-historians have tended to judge the past by how it relates to the present, perceiving medicine in the present to be "better" than medicine in the past.25 My interest in Mackieson's case records lies in how they can provide the medical historian with a basis for discussion about how he did what all physicians, regardless of when they have practised, have had to do: look after patients by solving clinical problems, using the means that are available. Mackieson did what he could with the knowledge and technology in his time, and he practised the art of medicine accordingly - in a manner that, from the point of view of human interaction, was no worse or better than that of the present. It is also important to analyze the case records critically, and to keep an open mind about any underlying meaning. When Mackieson refers to working with "a country midwife" or "a kind of midwife," it is legitimate, for example, to wonder what feelings he might have had about working with individuals who were not formally licensed. (For a fuller discussion on midwives, see chapter 5.) The comments of Ludmilla Jordanova on medical history also are instructive. She has commented on the special value of "local history" for the medical historian. A sharp geographical focus makes it easier "to pick up diverse and primary sources" and, she writes, "to reconstruct its diverse constituent elements."26 Certainly the diversity of Mackieson's cases and career comes across in a study of his manuscripts and other contemporary documents. Moreover, the information in these Island-based documents permits one to place Mackieson's work in the context of medical practice in other parts of British North America, particularly Ontario. Although there are some limitations to the value of his cases as sources, such as the brevity of the span they cover, the clinical case records provide a discrete point of entry to a review of medicine in nineteenth-century Prince Edward Island in particular, and elsewhere in Canada. Some of the interest of the Mackieson material lies in the fact that, to use Cook's words, "in the echoes of his life one can hear the sounds of many others, too."27 One example is Mackieson's case report of the illness of George Coles, who was premier of the Island when ill health xxii

Introduction

forced him to retire from politics/8 Mackieson's case report not only introduces a poignant account of this Islander's suffering and of the horrors of the untreatable mental illness that Coles had to endure but also raises questions, which are admittedly hypothetical, about the effect his illness might have had on the course of Island politics, had he been able to recover from his mental illness. (See also chapter 6.) Mackieson shared with Coles the experience of living in Prince Edward Island during a period of profound social and political change with issues that generated much controversy. These issues included absentee landlords and the land question, responsible government, and free education. It was a period that included the years that Buckner and Reid have characterized as "the consolidation of colonial society."29 These years form the background to Mackieson's life in Prince Edward Island. Particularly in the 18305, the small colony was maturing, with immigrants flowing into the Island in ever larger numbers. By this time, Mackieson had established a firm position for himself as a doctor, and though he was closely connected to the inner circle in Charlottetown indeed, perhaps because of that - the various transformative changes did not significantly affect his work as a doctor. His connections enabled him to maintain a stable position in society. One of these connections was forged through his marriage. In 1830 Mackieson married the, daughter of Ralph Brecken, a merchant who in 1812. had been Speaker of the House of Assembly and a member of a Family Compact that wielded great power in Charlottetown.30 His appointments in 1833 as port health officer, and as medical superintendent of the Charlottetown Lunatic Asylum in 1847, strengthened his social position and gave him visibility as a local figure in Charlottetown. Thus Mackieson became a member of the elite - that group of "interrelated patricians centred on the great officers of the Crown and a few proprietors, or their agents and merchants, who controlled the Legislative and Executive Councils."31 This group would have shaped Mackieson's perspective on Island life, though, apart from serving in state appointments, he played no active part in the events that were transforming that life. He practised as a well-trained and competent doctor, and lived the life of a well-connected citizen. The authority and prestige that Mackieson's several state appointments conferred upon him did, however, lead him in 1856 to engage with politicians on the question of licensing of physicians.32 Mackieson's career therefore illustrates the way professionalization affected medical practice in the second half of the nineteenth century. xxni

Introduction

As founding chair of the local medical association in 1855, he became involved in one of the central issues to affect physicians in the second half of the nineteenth century.33 Although his attempt in 1856 to have legislation enacted to license physicians failed,34 it did provide the first guide post on the path for later efforts that led to licensing of physicians in 1871.35 The complex issue of professionalization in medicine has attracted the attention of many historians. With respect to Island matters, Baldwin and MacBeath have suggested that the failure of Mackieson's 1856 petition lay, in part, in the fact that the perceived desire for medical monopoly "smacked too much of the contentious absentee landlord situation."36 In an era in which many individuals claimed to be able to heal, his efforts to legislate the licensing of physicians may well have been regarded as a manifestation of monopoly. Nor was his cause helped by the fact that many of the assemblymen lived in rural areas where "irregular" practitioners, lay healers, and quacks flourished and were often held in high regard. Though Baldwin and MacBeath have suggested that doctors faced "stiff" competition from such individuals, there is no evidence that Mackieson did.37 His established city-based practice was likely to have insulated him. If Mackieson took no other active part in politics, Island politics did on occasion affect him. His diary for i May 1851 provides an example. He evidently regretted the introduction of responsible government and the repeal of the "old" Board of Health Act. His Tory leanings led him to view these actions as among "the first fruits of the Responsible Council!" As a result, he "lost the situation of 'Health Officer.'"38 Significant as changes in Island politics were during Mackieson's career, the focus of this study is Mackieson's medical practice, the impact on it of the advances in medicine in the nineteenth century, and his contributions to health care on the Island. His lengthy career meant that he saw many changes in his time on the Island. When Mackieson arrived in Charlottetown in 182.1, he was one of but a handful of doctors, all of whom had been taught in Great Britain by professors whose ideas on health and disease came from the eighteenth century. By the time he died in 1885, there were more than fifty doctors across the Island, some trained in Canada, and the medical infrastructure now included a general hospital in Charlottetown. During his career, medicine was reshaped by revolutions in thinking, in diagnosis, in technology, and in therapy. Concepts of disease had begun to change around xxiv

Introduction

the time Mackieson graduated: physicians began to think in terms of disease underlying symptoms, making specific diagnoses by correlating clinical features with pathological findings. This process was aided by some of the technological innovations of the nineteenth century - the stethoscope, the ophthalmoscope, the laryngoscope, the kymograph, and the microscope, for example. Other advances facilitated surgical practice, such as anaesthesia and antisepsis. Later, extraordinary developments in histology, bacteriology, and immunology finally brought the advances of science to bear on the practice of medicine, though not on his own practice. Mackieson's practice covers the years from 1821 to 1885, coinciding with "the changing therapeutic perspective" in that period that John Harley Warner has discussed.39 In all of this period, Mackieson maintained a keen interest in medicine. He began his "Sketches" in 1826 and his "Formulary" fifty years later; and his "Codex" gives clear evidence of his interest in and knowledge of the current medical literature. It is therefore useful to ask how the many advances in biomedical science in the middle of the nineteenth century influenced Mackieson's daily practice. Mackieson's manuscripts tentatively suggest how changing paradigms and innovations influenced his practice. The "Codex," for example, indicates that he read the medical literature carefully and was aware of changes in medicine. The "Sketches," which reveal his experience in general practice and his special interests in surgery, obstetrics, the care of the mentally ill, and therapeutics, indicate that he did introduce innovations in his practice. But the "Sketches" also indicate a degree of conservatism. His use of bloodletting, for example, suggests that he would have agreed with the sentiments of a physician's 1879 observation, that "change and progress are not always synonymous, and the wisdom of a decade does not easily outweigh that of many centuries."40 Mackieson may have been reactionary in not making use of anaesthesia - at least up to 1858 - but it was not so much a matter of believing that anaesthesia was inefficacious as being cautious concerning a very recent advance in medicine that was not free of danger. Anaesthesia was introduced toward the end of the period spanned by Mackieson's casebooks, and experience with it was limited. As Pernick has pointed out, practitioners in Mackieson's day had to answer a clinically important question: "Which was the 'lesser evil' - the harm likely to be caused by pain or the harm that might be caused by the painkiller?"41 xxv

Introduction

Yet, Mackieson did accept the value of progress. In diagnosis, he saw the value of the stethoscope, which he referred to for the first time in a case report in i842, 4Z even though this was long after Laennec had invented it in i8i6.43 In therapy, he was prepared to introduce new drugs and techniques into his practice. In 1837, for example, he gave ergot,44 a drug that had been first used in Canada in i8z6;45 in 1871 he treated George Coles with chloral hydrate,46 which had been introduced just two years earlier;47 and in 1826 he performed the first operation for strangulated inguinal hernia on Prince Edward Island.48 But more often than not, Mackieson stayed with drugs and techniques that he had used over the years, and in this respect he was similar to a general practitioner in Quebec in 1870 whose practice Bolduc has recently studied.49 If Mackieson tended to be conservative, as in his reliance on bloodletting, he was not alone. Even the great William Osier wrote, as late as 1892. of the treatment of pneumonia, that "during the last decades we have certainly bled too little."50 The value of bloodletting had been questioned by P.C.A. Louis in i836 51 and again by J.H. Bennett, in Edinburgh, twenty years later,5i but Mackieson used the technique as late as 1857." He used it as therapy, however, because, as his patients attested, it often seemed to be efficacious; and, as Rosenberg has observed, for many nineteenth-century physicians "the inertia of traditional practice was powerful indeed."54 Mackieson's attachment to bloodletting is understandable, too, given his training in a period when the physician's art "centered on ... [the] ability to employ an appropriate drug, or combination of drugs and bleeding, to produce a particular physiological end."55 For both Mackieson and his patients, therapy that produced a visible or palpable effect often seemed beneficial. Although some of "the sounds of many others" in Mackieson's manuscripts are his patients, such as George Coles, few of them speak at any length about Mackieson himself and his care, or about medical care in general. Yet some of Mackieson's records do provide pointers to the reactions of patients in individual cases. For example, a warm welcome was given to Mackieson by a young child with croup on his seeing his doctor enter his room.56 Quite different was the reaction of a woman in the country who had a hernia, a disorder that was common enough among people engaged in strenuous work such as farming. She had had the hernia for twenty years, but it had never troubled her. At first she declined Mackieson's advice for surgery; all she wanted was something that might give her "a little ease." She told xxvi

Introduction

Mackieson that the pain she had now came from her stomach, not from the hernia, which had never troubled her acutely. Understandably, she was reluctant to submit to surgery with the risks and suffering that it entailed. Unfortunately, by the time she did accept Mackieson's advice it was too late, and she died soon after a desperate operation to relieve the strangulation that had made her ill for a week.57 Suffering of a different kind and a different outcome was experienced by a woman with an equally long history of a tumour of the thigh. She, too, declined the advice for surgery at first, though she did change her mind later and lived for years after the operation.58 Sadly muted, in contrast, are the sounds of those women who died in childbirth; the suffering and the deaths of those otherwise young and healthy women are part of the dark shadow cast by childbirth in the nineteenth century. Among all the case records, however, the most detailed accounts of illness are of the two illnesses suffered by Mackieson himself, in 1827 and 1847.59 These gave him first-hand experience of serious illness, which likely gave him greater understanding of suffering in his patients. Other Islanders can be heard not only in Mackieson's manuscripts but in documents that are concerned with two events that occurred while he held government-related appointments. In these events, Mackieson's career lost some of its gloss. Some of the Islanders' voices concerning these events were critical enough to spur the government to take action, albeit late. One event was "the Lady Constable affair" in 1847, when a boatload of Irish immigrants brought typhus with them. Mackieson was thought to have mishandled the management of this episode, and he had to resign from his post of port health officer (see chapter 3). The other event occurred in 1874, when neglect of patients at the Charlottetown Lunatic Asylum became the subject of an investigation by a grand jury (see chapter 6). Along with the asylum trustees and the asylum keeper, Mackieson, who was medical superintendent, had to share blame for the situation, and had to resign from a state appointment for a second time. These events marked low points in his career; they point to areas in which he failed, and raise the question of why an apparently successful physician should have erred (see chapter 7). Mackieson's career illustrates many aspects of nineteenth-century medicine. Two emphasize his place as an Island doctor; one concerns his state appointments. These illustrate his ability to create a firm xxvii

