Sante et societe au Quebec: XIXe-XXe siecle

Peter Keating and Othmar Keel have collected in this volume eight previously published articles by various authors on the history of public health in the province of Quebec. The pieces initially appeared in various periodicals—and in the case of three of them, even in other edited volumes—between 1979 and 1983, so the research presented here can hardly be considered new. However, the editors have done a service to historians of Canadian medicine and public health by assembling these articles, and by adding to them a lengthy historiographic review essay. The result is a volume whose impressive breadth of scope makes up for its lack of originality.

Not only do the essays collected here cover a full century and a half—from the 1820s to the 1970s—but they also collectively construe “health and society,” the core of the book’s surprisingly broad title, quite broadly indeed. Demography, epidemiology, therapeutics, preventive medicine, professionalization, industrialization, religion, and politics all take their place in these pages. The editors’ ambition seems to be to capture medicine’s profound embeddedness in modern society, from the sinews of political and economic power structures to the texture of each citizen’s everyday life.

In this lofty and laudable enterprise, they succeed—in part. The book is at its strongest when the authors focus on multiple, interconnecting historical developments that have shaped (and in turn been shaped by) health and disease. This approach tends to work best when the chronological, geographic, and/or institutional boundaries of study are narrowed. For example, Michael Farley, Othmar Keel, and Camille Limoges limit themselves to the administrative apparatus of public health policy in the city of Montreal during a twenty-year period, 1865–85. Significantly, this was not a period noteworthy for either medical advances or epidemiological calamities. The result is a subtle, detailed picture of a time of political mobilization and professional legitimization in the area of public health, a time that saw the necessary groundwork laid for later, more dramatic episodes of state intervention and control.

Similarly, Keel and Peter Keating zero in on the brief life of the Journal de Médecine de Québec/Quebec Medical Journal in 1826–27 in order to examine in detail the early stages of “medicalization” and professionalization in the province. Among other things, this fascinating blend of intellectual and political history refutes the too-simple characterization of Francophone physicans as progressive and Anglophones as conservative in the early nineteenth century.

The essays are weaker when they accord absolute primacy to a single causal or explanatory factor, or eschew interpretation in favor of simple quantitative analysis. For example, Louise Dechêne and Jean-Claude Robert devote their entire essay to an exhaustive statistical breakdown of the morbidity, mortality, and demographic consequences of the 1832 cholera epidemic, only to conclude (or at least imply) in their final paragraph that the true importance of the crisis was cultural and political in nature, as rumors of conspiracy reinforced resentment among the poor toward the British and toward local elites.

Martin Tétreault, in his survey of the principal causes of death in Montreal between 1880 and 1914, defines tuberculosis, smallpox, diphtheria, typhoid fever, and infantile diarrhea as “diseases of poverty,” and concludes that poverty was the crucial factor in the city’s differential rates of disease and death during that period. This is hardly a novel conclusion, and at a very basic level the assertion is quite true. However, to identify poverty as the culprit and to stop there begs many questions, and scarcely begins to elucidate the patterns and meanings of health and illness at the turn of the century. For example, Tétreault tells of an investigation by the College of Physicians into the death of a baby following a smallpox vaccination. The vaccinating physician was asked about the baby’s diet, and reported that because the parents were poor, the baby ate what...