Histoire du Service de sante de la ville de Montreal, 1865-1975 (review)

In their history of Montreal's health department, two noted public health experts and a prominent medical historian demonstrate the benefits of cross-cultural collaboration. Building on their previous studies of the development of public health activities in nineteenth- and twentieth-century Quebec, the authors present a detailed analysis of the genesis and development of public health services in Canada's leading Francophone city, from their formal establishment to the dismantling of the department in 1975. Drawing on the existing but limited British, American, and Canadian historiography of urban public health, they have produced a chronological examination of the way that local circumstances, politics, and public attitudes interacted with provincial policy and international developments to create Montreal's public health services and programs. Quite correctly they note that although Montreal's department was the earliest, its English-speaking counterpart—Toronto—is much better known and more widely accepted as the leader in Canadian public health circles. They query why Montreal's history is not better known, and also focus attention on its place within the North American context. Their key question, however, is why the local populace did not oppose the provincial initiative to unite preventive and curative work in a single entity at the beginning of the 1970s. Politics, changing ideologies, and apathy made Montreal a marked contrast to Toronto in this regard.

By using the careers of the four medical officers who adapted American and European public health theory and practice to Montreal's needs, the authors demonstrate in great detail the multiple phases in that process. Under Alphonse Barnabé Larocque, who held office from 1865 to the smallpox epidemic of 1885, the fledgling department focused attention on sanitation and disease control in spite of municipal parsimony. After Larocque's dismissal for strongly supporting compulsory vaccination in spite of sustained public opposition, his successor, Louis Laberge, served from 1885 to 1913 and oversaw the transformation of the department into the Bureau of Hygiene and Statistics. This meant that Montreal, like other major North American cities, developed contagious-disease inspectors and policies as well as purpose-built isolation facilities and a municipal laboratory. Early in the twentieth century, school medical inspection, milk depots, and well baby clinics were established through the support of voluntary groups and the Bureau, but the continuation of municipal patronage and the corruption of some inspectors left Laberge's successor with much to change.

A scathing review of the Bureau's structure and activities by the New York Bureau of Municipal Research in 1918 enabled Séraphin Boucher, the city's MOH from 1913 to 1937, to reorganize his rapidly growing and professionalizing staff into new divisions and to rename his organization. Drawing heavily on the American Public Health Association for both review committees and standards, the Service de santé reflected North American norms and the interwar focus on maternal and child health services and educational programs. For Adelard Groulx, the MOH from 1937 to 1964, maintaining high-quality services during World War II and reorganizing the various divisions to deal with new health needs in the postwar period were the dominant concerns. But as the authors note, the same reliance on traditional administrative procedures that was the hallmark of North American municipal health departments in the turbulent 1960s left Montreal's Service de santé vulnerable to external pressures.

In an important final chapter, the complex story of the destruction of Montreal's Health Department is recounted. As part of the extensive social and political restructuring of Quebec that occurred during the 1960s, the provincial government appointed a commission to examine health services. The commissioners were...