Introduction

position for himself on the Island. His connections to the social and political spheres on the Island enabled Mackieson to play a small part in the hierarchy as the colony grew in prosperity. He was part of the establishment, he had informal access to those who had power and authority, and he was one of those citizens whose opinions may well have been heard on some of the many occasions when, as his diary shows, he "hobnobbed" with the elite, much to his pleasure.60 His opinions may have concerned some of those "paraclinical" matters that were significant in terms of the relationship between the state and the Island, such as the state's responsibility in dealing with the threats of communicable disease, with care of the mentally ill, and with the provision of medical care by others besides "regular" physicians, and with the professionalization of doctors. The second aspect of Mackieson's career lies in his everyday clinical work. His writings, which are the focus of this book, tell us about the nature of his clinical practice and give us a picture of nineteenth century medicine, both in Prince Edward Island and beyond its borders. His manuscripts also tell us about Mackieson himself. Behind, or around, the pages of these manuscripts stands their author, or at least his literary ghost. Harold Cook, in considering his study of Joannes Groenvelt, said that "all we have left are words and objects, largely in the form of ink on paper: the tangible signs of vanished spirits."61 John Mackieson left manuscripts that are the tangible signs of an Island doctor long gone from us; they create a portrait of him and the practice in which he endeavoured to comfort and heal his fellow Islanders a century and a half ago.

xxviii

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•z• JL tyotsman fettles in ^Prince £dward Jsland

John Mackieson came from a Scottish family who lived near Stirling, a historic city not far from Glasgow. He was born on 16 October 1795 in Kilsyth, near the Campsie hills, where his father farmed. His mother taught him to read and write before he went to school, so he had a good start in learning at home. In 1803 he went to school in nearby Craig and two years later to Chapel Green School, where he benefited from a formal education.1 In due course, Mackieson enrolled as an arts student in Glasgow University, where teaching was influenced by the liberal and skeptical ideas of the Scottish Enlightenment.2 He matriculated in i8n. 3 Great Britain was then still at war with France and needed military doctors, which may have led to Mackieson's decision to study medicine. He enrolled as a medical student in Glasgow in November i8iz. Mackieson was one of some four hundred students who registered for the 1812-13 course in anatomy and surgery at the University of Glasgow.4 His anatomy professor was James Jeffray, also from Kilsyth. A knowledge of this basic science was valuable to Mackieson in his surgical practice later in Prince Edward Island. We know of his interest in anatomy by a 1750 textbook on the muscles of the body, which is the only artifact we have that carries Mackieson's own signature.5 Many of the technical terms are in Latin and a few are in Greek, but his knowledge of these classic tongues would have made him familiar with all the terms in the book. Mackieson took all the available subjects in the medical curriculum, rather than selecting just a few of them, which was permissible for those students who were apprenticed to practising physicians. In 1813 he took chemistry from Robert Cleghorn in addition to his continuing

Island Doctor

courses in anatomy and surgery, and in 1814 he added medicine, taught by Robert Freer, midwifery with James Towers, and materia medica (the use of drugs) from Richard Millar. His teachers were leaders in their profession, and the curriculum at Glasgow University covered all the basic book knowledge needed. In 1815 he "walked the wards" of the new Glasgow Royal Infirmary as well as studying botany and the elements of general practice. Thus Mackieson obtained a medical education in a school that was among the best of any in Britain. His medical diploma, which he received on 7 November 1815 from the Faculty of Physicians and Surgeons of the City of Glasgow, indicates that Mackieson was "a fit and capable person to exercise the Arts of Surgery and Pharmacy."6 Because the war between Great Britain and France had ended that year, military doctors were less in demand, and the twenty-year-old Mackieson could decide for himself where to practise. However, having only the diploma of a "country licentiate," rather than the higher degree of Doctor of Medicine, he was limited in his choice. To practise in Glasgow itself he would have needed the doctorate, which would have meant more study and additional expense for the son of a small farmer. His "country" licence did entitle him to practise outside the city and "within the bounds of the Jurisdiction" of the Glasgow medical faculty,7 so he decided to set up practice in the city of Stirling, near Glasgow, which he knew well. As many of his compatriots did, Mackieson eventually moved away from Scotland. He moved south to England, where the much larger population may have attracted him. He chose the city of Liverpool, a bustling seaport city and one of the principal gateways to the New World. Whether he was satisfied with his move to England is not known, but he would have had to observe the regulations relating to practice in England. "Doctors" there were divided, according to their qualifications, into a hierarchical structure of physicians (who had obtained the MD degree), surgeons (with the MB, BS, and probably the MCRS diploma) and apothecaries (with the LSA licence).8 M Mackieson may have pondered the desirability of continuing to work in England, for he may have been one of those Scottish and Irish graduates who had "a bone of contention" with the influential Society of Apothecaries.9 Under the terms of the Apothecaries' Act of 1815, doctors graduating in Scotland or Ireland were required to pass the society's examination or face the possibility of being prosecuted for practising illegally as apothecaries. 4

A Scotsman Settles in Prince Edward Island

Medical diploma awarded to John Mackieson on 7 November 1815. It permitted him to practise as a "Country Licentiate," outside the City of Glasgow and within the western part of Scotland. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2398/2)

Mackieson never left any record of why he chose to leave England for Prince Edward Island. But while in Liverpool, he met a man who was familiar with British North America, particularly Prince Edward Island. This was John MacGregor, member of Parliament for Glasgow, formerly high sheriff of Prince Edward Island.10 His account of the Island may have piqued Mackieson's interest, and one account does tell us that it was MacGregor who induced him to emigrate to the Island.11 In making this decision, Mackieson did what so many Scots had done since the last years of the eighteenth century.12 Living in Liverpool, he would have been familiar with the steady flow of ships filled with people sailing for North America, including Prince Edward Island. Young and enthusiastic, Mackieson, like many of his fellow Scots, was likely 5

Island Doctor

attracted by the general idea of moving to a new life and in particular to the part of the New World that MacGregor had told him about. By emigrating he would also enjoy the freedom from licensure regulations and the need to take further examinations. Prince Edward Island had become part of British North America in 1763, after the war between Great Britain and France. The Island was surveyed by Samuel Holland in 1765, when it was known as St John's Island.13 Then a "barren" land, populated by a few Aboriginal North Americans and Acadians, the survey made it better known in Great Britain. It began to be settled soon after land was distributed by lot, and between 1770 and 1775 almost a thousand immigrants came to the Island, the first group landing at Stanhope Cove in June 1770. Many of the early immigrants were from Scotland, where the tension between landlords and tenants in the Highlands, and between Protestants and Roman Catholics, led to the decision of the oppressed to become "exiles from their fathers' lands."14 Charlottetown's natural harbour became a port that attracted many immigrants, and Charles Morris's street plan of 1768 for Charlottetown (or Charlotte-Town, as it was originally known in honour of Charlotte Sophia, consort of George in) gave the principal Island town a base on which to grow and develop. Governor Walter Patterson arrived in the small outpost in 1770, which in 1799 was renamed Prince Edward Island for one of the sons of George in. A steady trickle of immigrants flowed into the Island in these early years. In the decade in which Mackieson came, some three thousand persons in 205 vessels arrived on the Island.15 Mackieson sailed on the brig Relief, captained by Simon Dodd, which left Liverpool on 15 October 1821 and reached Charlottetown on 7 November.16 Because the city had grown with immigration, there would be a need for doctors, and it must have seemed a good place to set up a practice. For Mackieson the move worked out well: he would practice in and around Charlottetown for the next sixty-four years. As an emigrant, Mackieson took with him to Prince Edward Island a mix of character, self-dependence, culture, and adventure that enabled him to succeed in the New World. His university education, first in the arts and then in medicine, fitted him well for his work as a doctor, which was aided by health and vigour and a strong Christian faith. Although the portrait of Mackieson that emerges here is shaped primarily by his medical writings17 and his diary,18 among his manuscripts 6

A Scotsman Settles in Prince Edward Island

there is also a great deal of poetry, which reveals another side of him.19 His interest in verse suggests that writing in general was important to him. Like his case records, his poetry attests to his powers and acuteness of observation, though in itself it does not explain the care and attention he gave to his medical manuscripts, for the writing of case records, daybooks, and journals by physicians was common in the nineteenth century.zo Nevertheless, Mackieson's poetry reflects the artistic side of his personality. Mackieson evidently started writing poetry as a young man, for he wrote a poem called "The Picturesque" as early as 2,6 August i8z6,21 soon after he had begun his clinical casebook entitled "Sketches of Medical and Surgical Cases" (see chapters 3, 4, and 5). He wrote this poem from the view of an emigrant who had left Scotland for a part of the world that he came to love. The poem was inspired after a walk "in rural Keppoch ... a delightful silvan retreat." From it he could see the magnificent Bay of Charlottetown, its beautiful Islands, the Straits of Northumberland, and in the background, the blue hills of Nova Scotia. But Mackieson never forgot his native land, and much later in life he wrote several poems in which he wove the theme of "a land of the torrent, the mountain and glen" into his verse. One such poem, which was published on 16 April 1878," shows that the memory of his "own Caledonia" never left him, much as he loved Prince Edward Island: THE EMIGRANT'S DREAM Air-"Alabama Again" I dreamt of a fair land I left far behind me, A land of the torrent, the mountain and glen, And I gazed on her hills till the tear-drops did blind me, For I thought 'twas my own Caledonia again. CHORUS

Caledonia again! Caledonia again! Blow softly thou breeze, o'er the white crested billow, And waft me to fair Caledonia again. Twas the land of my sires, for the grey mist was low'ring, O'er the storm rifted summit, and heath purpled ben, O'er the cairns of the mighty the Eagle was soaring, And bright shone the rivers that flowed to the main.

7

Island Doctor And there rose the home where I sported in childhood, The hymn of the torrent that flowed thro' the glen, The oaks and the eyry that skirted the wildwood, And grey castled turrets that frowned o'er the plain. On high roamed the flocks on the brow of the mountain, Still sacred to freedom, ne'er foe could enthrall, The shepherd his loves on his pibroch recounting, Bedecked with the bonnet and garb of old Gaul. As I gazed on the landscape all glowing before me, The glories of sunset burst wide o'er the plain, And I saw there a form, every joy did restore me, Tho' I sigh still to see that fair vision again. For me thought like an Angel, it floated around me, Her smile was the sunshine, like music's soft strain, Her voice round my heart stole, in fetters so bound me, I never could leave Caledonia again.

All emigrants leave something of their hearts behind them. Mackieson did, but he also had the capacity to hold in his heart the joy of his new home, and to live a long and rewarding life in Prince Edward Island.

8

•2-

$odal, cFamily) and ^Professional Life in fflarlottetown

fflarlottetown: The QVfwWorld John Mackieson, full of the enthusiasm of a young man looking to fulfil his ambitions in a new world, sailed into Charlottetown's sheltered and capacious harbour six years after he had graduated. Compared to the two large port cities of Glasgow and Liverpool that he knew so well, Charlottetown was small and undeveloped.1 Its population was under two thousand. The town provided a marked contrast with its natural and clean harbour. "Refuse littered the streets," runs one account. "Human excretion was dumped into holes sunk to the water table, or soaked through the ground to contaminate shallow wells. Poorly drained roads, outdoor privies, bogs, cesspools, slaughterhouses, and roaming farm animals added to the city's stench and filth."1 Charlottetown was a small and rather primitive outpost in British North America. It was the capital of the colony of Prince Edward Island, but with "barely 300 homes and 'several tolerable taverns and public houses.'"3 The streets were laid out in a grid pattern without sidewalks and it lacked any look of importance. Even when sidewalks were laid in 1863, they were only of hemlock planks. The streets were not lit - gas lighting was not introduced until 1859, electric lighting was installed in 1885, and facilities for running water were initiated only in i88y. 4 When Mackieson came to perform operations, he often had to do so by candlelight and water had to be brought to him and boiled. The roads from Charlottetown to other communities were rough, and in the winter almost impassable, which added to

Island Doctor

A view of Charlottetown Harbour, c. 1830, by artist George Thresher. The harbour would have been little different in 1830 than in 1821, when Mackieson sailed into it. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2916/1)

Mackieson's difficulties in seeing patients who called for him from the countryside. But Charlottetown, and the Island, had potential for growth, and in his sixty-four years in Prince Edward Island Mackieson saw changes that made Charlottetown a well-known Canadian capital city and Prince Edward Island the smallest Canadian province. The population of the city increased about fourfold and the province went from approximately 15,000 to n0,000.5 Besides being a colonial administrative centre, Charlottetown was a market town and a port with excellent shipbuilding facilities. With an abundance of timber nearby, shipyards and warehouses proliferated as ships were designed and built for Britain and for the other Maritime provinces. Between 1830 and 1870, more than three thousand ships were launched from Charlottetown and other yards around the Island; Mackieson refers to one of them, the Ethel (1795 tons and a keel length of 2,10 feet), in his diary for 29 May 1858^ Earlier, Mackieson had become familiar with 10

Social, Family, and Professional Life

Wright-Patterson Plan of Charlottetown, 1771. Survey by Thomas Wright for Governor Walter Patterson, showing grid plan. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. Map 0,534 [detail])

Charlottetown harbour, for he was port health officer from 1833 to 1847, a post that was only one of several he filled outside his general practice in Charlottetown (see the chronology of Mackieson's career in appendix A). As medical attendant to Charlottetown's jail from 1863 to 1884, Mackieson came to know another side of Charlottetown. Though there was little crime, there was no police force, and it was the presence of a British military garrison that provided security. The garrison, which was quartered in Fort George, in Charlottetown's southwestern corner, also brought social life and activity to the Island and its capital city. Charlottetown attracted naval ships, especially from Great Britain and the United States, and their visits to a town with military personnel led to a sharp increase in varied social activities. When dignitaries (naval and otherwise) sailed into Charlottetown they were entertained, and they entertained in return, in grand style. Mackieson revelled in these parties, and his diary contains many entries that note his enjoyment of them.7 In 1851, he became Surgeon General to the militia, which gave him even more opportunities for enjoying Charlottetown's social life. The central point of Charlottetown, which was the Island's administrative centre when it was still part of British North America, had ii

Island Doctor

Drawing of Round Market, Charlottetown, c. 1825 (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2702/4)

always been Queen (or Market) Square, and from the 1840s on the focal point was the Colonial Building, built on what had previously been Queen Square.8 The Legislative Assembly of Prince Edward Island met there for the first time in January 1847. The movement for responsible government was then gathering force, one of its leaders being the Liberal, George Coles, who later became premier. Mackieson's life and this political movement intersected in two ways. The first is described in his diary. On 23 April 1851 he noted that "Responsible Government [was] introduced, by the Governor signing the Bill for the Civil List and pensioning the officials."9 Then on i May 1851 he wrote that he "lost the situation of Health Officer on the old Board of Health Act being repealed - (the first fruits of the Resp. Council!)"10 Clearly, Mackieson was a Tory, unlike George Coles, who introduced the legislation. Mackieson's life intersected with Coles again; when Coles was later disabled by mental illness,11 he became a patient of Mackieson's (see chapter 5). Eventually the Colonial Building became Province House, and Charlottetown became better known as the city where the proposals 12.

Social, Family, and Professional Life

Queen Square, Charlottetown, c. 1860. Drawing attributed to Fanny Bay field. The couple in the left foreground are standing at what is today the corner of Queen and Grafton Streets, with St Paul's Church, Province House, and the Round Market as the landmarks. Queen Square was within easy walking distance of the Mackieson house. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2702/3)

for Confederation were discussed, beginning in 1864. It was in the mid-i86os that the other parts of British North America got to know Charlottetown and to appreciate Prince Edward Island, which, in George Brown's words, was "as pretty a country as you could ever put your eye upon."" Mackieson had a grandstand view of these momentous political events, though in his diary he did no more than make brief mention of them. Prince Edward Island became a province of Canada in 1873, but in his diary for 26 May of that year, Mackieson simply noted that the Confederation Bill had been passed by the Legislative Assembly.13 In his diary he noted with equal brevity a number of other events, both in the Island and elsewhere: the duel in Charlottetown between George Coles and Edward Palmer on 2.5 June 1851;14 battles in the Crimean War (i854~6); 15 the laying of the first cable across the Atlantic in 1858;16 the visit of the Prince of Wales (later King Edward vn) to Charlottetown in i86o;17 General Robert E. Lee's surrender on i865;18 a visit to Sir John A. Macdonald at Falconwood, just outside Charlottetown in the summer of iSyo;19 and the introduction of the Prince Edward Island Railway in 1871,^° the cost of which led the Island to join the Confederation. Mackieson's 13

Island Doctor

Matilda Brecken Mackieson, n.d. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2^8/8g)

diary does not tell us what his views were on the large political issues that shaped the Island's development during his life there. Like many doctors, then as now, his primary interest lay in practising medicine. By the time political issues came to the fore, Mackieson was well enough established in society to accept the changes that were taking place around him. On arriving in Charlottetown, Mackieson's first need was to find accommodation and office space. In this his friendship with Simon Dodd, captain of the Relief, proved useful: he found accommodation and office space in Dodd's tavern, the Ship Inn, at the western end of 14

Social, Family, and Professional Life

King Street. Mackieson was still there in 1823, when he was advertising that he had medicines from England for sale/1 His medical practice soon flourished, for in his second decade in practice he advertised for an apprentice.22 However, there is no evidence that anyone answered his advertisement. Evidently Mackieson had little difficulty in building up his practice. The Island's population was growing, with the 1827 census putting it at 23,473,23 and he was one of only two or three physicians in Charlottetown and one of only six or seven on the Island.24 However, Mackieson had certain attributes that enabled him to find a special niche as a doctor. Well trained in all aspects of medicine, he had a particular interest in surgery. His surgical skill was soon noticed, particularly in operations to repair strangulated inguinal hernia.25 A newspaper report in 1834 drew attention to the fact that Mackieson was the first on the Island to operate for hernia, thereby acknowledging his special ability as a surgeon early on in his career.26 His interest in obstetrics also served Mackieson well as he built up his practice, and he earned the respect not only of his patients but also of those members of the colonial city with power and influence. The young doctor no doubt also sought to live as befitted a physician with an eye on advancement in society. Soon he owned property in Charlottetown, and in 1831 he was in a position to advertise "a commodious and pleasantly situated dwelling house for rent."27 The Scots-born immigrant, still only in his thirties, was evidently successful in finding a place in Charlottetown society.

$ocial and ^Family Life By this time Mackieson had another reason for building up an equity in property, for his marriage on n February 1830 meant that he needed a house that would be large enough for a family. The woman he chose as his wife was Matilda Brecken, whom he met sometime in the late 18208. By marrying the daughter of Ralph Brecken, a wellknown Charlotte-town merchant and member of the legislature, Mackieson did more than find a companion for the next four decades. His marriage to the well-connected Matilda gave him access to part of the Family Compact that was influential in Charlottetown society. He soon became well known as a physician and as a member of Charlottetown society and even of its elite, and some of his patients would be influential in furthering his position in society. 15

Island Doctor

The Mackieson home, 238 Pownal Street, Charlottetown. Built by Colonial Secretary John Edward Carmichael in the 1820$, the house has changed little in its exterior appearance since Mackieson s day. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2398/8!)

The house that he and Matilda purchased was entirely suitable for them. Located at 238 Pownal Street, near the corner of Euston Street, it still stands as one of Charlottetown's most elegant Regency houses/8 It was originally built for John Edward Carmichael, who had been colonial secretary before he died in 1828. Edward Jarvis, the chief justice, then rented it for two years, after which it was put up for sale as part of the Carmichael estate, when Mackieson purchased it. The house had several pleasing features. One was its situation, set back from the street on a double lot. Another was the architecture, particularly the columns, the colonnade, and the casement windows. The large garden was also a source of pleasure; Mackieson made frequent references in his diary to their garden and its fruit and vegetables.29 There was a pump in the garden, which meant that water did not have to be fetched from a communal supply some distance from his home. The house also provided room for his "surgery," or office. Mackieson's care for his house is evident from the many references he made to its upkeep in his diary.30 16

Social, Family, and Professional Life

Notice for the Charlotte-Town Sleighing Club, c. 1840. The Mackieson family were probably members of the club, thus participating in one of many activities in Charlottetown's snowy winters. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. ^66/HF 78.72.6,)

Matilda bore six children, two of whom died in infancy.31 Of the children who survived, John Wallace was born in 1832,, Leila a year later, Amelia in 1835, and Augustus in 1836. Charlottetown was a good place for a family. There was plenty to do and enjoy. In the winter they could skate, play in the snow, and go carriole riding; indoors, as well as continuing to enjoy parties and dinners - often until 2 or 3 A.M. - they could learn the latest dances and attend theatricals, both professional and amateur, which could "dispel melancholy and banish care."32 In the summer there were picnics, riding, fishing, and sailing. The house had another advantage: it was just across the street from the Scottish Kirk of St James, which was erected in 1830 and which Mackieson helped to found. Both he and Matilda were diligent in attending the church and taking part in organizing its teas and bazaars, as well as the numerous other social functions that were held elsewhere. Matilda was for many years a member of the Ladies Benevolent Society, a charitable organization of the kirk, and its president on more than one occasion. Mackieson himself was a member of 17

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Panoramic representation of Charlottetown in 1849, showing principal landmarks (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2320/5-3)

the congregation from the beginning, and for many years he was a member of the Kirk Session; he was also ruling elder in 1858 and 1859 and also in i86y. 33 When the "new" building was officially opened with a service on 20 October 1878, one of the hymns that was sung was the "Dedication Hymn," written by Mackieson himself.34 Mackieson was also socially active, apparently thriving on late-night dinner parties and balls,35 but he also enjoyed time with his family, whose activities he frequently referred to in his diary.36 Photographs of him, like so many Victorian portraits, emphasize the stern and serious aspect of the father, but he took pride and pleasure in what his children did. Wallace, like his father, became a doctor, taking some of his training apprenticed to Dr Edward Clarke in Boston.37 In 1852. he emigrated to Australia. Mackieson's numerous entries about Wallace's activities, which included working in the gold fields, show that he followed his son's career and family life with the deepest interest. He must have often been saddened by the fact that he never saw Wallace again; an entry in his diary on n May 1872 simply notes that it was twenty years since Wallace had left for Australia.38 More painful was the death of his other son. Augustus became ill in the spring of 1867, probably with tuberculosis, and his condition deteriorated through the summer. His father, who would have known the gravity of his illness, visited him on their farm on several occasions. A typical entry was that for 4 May 1867, when he "visited and bled Augustus with a Pleuritic attack."39 By the late summer Augustus was dying, and Mackieson 18

Social, Family, and Professional Life

remained with him "from October 3 to 13," to take care of him day and night. On 13 October 1867, Mackieson had to write the sad note that "R. Augustus Mackieson died at V4 to 6 A.M."40 He was not yet thirty-one. Of the two girls, Amelia married and eventually left town for Montreal, so only Leila remained in Charlottetown. This must have been of some solace to her father, especially after Matilda died in 1877, following a protracted illness, probably the result of a stroke.41 On 22 May 1877, Mackieson had to pen another terse note about death in the family: "Mrs Mackieson died this morning at 7. Married 46 years, & 4 months."41 At this time Mackieson was eighty-two years old, so the presence of Leila in Charlottetown would have been a comfort.

^A "^uccessful" ^Physician Mackieson's purchase of the house on Pownal Street tells of his success in emigrating from his native country and integrating himself in Charlottetown society. It is a sign that he was succeeding as a doctor. Many doctors in the Victorian era had "a comfortable but not affluent income,"43 and this is also true of Mackieson. He was comfortable, if not overtly affluent. He would have earned more than many Island doctors, some of whom had to supplement their clinical income by running a drug store or a general store. For example, the account book of Dr William Grigg, of Tyne Valley, for 1877 shows that he earned only $290.71 from his medical work (the equivalent of $14,500 today), and he must have worked hard to earn an additional income from his general store.44 Mackieson was a busy practitioner in Charlottetown who frequently treated the elite. Although we have neither personal financial statements nor a Prince Edward Island fee schedule, it is reasonable to conclude that his clinical income would have exceeded that of Grigg and other rural practitioners. An idea of what Mackieson earned may be obtained from considering the income of doctors practising in nearby Nova Scotia. Information for 1839 provides examples. The income then of Dr Alexander Forrest, of New Glasgow, was £196; for Dr Henry Farrish, of Yarmouth, it was £568; and for the well-established Dr William B. Almon, who had a large practice in Halifax, it was £1000.45 It is reasonable to assume that Mackieson, who had a busy practice in Charlottetown and in some of the communities outside the city, and who could afford a gracious home as well as other property, earned 19

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Margaretha Stevenson alongside wharf in Charlottetown, c. 1866. St Dunstan's Church and Province House are visible in background. (Courtesy Public Archives and Records Office of Prince Edward Island; ace. no. 3466/HF 74.27.3.104)

more than Dr Farrish but less than Dr Almon. Some of Mackieson's income came from his state appointments. Complete information about his salary from these sources is not available, but statements in the accounts of the House of Assembly give an idea of the salary his state appointments generated. In 1848, for example, Mackieson received £40 58. yd. for attendance at the former Central Board of Health; in 1854, as medical superintendent of the Charlottetown Lunatic Asylum, £50; and in 1864, as medical attendant to the Queen's county jail, £io.46 (Allan Marble's Nova Scotia research has suggested that a salary of £50 for work outside daily clinical practice would have been one-tenth or one-fifth of a doctor's total income in the middle of the nineteenth century.)47 Mackieson would have also received a stipend for his service as surgeon general to the militia, and as medical examining officer for the New York Life Insurance Company. Additional sources of income were for miscellaneous services such as attendance in cases of cholera and smallpox, and at inquests and 20

Social, Family, and Professional Life

Queen and Kent Streets, Charlottetown, late nineteenth century. Many of Mackieson's patients would have made use of a horse "missinger" to summon him. (Courtesy Public Archives and Records Office, ace. no. 2320/88-10)

autopsies. These other earnings were significant; an estimate of them and his clinical earnings makes it reasonable to conclude that Mackieson's income was indeed comfortable. (In Mackieson's day, £1= $4. $i then=$4o today. One pound in Nova Scotia currency w 5 of sterling.) His income from all sources was, however, likely not as high as James Langstaff's in Ontario, whose income from clinical sources in 1880 was $4,874-7348 and who, on his death, left assets made up of bank shares, stocks, promissory notes, and a well-stocked farm worth $59,zi9.49 Langstaff provides an example of a doctor who indeed can be said to have been affluent. Like Langstaff, Mackieson owned some property, though his holdings were not as extensive as Langstaff's. Land assessment records show that Mackieson owned several properties. In 1857, 1858, and 1859, his name is recorded in connection with lots 8 and 9 and 52, 53, 54, 55, and V4 of lot 56 in the fifth hundred in Charlottetown, and with six pasture lots in Charlottetown Royalty.50 In 1858 he owned a house and two fields in Charlottetown, and by 1870, a house, a cot2.1

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Hillsborough and Fitzroy Streets, Charlottetown, c.,i8^o. Earlier, Mackieson owned a house on this corner, on the right. The house on the left was owned by John Stumbles, saddler. (Courtesy Public Archives and Records Office of Prince Edward Island, ace. no. 2301/233)

tage, five town lots, and a farm outside the city.51 Mackieson's will indicates that he owned six lots in Charlottetown, and, in Queen's County, two properties of one hundred acres and four hundred acres; currency sums amounted to approximately $5,ooo.5i From the two standpoints of a man who married well and had a family, Mackieson may be regarded as being a successful citizen and provider. But what conclusions can be reached about Mackieson as a doctor in his profession? According to Harold Wilensky, "a career, viewed structurally, is a succession of related jobs, arranged in a hierarchy of prestige, through which persons move in an ordered, predictable sequence."53 Mackieson's career is paradigmatic of this structure. It is likely that his success in obtaining a succession of prestigious appointments outside his daily clinical work gave him the standing, in due course, to become the doyen of the medical profession in the Island. In 1833 he was appointed port health officer for Charlottetown, and in 1837 he 2,2,

Social, Family, and Professional Life

became a member of the Central Board of Health (see chapter 3 for a full account of Mackieson's responsibilities in these posts); in 1847 he was appointed medical superintendent of the Charlottetown Lunatic Asylum (see chapter 6); and in 1863, he obtained the appointment as medical attendant to the Charlottetown jail. In 1851 he became surgeon general to the local militia (see also appendix A.) Separate from his general practice, these posts can be seen as steps in his career that gave him considerable authority and a measure of prestige. Like other physicians in the Maritimes, he enjoyed a "multitude of opportunities" that enabled those physicians, as Colin Howell has pointed out, to demonstrate their professional worth in an industrialized centre.54 The authority Mackieson gained in acquiring these state appointments was valuable to his role as the leader of the Island medical profession when, in 1856, he sought to have the licensing of physicians made stricter (see also chapter 3.) His efforts as founding chairman of the Prince Edward Island Medical Association55 were part of the general nineteenth-century professionalization of physicians.56 While there is no evidence in the Mackieson archive to support the statement of Baldwin and MacBeath that physicians in this era faced stiff competition from "patent medicines, lay practitioners using native herbs and folk remedies, midwives, 'quacks,' and a flood of poorly trained, American-educated doctors,"57 Mackieson's main concern was to have the House of Assembly enact legislation that would prevent "ignorant pretenders to medical knowledge" from being permitted to practise on the Island.58 Although his petition to the assembly did not receive the support he had looked for, it was the beginning of professionalization on the Island. (A fuller discussion of the roles of individuals without medical licences in health care on the Island is provided in chapter 3.) Magali Sarfatti Larson sees professionalization as "the process of collective mobility by which the early modern professions attached status and social standing to their transformed occupational roles."59 Mackieson contributed to such a process of professionalization in Prince Edward Island. He himself made no comments on any role he may have played, but the very fact that he founded the medical association in the Island implies a concern with the type of movement that Larson has called "the collective mobility project."60 As Howell has observed, physicians in this period were "increasingly aware of their own professionalism."61 Though the archival sources do not permit any definite statements, it is likely that Mackieson was aware, for example, of the growing professionalization of physicians in nearby

2-3

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Nova Scotia. Mackieson was thus an agent of change in this respect in the much smaller medical profession in Prince Edward Island. These considerations are additional to those concerning his apparent success as a clinical practitioner, which is most evident in his "Sketches of Medical and Surgical Cases." If the whole of his work is considered, in terms of his varied career as an Island doctor, Mackieson must be regarded as having been eminently successful. Mackieson survived Matilda by seven years; he died on 17 August 1885. An obituary said of him that "his example as a man and citizen was one which might well be imitated. "6z Nearly ninety years old when he died, he had indeed made exemplary contributions to the Island during his time there, his presence being felt in many ways over the six decades that he lived in Charlottetown.

2-4

•3-

J~Lealth andjllness in ^Nineteenth^entury ^Prince £dward Jsland: J/Ladtieson's ^Practice in J/Lcdicine On 27 April 1847 Mackieson was sent for to attend a forty-nine-yearold preacher. Summarized, the details of this case are as follows: caseCase 160: Pneumonia, Treated \>y Bleeding — Tart. Ant., Calomel & Opium (27/4/1847) Four days earlier the patient had stood for fifteen minutes in his garden, dressed in a robe and slippers, giving instructions regarding his chapel. He then felt chilled and feverish. Later, his chest became sore and he expectorated "large" amounts of rusty coloured mucus that was tinged with blood. When Mackieson saw him, his skin was hot and dry, the pulse rate was 120 per minute, and deep inspirations were painful. Treatment initially included the following: venesection of blood (12 ozs [348 ml]), the blood being "highly buffed" (and so indicative of the presence of white blood cells in the supernatant layer and thus a state of inflammation in the body); four powders of ipecacuanha (i grain) and antimony powder (3 grains) every two hours, together with a saline mixture of antimony tartrate (i dessertspoonful). This promoted the expectoration and made the skin "damp." It was followed by one-tablespoonful doses of a mixture containing ipecacuanha powder, antimony tartrate solution, tincture of hyoscyamus, and acetate of squill, in water flavoured with syrup of maple sugar and oil of lemon. Next day the patient was short of breath and complained of

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"oppression" of the chest. Repeated bloodletting produced "relief to the above symptoms." The antimony tartrate mixture was also repeated, and though the patient vomited, his fever appeared to be relieved. Over the next ten days the patient seemed to be getting better, with a reduction in his pulse rate to between eighty and ninety per minute. On 7 May, however, a cold rigor, exacerbation of the fever, and a return of the previous symptoms, including expectoration of mucopurulent sputum, signalled a relapse of the condition. Mackieson repeated the bloodletting to a further sixteen ounces, applied a blister to the seat of the pain in the left side of the chest, and started treatment with calomel (5 grains) (a mercurial preparation) and Dover's powder (containing opium and ipecacuanha) (3 grains) in molasses every five hours. On 9 May the pulse rate was 120 and the patient noticed "the brassy taste" of mercury. Mackieson considered it "necessary" to "abstract" yet a further pint (540 ml) of blood. The calomel and Dover's powder were continued, and morphine muriate (twenty-five drops) was given to help the patient get some sleep. Next day the pulse was still rapid, and, not wishing to take any more blood, Mackieson consulted with the naval doctor, Kelly, who recommended more calomel, Dover's powder, and a blister between the shoulder blades. The diet consisted of gruel, sago, barley water, and panada. The patient failed to recover, however, and he died on 17 June. Mackieson added the patient showed "all the symptoms of Pulmonary Consumption."1 This case illustrates several aspects of medicine in Mackieson's practice. It describes the clinical features and natural history of one of the commonest disease complexes in Mackieson's day. The patient probably died from pneumonia that was superimposed on tuberculosis of the lungs, a disease often referred to as "the captain of the men of death. "z The case shows how Mackieson dealt with a clinical problem using the means of diagnosis and treatment that were available to him and his contemporaries. It is one example out of many of Mackieson's case reports that, taken together, make them a unique primary source on medicine in Prince Edward Island in the nineteenth century. It also reminds us of the burden of disease in Islanders in this period. 26

Health and Illness in Nineteenth-Century PEI TABLE 3.1

Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

RANKING OF THERAPIES, BY FREQUENCY, IN MEDICAL CASES Drug/agent Mercurial preparations Opium Hot water, fomentation Bloodletting (venesection) Senna Jalap, quinine, antimony; Cold water, ice Ammonia preparations Ipecacuanha Seidlitz powder/' mineral salts Squill, Dover's powder51"* Iron, enemas Liniments Quassia, sulphuric acid, castor oil; Hot blankets Turpentine, hyoscyamus Croton oil, aetheris nitrosi

*

A mild laxative containing sodium bicarbonate, potassium sodium tartrate, and tartaric acid. * * Contents: Opium and ipecacuanha.

Mackieson's case reports also provide a database that enables us to compare his practice with that of doctors elsewhere. Two examples of his treatment make this clear. First, a patient with a stroke (whom Mackieson saw on Z3 November 1839) had been treated some time earlier in England with the same type of mercurial preparation as he used in his own practice.3 Second, Mackieson's choices for therapy (table 3.1) were similar to those of James Langstaff, who practised in Richmond Hill, Ontario.4 Mackieson's case records, considered with those of other doctors elsewhere, allow us to draw conclusions not only about his own practice but about norms of practice in the nineteenth century. A study of Mackieson's medical practice and allied topics generates other questions. What were his concepts of disease and what influenced his approach to diagnosis and treatment? How similar were his ideas and concepts to those of physicians elsewhere? Was his treatment effective and did it change over time as advances shaped medicine in the nineteenth century? What was his position and standing in the 27

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community and in the medical profession in Prince Edward Island? Other questions concern Mackieson's patients and the public - their views about illness and physicians, and about lay healers and practitioners of alternative medicine and "quacks." In the context of nineteenth-century medicine, two aspects of Mackieson's practice should be considered. The first is the picture of his daily clinical work: the illnesses in his patients, how his cases indicate which diseases were prevalent in his practice, and his approach to making a diagnosis and to treating his patients. This picture is provided primarily by a discussion of the cases described in the "Sketches." The "Codex" and the "Formulary" are other useful sources, but they do not have the same immediacy of interest that stems from first-hand accounts. The second aspect of Mackieson's practice relates to his involvement in health care, including issues such as the threats to the community posed by communicable diseases, health care as delivered by different providers, and the professionalization of physicians. He was involved with such issues through his state appointments and when he served as the founding chair of the local medical association. This wider aspect of Mackieson's career is revealed partly by the "Sketches" but more by other sources such as government documents, newspapers, and accounts written by individuals. Management of Jllness in J/Lackiesons Tractice Of Mackieson's several manuscripts, the casebook he titled "Sketches of Medical and Surgical Cases" sheds most light on health and illness in nineteenth-century Prince Edward Island.5 The "Sketches" include 2.57 case reports. Of these, 139 deal with conditions that may be considered medical and are discussed in this chapter. (The surgical reports are considered in chapter 4; the obstetric reports in chapter 5; and the mental disease reports plus those from the lunatic asylum record in chapter 6.) The classification of diseases and disorders Mackieson wrote up in the "Sketches" (see table 3.2.) reflects what is likely to have been the pattern of medical illness in Prince Edward Island in his day. Because we do not know the total number of cases he saw, either in the time period of the "Sketches" or in his entire career on the Island, we cannot estimate the prevalence of the conditions he reported or their mortality. However, comparison with the well-documented study of Langstaff's practice in Ontario suggests that, in this respect, the med28

Health and Illness in Nineteenth-Century PEI TABLE 3.2,

FREQUENCY OF DIAGNOSES IN MEDICAL CASES

More than One Case Diagnosis Number

Single cases

Hepatitis Chronic Acute Fever* Pneumonia Erysipelas Ascites,hydrothorax Apoplexy Brain inflammation** Cholera Croup Hydrocephalus Nephritis Cancer Stomach Liver Dysentery Dyspepsia Bronchitis

Asthma Bronchocele Cephalalgia rheumatica Chest pain Chlorosis Chorea Congestion in head Convulsions Diabetes mellitus Diarrhea Emphysema Enteritis Gangrene, senile Gravel Headache Hip joint disease Intestinal irritation Intrathoracic abscess Locked jaw Lower jaw swelling Neck cramp Neuralgia of heart Palpitations Paralysis Paraplegia Pericarditis Peritonitis, acute Perspiration, suppressed Phrenitis Pleuritis Rheumatic fever, endocarditis Scrofula, mesentery Smallpox Syphilis, ulcers Stomach cramp Tetany Tonsillitis Ulcers, irritable Urticaria/nettle rash Vomiting

Climacteric decay Hemoptysis Knee joint disease Parotitis/mumps Phthisis Typhus Rheumatism Chronic Acute Others

18 1 11 7 6 5 5 4 4 4 4 4 3 1 3 3 3 3 2 2 2 2 2 1 1 2

Intermittent, 4; and one each of: infantile remitting, nervous, quotidian, remitting, synochus, triple tertian, worm. Including one case of hysteria/phrenzy (fatal) and one of phrenitis.

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ical cases in the "Sketches" are not significantly different from those that occurred in Ontario.6 Many of Mackieson's medical cases had an inflammatory basis. As one would expect in a period when physicians emphasized symptoms rather than disease entities, the diagnosis of "fever" as a separate condition was common.7 The frequency of disorders with an inflammatory component explains why Mackieson relied on anti-inflammatory, or antiphlogistic therapy (phlogos = flame; phlogistos = inflammable). The gastrointestinal system was affected in forty-three patients. Hepatitis was diagnosed in nineteen, but without laboratory confirmation it is impossible to say whether the hepatitis cases really were cases of inflammation of the liver or some form of gastrointestinal upset or another medical condition. However, it is possible that hepatitis was, like some of the other conditions reported by Mackieson, common in his day; examples are "cholera" (but not of the classic Asiatic type), Sydenham's chorea, erysipelas, "scrofulous mesentery," smallpox, and a tertian and quotidian type of fever that may have been due to malaria. The central nervous system appeared to be involved in twenty-six cases, of which six were stroke and four, acute hydrocephalus. A case that was given the diagnosis of "Congestion in the Head" illustrates the difficulty of, but also the historical interest in, second-guessing Mackieson's diagnoses. Case 62: Congestion in the Head (18 May 1837) A thirty-seven-year-old man complained of giddiness, headache, dimness of sight, and ringing in the ears. A similar episode had occurred three years earlier, and double vision had troubled him since. He also noticed that he was unsteady when walking. He had been bled "in the Country" and given a purgative of salts. Further treatment included a repetition of the bloodletting, a blister to the occiput, and a mild purgative of Seidlitz powder and magnesium sulphate, together with calomel and jalap; the head was bathed with cold-water cloths and his feet were warmed by being placed in warm water. His condition soon improved and he could walk and see more easily. Although he squinted "a little" and turning his head suddenly caused blurring of vision, in two months he was "quite recovered."8

30

Health and Illness in Nineteenth-Century PEI

The interest in this case lies in the question of whether it might have been multiple sclerosis, which was then becoming recognized by JeanMartin Charcot and others in France but was not yet familiar elsewhere.9 While it is impossible to answer this question with any certainty, it does illustrate how some of the cases in his practice might be assigned a more definitive diagnosis in light of modern knowledge. The respiratory system was the site of disease in nineteen cases, but, again, the causative agent or process cannot be ascertained. In one-half of the cases, the diagnosis was pneumonia or pleuritis. Tuberculosis the likely cause of death in Mackieson's younger son - was the diagnosis in only two of the respiratory cases, but it might have been a factor in pneumonia and pneumonitis and in haemoptysis. The heart and vessels, other than the cerebral, were affected in four patients. Cancer was relatively uncommon, being the diagnosis in only four of the medical cases. There were forty-five deaths among the 139 medical cases (32.8%) (table 3.3). In many of the patients, the disease was pathologically advanced (e.g., in cancer or tuberculosis) or uncorrectable (e.g., apoplexy [stroke] and acute hydrocephalus), while in others a therapeutically specific agent was not then available (e.g., for diabetes or erysipelas or pneumonia). In some patients, a disease process was advanced when Mackieson first saw them so they were unamenable to treatment; sometimes the sick person lived far from his office or had been reluctant to seek him for fear of the disease or of the bill (though Mackieson did hold a "free" clinic on Saturday mornings for those who could not afford the doctor's bill).10 An individual might also first seek the services of a lay healer or perhaps a quack. The causes of death in Mackieson's practice cannot readily be compared with those in Langstaff's practice. We do not know the total number of cases that Mackieson saw in his career or even in the period from 1826 to 1858, and Mackieson's series is a smaller and selected one. In Langstaff's forty-year series, the leading causes of death were conditions affecting the respiratory tract, followed by febrile disorders such as scarlatina, sore throat, and whooping cough; other causes included gastrointestinal disease (including liver disease), heart disease, cancer, and stroke.11 In Mackieson's series, the leading causes of death were stroke, streptococcal infection (as erysipelas), chronic hepatitis, hydrocephalus, and pneumonia, so there are some points of similarity between the two practices, though only in broad outline.

3i

Island Doctor TABLE 3.3

CAUSES OF DEATH IN MEDICAL CASES

Cause

No.

Apoplexy/stroke Erysipelas Hepatitis, chronic Hydrocephalus Pneumonia Ascites Stomach cancer Croup Brain inflammation Bronchitis Chlorosis Climacteric decay Diarrhea Gangrene, senile Hydrothorax Nervous fever, melena Paraplegia Phrenzy* Phthisis Pleuritis Scofula, mesentery Tetanus Typhus gravior

5 4 4 4 4 3 3 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Total

45

Included with brain inflammation in table 3.2..

Qoncepts Underlying J/iackieson's^Approach to Patient Qare A summary of one of Mackieson's case reports provides an introduction to the concepts that guided Mackieson in looking after his patients. ^) Case 80: Sanguineous Hemiplegia (23 November 1839) A thirty-four-year old man, who was the Colonial Secretary, suddenly felt tingling in his left arm on the night of

3z

Health and Illness in Nineteenth-Century PEI

2.3 November 1839. He had been previously well, except on one occasion two years earlier when he had been treated in England by "celebrated practitioners" who had given him "a very liberal quantity of mercury." On the night of his present illness, his wife noticed that his mouth was twisted to the right and that there was a "faltering" in his speech. She called Dr Benjamin de St Croix, who lived next door, who in turn called in Dr Lawrence Tremain. Dr Tremain "immediately" bled the patient "to the extent of a quart" and applied a mustard cataplasm to the arm and forearm and the thigh, calf, and sole on the left side, as a stimulant because the left side was devoid of feeling and motor power. The bleeding "apparently" relieved the patient. Mackieson was then sent for at 2, A.M., one hour into the illness. He noticed that the blood taken "exhibited no buff," meaning that there was no layer of white (anti-inflammatory) blood cells on its surface. He also observed that there was no "unusual excitement" in the vascular system, the pulse feeling "small & subdued" and did not "throb." Mackieson's treatment included bathing of the feet in hot water (to soothe), cold water to the head and brow (to calm overactivity within the cranium), a blister between the shoulder blades (as a counterirritant), and calomel, jalap, and croton oil, followed by salts in senna tea (to open the bowels). The diet consisted of gruel. Over the next three days, the patient seemed to regain feeling and power of movement, but the pulse rate was 105 per minute and the face was flushed, so cupping was applied over the occiput. Flushing of the face indicated "symptoms of reaction" and he was bled again, this time until he felt faint and had ringing in the ears. Another blister was applied to the nape of the neck and a diaphoretic, consisting of ipecacuanha powder, spirit of "Aether nitros," and camphor, and purging were continued. His diet now included that sovereign remedy, chicken soup. By day four, however, a friend of the family thought that the patient was not recovering fast enough, and "another practitioner (who had rendered himself inimical to the present attendants) was sent for contrary to our wishes." He

33

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took over the case. However, on day seven the patient died. Mackieson indicated that the patient had been purged "to such a degree that he was in fact fairly Cholerized out of existence."12 This case illustrates several aspects of medical thinking in Mackieson's day. His own observations on pathology recall the ideas of the Scottish physicians William Cullen (1710-1790) and John Brown (17351788).I3 For Cullen, the nervous system was the source of life and excitability of the body tissues was thought important; Mackieson similarly noted the absence of "unusual" vascular excitement in the patient. Brown believed that a disease was either sthenic, or overstimulated, or asthenic, indicating the opposite; Mackieson wrote of "symptoms of reaction," which seems to use the same notion. Their ideas were consonant with the age-old idea of the healthy body being in a state of balance, both in terms of its internal milieu and its external environment. The body was thought to contain four "humours" blood, phlegm, yellow bile, and black bile - which, in health, were in a state of balance that was normal for a particular individual. Also, four external qualities were held important: earth, air, fire, and water. Disease was thought to develop when internal factors such as a person's constitution, gender, or phase in life, or external factors such as locale and climate, so interacted that they put the gyroscope of one's normal balance out of kilter. The humoral concept was reasonable and served physicians for two thousand years; to this day health is thought to depend to some extent on the body's ability to remain in balance with the internal and external environments. There were skeptics, however; James Gregory, an Edinburgh physician, pointed out that "much more than ninety-nine parts in the hundred of all that has been written on the theory and practice of physic for more than 2,000 years is absolutely useless."14 When Mackieson graduated, and for long afterwards, diagnosis was based mainly on the physician's understanding of the responses of a patient's body to the condition producing the illness. Mackieson's techniques were limited to the use of his physical senses, and as the case report indicates, his diagnostic data were obtained from observation of the skin, the pulse, his patient's blood and excreta, and of signs and symptoms that pinpointed the site of disease. The technique of diagnosis when Mackieson graduated is described by Rosenberg:

34

Health and Illness in Nineteenth-Century PEI

Typical case report: Chronic hepatitis, 1836. This case report is shorter than many, but indicates the importance of the history in making the diagnosis and includes mention of a common regimen of quinine and ferrous sulphate (a tonic) and colocynth and a mercury preparation (for the bowels). (Courtesy Medical Society of Prince Edward Island)

The ... physician in 1800 had no diagnostic tools beyond his senses and it is hardly surprising that he would find congenial a framework of explanation which emphasised the importance of intake and outgo, of the significance of perspiration, of pulse, of urination and menstruation, of defecation, of the surface eruptions which might accompany fevers or other internal ills. These were the phenomena which he, as a physician, the patient, and the family could see, evaluate, and scrutinize for clues to the sick individual's fate.15 Means of diagnosis were limited to the physical senses - how the skin looked and felt, how the pulse felt (e.g., rate, hardness or softness, throbbing), the appearance of the blood that was drawn, especially whether or not it was not "buffed" (i.e., whether or not there was an

35

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unusual abundance of white cells in the supernatant layer, which suggested that the condition did or did not have an inflammatory basis), and how the body excreta looked and smelled. Mackieson graduated in 1815, a year that marked not only the end of the war between Britain and France but also the end of a whole system of clinical thinking. Notably, in the following year the French physician, Rene-Theophile-Hyacinthe Laennec, conceived the idea of the stethoscope, the very emblem of modern medicine.16 It became emblematic for two reasons: physicians could now hear the sounds of the lungs and heart to detect internal changes (and to learn about the physics of these sounds), and they came to accept the idea that disease had a solid, or anatomical, basis. As the late Roy Porter picturesquely put it, "bodily organs revealed the footprints of disease."17 With the new thinking came technological advances that led to the introduction into medicine of the microscope (18305), the ophthalmoscope (1851), and the thermometer (1868). It was some years, however, before these devices became part of everyday medical practice. Mackieson first referred to the use of the stethoscope in a case record dated 1842, which he followed up with a reference to it in his "Codex" some twenty years later, though he made no mention of the other instruments.18 (The discovery of X-rays and the invention of the sphygmomanometer came the decade after Mackieson's death.) Making the correct diagnosis was a challenge to Mackieson's ability to solve problems. Diagnosis remained mostly a matter of taking a history from and observing the patient, and making use of his own native intelligence and the experience that he had gained over the years. Mackieson, like other physicians in this era, was also faced with the problem of treating patients with agents that, to a great degree, lacked organ specificity and were directed in a palliative manner at symptoms rather than an actual disease. Options for 'Treatment Two of Mackieson's cases illustrate different aspects of treatment in the nineteenth century. ^ Case 8: Hydrothorax (8 March 1828)

A forty-six-year-old captain in the rifle brigade saw the garrison surgeon, Dr de St Croix, because of headache and stomach discomfort. He was bled and given tonics. 36

Health and Illness in Nineteenth-Century PEI

Mackieson saw him shortly after this. The patient could not breathe while lying flat and he had been troubled with nosebleeds. His pulse rate was 100-108 per minute. Mackieson gave him a tonic of dilute sulphuric acid and quinine, and he ordered a diet of soups, eggs, custards, and jellies. Discomfort around the heart led Mackieson to prescribe digitalis, a cardiotonic, and spirit aetheris nitrosi to enhance the diuretic action of the digitalis. An iron preparation was also prescribed. Though the pulse rate slowed to 76 per minute, the patient's condition failed to improve, and he died ten days after first being seen. An autopsy revealed that the chest contained two quarts (1900 ml) of fluid "in which the lungs seemed to float" and the lungs were "suffused" with serum. The heart and liver were both enlarged.19 This case is of interest for the treatment with digitalis, which was one of the few drugs then available that had an organ-specific rather than a purely symptomatic action. Since its discovery by William Withering in 1775, digitalis was known to enhance the action of the heart, which had clearly failed in this patient. The case also illustrates how diagnosis, after death, was aided by the autopsy, a technique that was found to be increasingly valuable since the latter part of the eighteenth century. A second case illustrates therapy that was given to alleviate symptoms, in the manner of blunderbuss rather than single-shot therapy. Case 251: Phrenitis or Inflammation of the Brain (31 March 1857)

A sixteen-year-old boy had a severe cough for several days and pains in the head. Next day he became speechless. When Mackieson saw him, he was "howling" and extremely restless, needing to be restrained. He did not appear to look flushed and his pulse, which was "not very firm," beat at 80 per minute. Mackieson took "about a quart Bowlful of Blood" from him, noticing that on standing it did not become "sizy" (or buffed). Ice cold water was poured over his head "till the heat was abstracted," cold cloths were also applied to the head, and his hair was cropped. He was given calomel (a mercurial) and jalap to purge the bowels. Later that day he became tranquil and able to speak. The 37

Island Doctor

treatment, including the venesection, was repeated, croton oil being added to the regimen. Further treatment included an enema of salts, muriate of soda, oil of terebinth, and Black draught (a senna preparation). To the treatment was added Seidlitz powder (containing antimony). The patient evidently recovered/0 At the end of the case report, Mackieson remarked that it showed "the benefit of early and energetic Medical treatment," particularly "the vast amelioration of the symptoms which followed free purging." Treatment included the "unholy trinity" of emetics, purgatives, and bloodletting that was a mainstay of treatment in the nineteenth century.ZI The reasons for this therapeutic trinity, with its unpleasant and vigorous side effects, may seem unclear today, but for Mackieson and his contemporaries it had a firm rationale. As Lester King has advised, "if the old procedures and assertions seem absurd, we must not conclude that they were absurd."" The use of bloodletting is an example. As Mackieson's case reports show, it did seem to lead to improvement in some cases, both in the patient's opinion and in Mackieson's. His rationale for bloodletting was quite consistent with that given in contemporary textbooks. Thomas Watson, a leading British authority whom Mackieson referred to in his " Codex, "^ and presumably read, postulated that bloodletting, which countered the adverse effects of plethora in such conditions as pneumonia, reduced the blood flow (or "fuel") to fiery, inflamed sites/4 This must have seemed a reasonable explanation for the value of bloodletting in states of inflammation and in cases of fever. Watson's explanation for the value of other elements of what was known as "heroic medicine" in the treatment of inflammation was not unreasonable/5 For example, most of the therapeutic agents and techniques he described operated by evacuating various bodily products. Mercurial preparations increased the flow of saliva and bile and, in particular, the outflow of the watery contents of the intestines. Jalap did much the same. Antimony and ipecacuanha made patients vomit or perspire, depending on the dose. Senna (including Black draught) and Seidlitz powder evacuated the bowels of their contents. Dover's powder, which contained opium and ipecacuanha, was another sweatinducing agent. James's powder contained antimony, and Plummer's pill, mercury. Turpentine was used in enemas and fomentations, and castor oil, croton oil, magnesium sulphate (as Epsom salts) all purged 38

Health and Illness in Nineteenth-Century PEI

the intestines. As table 3.1 shows, from time to time Mackieson used all these agents. In his "Formulary" he classified these and all the other therapeutic agents and techniques in use in the nineteenth century (see appendix B). What was also known as depletive therapy was vigorous - or, as Mackieson put it, "energetic."16 Its effects on the body could be observed by both patient and physician; it could be seen and felt to work. Opiates (opium, laudanum, and morphine) deadened pain and sedated; hot water, in general and topical baths, calmed and soothed, as did valerian; cold water refreshed and quieted the patient. Hyoscyamus had a sedative, calming effect and relieved spasm, as in colic of the bowels, biliary tract, and ureters. In contrast, quinine and other bitters (e.g., quassia, gentian, and columba) stimulated the body and were used as tonics; dilute sulphuric acid enhanced a tonic action when given with quinine. Ammonium preparations like sal volatile also stimulated. Iron was different; it is the only agent in table 3.1 with nutritive qualities, and often given as a tonic. A third point is that many of the agents Mackieson used had an anti-inflammatory action, which was consistent with the frequency of conditions with an inflammatory basis. He used the "unholy trinity," or "heroic medicine" because of this. Warner has summarized the rationale of such therapy: Ordinarily the system was first cleansed of matter that might impede its functioning. Drawing off excess excitement from the body was not entirely metaphorical, for it was often accomplished by draining fluids thought to stimulate the internal structures. Depletion was brought about by such drugs as cathartics (calomel, corrosive sublimate, jalap), emetics (tartar emetic [an antimonial], ipecacuanha), and counterirritants (blisters), by low diet, and by drawing blood.27

Mackieson, then, was by no means alone in using depletive therapy. As is evident from his manuscripts, particularly the "Codex" and the "Formulary," he was familiar with the teaching, and therefore the practice, of leading authorities of the day, as described in medical journals and textbooks. Writing his own manuscripts meant that he had to keep abreast of accepted practice. His treatment (table 3.1) is similar enough to that of Langstaff to suggest that in this respect, the two physicians' practices were similar.*8 Mackieson, then, was au courant with the medical science of his day. But since, as Shortt19 and Warner30 39

tSLAND DOCTOR

Case report: Bronchocele, 1847. Whether the lesion was a true bronchocele, arising from a branchial cleft, or a lesion of the thyroid gland is not certain. Achievement of a therapeutic blood level of mercury is suggested by the patient's perception of a metallic taste of mercury. Use of iodine might have been consistent with a thyroid lesion. (Courtesy Medical Society of Prince Edward Island)

have pointed out, what is regarded as "science" is always changing, Mackieson may not have been at the cutting edge of medical science. Even so, his reasons for using bloodletting and mercurials were probably sound. He would have used bloodletting because it was thought to lessen the force of the heart's action and to relieve gorged capillaries in the inflamed part; he would have given mercurials because they were thought to redistribute the blood on several surfaces at the same time, and so prevent excessive congestion in any one organ. These were 40

Health and Illness in Nineteenth-Century PEI

hypotheses, but they seemed "scientific" enough to form the basis of good medical practice. I have emphasized the unholy trinity of anti-inflammatory therapy because Mackieson frequently relied on it. He continued to rely on it as late as 1857, more than twenty years after Louis in France had first cast doubt on its value.31 However, once there seemed to be a good reason not to use it, he eschewed its use. Thus in case no. 8, in which there was no evidence for an inflammatory basis, he opted for digitalis, which had an organ-specific action. Mackieson's wide knowledge of drugs and physical agents is evident in his "Formulary," in which he described no fewer than fifty-nine classes of therapeutic agents and listed thousands of prescriptions drawn from contemporary authorities (see appendix B). He was thus quite capable of selecting drugs that seemed appropriate for a particular patient. When no treatment was likely to be of value for a patient with, for example, diabetes or acute hydrocephalus, he was ready to ensure that any "toxic" matter in the body was excreted and to comfort the patient as best he could. There were two other therapeutic options in the nineteenth century. One was to abstain from depletive therapy, on the basis that the cure was worse than the disease. Mackieson was well aware that many of the effects of depletive therapy were unpleasant. In 1827 he himself had taken chamomile flowers and never forgot the nauseating effect;3* and the "Sketches" indicate that he never gave it to any of his patients. He knew also that mercurial preparations produced, for example, soreness of the gums, which George Coles, Mackieson's most famous patient, complained about so bitterly33 (see also chapter 6). In many diseases illness was, as a natural state of affairs, followed by recovery, and treatment would not be expected to modify the course of the illness. However, most patients expected their doctor to do something for them, and most physicians found it difficult to do nothing. The other option was to look more closely at the value of the treatment. Although, Mackieson had a questioning mind, as the remarks he added to some of his case reports show, he did not actually test his beliefs and questions in any objective way. He never compared the results of bloodletting, for example, in one group of patients with a control group. His approach was empirical, rather than dogmatic. He did what the eighteenth-century Edinburgh physician Andrew Duncan taught: "physicians must base their treatments on their observations of their patients' responses to therapy."34 Mackieson practised in a way that he thought would help his patients best. 41

Island Doctor

The fact that Mackieson used bloodletting, at least until 1857, does not mean that he was unduly conservative. He was quite ready to administer drugs that were relatively new. For example, he gave ergot, which had been used in Canada first in i8z6, 35 as early as i837 36 (see chapter 5). He used chloral hydrate, which had been reported to have sedative properties in i869,37 as early as 1871, when he treated George Coles.38 These might, however, have been exceptions in a doctor who tended to be conservative; it is not surprising to find that his treatment of ascites in i8z5 39 and thirty years later were similar,40 as was his treatment of nephritis in i835 41 an 60-2, 69, 70, 76, 79-81, 84-6, 97, 124; in James Langstaff's practice, 31 debilitantia, 135 delirium tremens, 108 delivery by the art, 81 demulcents, 135 deobstruentia, 136 depletive therapy. See heroic medicine depression, 88, no depurantia, 136 derivativa, 136 de St Croix, Benjamin, 33, 36, 59, 62, 80, 86, I48n55 diabetes mellitus, 29, 31, 41 diagnosis: Mackieson and, xii, xiv, xx, xxiv, 26, 27, 29, 30-6, 57, 70, 72, 78; medical cases, 29; obstetric, as complications, 78; psychiatric, 109; surgical, 57; technique of in i9th century, 26, 34 diary. See Mackieson, manuscripts diet: in therapy, 26, 33, 37, 124, 125 digestive, 137 digitalis, 37, 41, 136, 137 diphtheria, 43 179

Index century, 29, 30 Fitzroy Street, 22 folk medicine, 23, 51 fomentations, 27, 38, 134, 136 forceps, 68, 72, 77, 78, 79, 80, 85 "Formulary." See Mackieson, manuscripts Fort George, n fractures, 57, 62-5 France: care of mental illness, 92, 93, 102; war with Great Britain,

dipsomania. See alcoholism discutantia, 137 disease: concept of, xxii, 34; in Prince Edward Island, 2.5-54. See also specific disease diuretics, 136 Dr Pierce's Pleasant Purgative Pellets, 51 Dover's powder, 26, 27, 38, 136; See ipecacuanha, opium, opiates drugs, sale of, 15 dysentery, 29, 47, 48, 49 dystocia, 68-70, 77, 78-81

3, 6> 36, 56 Friends' Asylum, Philadelphia, 93 fumigants, 137

eclampsia, 78-9, 84-5 eclectics, 51 electricity, 138 embrocations, 134, 136 emetics, 38, 39, 44, 132, 134, 135 emollients, 135 emplastra, 134 enemas, 27, 38, 59, 123, 134, 137 Enlightenment, 92; Scottish, 3, 118 epilepsy, no, 134 epispastica, 134 Epsom salts, 38, 131 ergot, xxiv, 41, 72, 80, 85, 121 erysipelas, 29, 30, 31, 43 Esquirol, Jean Etienne Dominique, 92, 93, 102 ether, 10, 66, 123 Executive Council, 45, 48, 50 expectorants, 137

gangrene, 29, 64-5 gastrointestinal system disorders,

2-9, 30, 43 gentian, 39, 134, 135, 138 Gidley, Richard, 113, 114 Gladesville Asylum, Australia, 115 Glasgow, 9; Faculty of Physicians and Surgeons of the City of, 4, 33; lunatic asylum, 99, 114; Royal Infirmary, 4; University, xix, 3, 4, 72, 99 gravel. See stone, urinary Great Britain: care of mental illness in, 92, 93, 102; war with France, 3, 6, 36, 56 Grigg, William, 19 Groenvelt, Joannes, xix, xxvi, 120 guiacum, 131 haemoptyis, 31 Hardy, Mrs Thomas, 5 8 Harris, Sarah, 51, 52, 73, 74 Hartford Retreat, 93 Haviland, Thomas Heath, 48 healers, lay. See lay healers

Falconwood, 13; Falconwood Farm, 112; Falconwood Hospital, 104 Family Compact, xxi, 15, 140^0 fees: doctors', 52, 74; midwives', 74 fever, as primary diagnosis in i9th 180

Index hygiene, in obstetrics, 71, 76 hyoscine, 107, no, 133, 138 hyoscyamus, 25, 27, 39, 138 hysteria, 29, 134

health and illness: in PEI, 2,5-54 health care: in PEI, 42-50; role of laity, 49-50, 51-4; role of physicians, 51-4. See also Prince Edward Island, medicine in i9th century heart disease, 31, 37. See also cardiovascular system disorders heat, 27, 61, 138 hemiplegia. See stroke hemorrhage, uterine, xii, xiv, 82, 83,84 hepatitis, 29, 30, 31, 35, 123, 133 hernia, xiii, xxii, 15, 55-60, 121 heroic medicine, 38, 39, 41, 52. See also bloodletting, emetics, purgatives Hillsborough Street, 22 Hippocratic Oath, 121, i62n4 history of medicine, value of, xx, 123 Hobkirk, Dr William Henry, 47, 48, I48n55 homeopathy, 51 Hooper's pills, 129 House of Assembly. See Legislative Assembly House of Industry, Charlottetown, 96 humanism, in mental treatment,

ice, as therapy, 27 illness, in Prince Edward Island, ^5-54 immigration, xxv, 6 incomes, physicians': in Nova Scotia, 19-20; in Ontario, 21; in PEI, 19 infant mortality, 70, 78, 79, 81, 83. See also obstetrics infectious disease(s). See communicable disease(s) inflammation, 30, 33, 37-41 innovations in therapy, Mackieson's, xxiii, xxiv, 41, 42, 121 iodine, 134, 136 ipecacuanha, 25-7, 38, 39, 117, 125, 132, 135-8 Irish Famine, 47 Irish immigrants, 44, 45, 47, 96, 118 iron, 27, 35, 37, 39, 107, in, 131, 134,135 irregular practitioners, xxii, 23, 42, 5*> 52., 53, 12-2. irresistible impulse, 108 isinglass jelly, 84 Islander, The, 58 Italy, 127; moral treatment in, 175

101

humours, 34 Hunter, William, 72, 77 Huntley, Henry de Vere, Sir, 46, 47,49 hydramnios, 79 hydrocephalus, acute, 29, 30, 31,

jail: Mackieson as medical attendant to, n, 20, 23 jalap, 27, 30, 33, 37-9, 105, in,

4i

hydrochloric acid, 134 hydrothorax, 29, 36-7

13^ i35 James's powder, 38, 45. See also antimony 181

Index linseed oil, 60, 62 liver disease. See hepatitis Liverpool, 4, 5, 6, 9, 46 lotions, 134, 135, 137 Louis, Pierre-Charles-Alexandre, 41, 121 "lunacy reform," 93 lunatic asylum(s): care of mentally ill, 92, 93; decline of, 93, 94; in 19th century, 88, 90, 122; problems in 93-4, 122; in Australia, 115; in Canada 88, 90,93,99, ioo, 102, 115; in Europe, 90, 92, 93; in Great Britain 90, 92, 93; Ontario, 90, 93, 115; New Brunswick, 88, 90, 93, 115; Nova Scotia 90, 93, 115; in USA, 90, 92, 93 lunatics, expenditure for care of in PEI, 94

Jardine, Dr, 5 5 Johnson, Dr, 57 Kelly, Dr, 26, 44, 65 Keppoch, 7 kidney disease. See nephritis, urinary stone Kilsyth, 3 King Street, 15 kino, 134 Kirk of St James, 17, 18, 95 Korsakoff syndrome, no Ladies' Benevolent Society, 17 Lady Constable affair, xxv, 44-50, 52,96, 118, 119 Laennec, Rene-TheophileHyacinthe: invention of stethoscope, xxiv, 36, 141^3 Langstaff, James: daybooks, xviii, xix, 78; compared to Mackieson's casebooks, xviii, xix, 27, z8, 30; deaths in cases, compared to Mackieson, 31; income, 21, 53; medical practice compared to Mackieson's, xviii,

Mackay, Robert, 55, 56, 58 Mackieson, Amelia, 17, 19 Mackieson, Augustus, 17, 18, 19 Mackieson, John: arrival in PEI, 16; birth, 3, 127; career, xxv, 19, 22, 44, 98, 118; clinical practice, xxvi, 28, 121, 131; competition from other physicians, xxii, 51, 52; conservatism of, xxii, xxiv, 42, 77, 121; as country licentiate, 4; death of, 24, 128; as doctor, xxiv, xxv, xxiii, xvi, 15, 19, 22,41, 73, 77, 117-19, 121, 123-6; as doyen of profession, 22, 23, 118; education, 3-5, 42, 56, 114, 118, 131; family life, 3, 16, 17, 18; as health officer, xxii, 12; illness of, xiv, xxv, 44-45;

2-7, 31, 39, 73, 78, 12.2; property, 21 laudanum. See opium, opiates lay healers, xxii, 28, 31, 42, 51, 54, 122 lead acetate, 137 Legislative Assembly of Prince Edward Island, 12, 13, 20, 23, 53,94,98,100,112 licensing of physicians, xxii, 23, 42, 53, 54, i*2lime water, 60 Lindsay, William, xix, 57 liniments, 27, 86, 134, 137 182

Index Medical Association of Prince Edward Island, xxii, 53, 118, i47-8n55 medical care, i9th century: lack of access in PEI, 70, 74, 76, 122. See also health care medical literature, xvi medical profession: competition from nonphysicians, 51, 52; England, structure in 4; "free trade" in medicine, 54; inadequate training, 45, 51, 52, 5 3. See also physicians medical schools in i9th century, 52,

income 19, 21, 21; marriage, xxi, 15; medical practice 28, 41, 121, 122; poetry of, 7, 8, 18; and politics, xxi, 12; as port health officer, xvi, xxi, xxv, n, 22, 44, 46, 49, 118; property of, 15, 21, 22; religious faith, 6, 17, 118; social life/position, xxi, xxvi, 9-2,4, 2.7-8, 61, 118; as surgeon-general to militia, n, 20, 23

- manuscripts: "Codex," xvi, xvii, xviii, 28, 36, 54, 86, 121, 122; diary, xvi, n, 13, 14, 16, 58; "Formulary," xvi, xix, xxiii, 28,

53, 54 medicine, in i8th century, xxii, 34, 42, 92; in 19th century, xx, xxii, xxiii, xxv, 26, 28, 34, 52, 57, 69, 78, 88, 90, 93, 103, 117, 121-3 melancholia, 108, 109 mental illness, xvi, xxi, 88-116; asylum care of, 90, 92, 93, 94; causes, 103, 105; diagnosis, 108-12; medical treatment and, 104-7; moral architecture and, 98-101; moral treatment and, 92, 97, 101-4; recovery from, 97, 107; restraints, use of, 104, 106, 112; treatment in i8th century, 92; in i9th century, 90,

39,41,42., 54, 12.2., 12.3, 129-38; "Record of Cases of Insanity," 90, 91; "Sketches of Medical and Surgical Cases," xiv, xv, xix, xxiii, 7, 28, 30, 41, 44, 54-6, 58, 66, 69, 108, 121, 133 Mackieson, Leila, 17, 19 Mackieson, Matilda, xxi, 14, 15, 16, 17, 19, 131 Mackieson, Wallace, 17, 18 McLean Hospital, Boston, 93 madeira wine, 84 magnesium sulphate, 30, 38 malaria, 29, 30 malpresentation, 79 mania, 105-6, 108-12 Market Square. See Queen Square masturbation, 103, 112 materia medica. See therapeutics maternal mortality, 69-70, 78, 79, 81, 83, 85, 87. See also obstetrics maternity. See obstetrics measles, 43, 47, 48, 49

97 mental retardation, 108 mercurial preparations, 26, 27, 30, 33, 35, 37-41, 44, 89, in, 117, 123, 131, 132-3, 135, 136, 138 miasma, 43 microhistory, xviii micro-organisms: as cause of disease, 79 183

Index and, 72-6; mortality, in i9th century, 69-70, 78-81, 84, 85. See also pregnancy Oldfield, Mrs (midwife), 51, 73,

midwifery: debate on, 72-3; in PEI, 73-8. See also obstetrics midwives, xx, 42, 51, 52, 82; fees of, 74; and Mackieson, xiii, xiv, xv, xx, 15, 70, 74-6, 78, 82, 84; perceived shortcomings of, 74-6 mimosa, 134 monomania melancholia, 88, 109,

74, ?6 Opium, opiates, xiii, xiv, 26, 27,

38, 39,44, 61, 66, 69, 72, 75, 76, 82, 107, 123-5, !32-, 133, 135-8 organic brain syndrome, 108 Osier, William, Sir, xviii, xxiv

in

monopoly, medical, 53 moral architecture, 98-101 moral insanity, 106, 107-9 moral treatment, 92, 97, 101-4 morphine. See opium, opiates mortality, infant, 68, 70, 76, 80, 81, 84; maternal, 78, 79, 81; perinatal, 78-81 multiple sclerosis, 31 mustard, 33, 85

Palmer, Edward, 14 palpitations, 29, 134 patent medicines, 51 patients, named in Mackieson's records. See Acorn, Joseph; Burns, John; Coles, George; Crisp, Mr; Hardy, Mrs Thomas; McKay, Robert; Pladwell, Mr; Proctor, Mrs patient-physician relationship, 123; Mackieson's, xxiv, xxv, 26, 27, 32-42, 117 pepper, 135 peppermint, 135, 136 perinatal mortality, 141, 144, 145, 78, 81. See also obstetrics, mortality personality disorder, 108, no pertussis, 31 pharmacy, 4, 129, 130. See also therapeutics phlebotomy. See bloodletting phrenitis, 29 physicians: competition from others, xxii, 51, 52; incomes, 19-21; irregular, xxii, 23, 42, 51-3, 122; professionalization, 24, 28, 122; shortage of, 74

negus, 62 nephritis, 42, 124 New Brunswick: asylums, 93, 115; medical licensing act, 53 New Glasgow, 19 New York Life Insurance Co., 20 nicotine enema, 55 North Rustico, 74 Northumberland Strait, 7 Nova Scotia: asylums, 90, 93, 115; medical licensing act, 53; Medical Society, 52; midwives' training, 74; nurses, 42, 58 obstetrics, xiii, xiv, xxv, xviii, 68-87, I55n9; conditions of, 128, 129; emergencies in, 76; Mackieson as obstetrician, xii, xiv, xv, 15, 70, 71-8; midwives

184

Index Proctor, Mrs, xii, xiv professionalization in medicine, xxi, xxii, xxvi, 23, 24, 28, 53, 118, 122 Province House, 12, 95 Provincial Asylum, Toronto, 102 psychiatric cases, Mackieson's, 89-91, 105-7, 110-21 psychopathic personality, 108 psychosis, postpartum, 78 public, views on: illness, 28; lay healers, 28; medical care, 52, 53; role of citizens, 49-50 public health, xvi, 9, 43-9, 50, 121; legislation, in i9th century, xvi, 9; in Prince Edward Island, 43-50 puerperal fever, 68-9, 78, 85-7 puerperal mania, 183 purgatives, 29, 30, 33, 38, 44, 85, 107, 134, 135, 137, 138

Pinel, Philippe, 92, 102 placenta previa, xiv, 78, 79, 81-4 Pladwell, Mr, xiii plaster, mustard, 33,85 plasters, 134, 137 pleuritis, 29, 31 Plummer's pill, 38. See also mercurial preparations pneumonia, xxiv, 25-6, 31, 38; treatment advocated by Osier, xxiv Poole, Charles, 61 population: of Charlottetown, 9, 10; of Prince Edward Island, 10, 15 port wine, 82, 133 postpartum coma/depression, 108; scarlatina, 78. See also puerperal mania potassium preparations, 131, 136, 138 poultice, 63, 86, 134, 137 practitioners, irregular, xxii, 42, 51, 122 pregnancy, fear of, 69. See also obstetrics prematurity, 79 premenstrual syndrome, no Prince Edward Island: Family Compact, xxi; history 6; immigration, xxi; Legislative Assembly, 12, 33, 94, 95, 100, 112; licensing of physicians, xxii, 28, 42, 53, 54, 122; medicine in i9th century, xx, 25-54, 57, 118, 123; midwifery in, 73-8; pioneer life in, 58-9; population, 10, 15; public health, 83-98; Responsible Government, xxii, 12; sociopolitical changes, xxi

quacks, xxii, 28, 31, 42, 51, 52 quarantine, 46, 48, 118 quassia, 27, 39, 125, 135 Queen Square, n, 12, 13, 95 Queen's Wharf, 46, 48 quinine, 27, 35, 37, 39, 45, 105, 107, 133, 134, 135, 137 raspberry vinegar, 51 "Record of Cases of Insanity."See Mackieson, manuscripts Relief, 6, 14, 127 respiratory system disorders, 29-30 Responsible Government, xxii, 12 rheumatic fever, 29, 43 rheumatism, 29, 134 Royal Gazette, The, 61, 129 rubefacients, 134, 136 185

Index streptococcal infection, 31 stroke, 27, 29-34 sulphuric acid, 27, 37, 39, 105, 107, 132-5, 138 sulphur preparations, 133, 134 surgery: Mackieson and, xiii, xiv, xv, ii, 15, 20, 23, 55-67; in i9th century, 9, 55-7, 58-62 suppositories, 137 Swabey, William, 98, 100 syncope, no syphilis, 29, no

St Eleanor's, 50, 124 St John's Island. See Prince Edward Island St Peter's, 5 5 salts, 27, 33, 38 sal volatile, 39, 123 sarsaparilla, 125, 131, 132, 136 scalds. See burns and scalds scarlatina, 43, 78 schizophrenia, paranoid, 108 science, i9th century medical, 39-40 Scotland, 3-7; emigration from, 3 5 scrofula, mesenteric, 29, 30 sedatives, 138 Seidlitz powder, 27, 30, 38, 45, 129, 131. See also antimony tartrate senna, 27, 33, 38, 85, 105 Ship Inn, 14 sinapsism. See plasters "Sketches of Medical and Surgical Cases." See Mackieson, manuscripts smallpox, xvi, 20, 29, 30, 43-5, 122 Smellie, William, 72, 77 Snow, John, 43 soda, 38, 55, 124, 125, 131, 136 sodium preparations, 136 sore throat, 31 specialization in medicine, xvi, 121 squill, 25, 27, 136, 137 Stanhope Cove, 6 steel, 107. See also iron stethoscope, xxiii, xxiv, 36, 141^43 sthenic disorders, 34 Stirling, 3, 4 stone, urinary, 29, 125, 133

tartar, cream of, 60 tartar emetic, 39. See also antimony preparations taxis, xi, xiii, 55, 59 tea, 136 tetanus, 29, 134 therapeutics, xvi, 26, 27, 41, 129-38. See also treatment tonics, 37, 133, 134, 135, 137 Toronto Hospital for the Insane, 90 traitement moral. See moral treatment transverse lie, 75. See also obstetrics treatment, in Mackieson's cases: medical, 25-6, 27, 30, 33-8, 40, 42; in i9th century, 38-9, 41, 79, 90, 92-4, 101-3; obstetric, 68-9, 75-7, 80-6; psychiatric, 105-7, 110-12; surgical, 55-66 Tremain, Lawrence, Dr, 68, 85-6, 119, 120, I48n55 tristomania, 109, 111-12 tuberculosis, 26, 29, 31 Tuke, Samuel, 102, 105 Tuke, William, 92, 102 tumours 57 65-6

186

Index valerian, 39, 134 venesection. See bloodletting version, xiv, 68-9, 79, 80-4

turning. See version turpentine, 27, 38, 62, 125, 134,

!35> 138 twins, 75-6 Tyne Valley, 19 typhoid, 43, 44 typhus, xvi, 43, 44-50, 87-98,

water: cold, in treatment, 27, 30, 33, 37, 39, 63, 84; hot, in treatment, 27, 30, 33, 39, 62, 118; pollution 'of, 9, 43; potable, 44, 65; running, 9 whooping cough. See pertussis wine, 45, 134, 137 Woolverton, Jonathan, 122 Worcester State Hospital, 94, 108 Wright, George, 95

I l 8 , 122

USA: care of mental illness, 90,

92-, 93 University of Glasgow. See Glasgow University urinary tract disorders, 29, 57, 125, !33> 134 uterus: hemorrhage from, xiii, xiv, 82, 83, 84; inversion 74-5, 78 uva ursi, 125

yeast, poultice, 63, 133 York Retreat, 92, 105 zinc oxide, 137

187