Surgeons, Smallpox, and the Poor: A History of Medicine and Social Conditions in Nova Scotia, 1749–1799 by Allan Everett Marble (review)

44z The CanadianHistoricalReview rethinkherestimate of •5oomendeparting withCartierin •54•. If she hadconsulted BruceTrigger'sseminal workon Canada's heroicage, shewouldknowthatthecustom ofexchanging younghostages wasnot something imposed on Nativepeoples by CartierandChamplain but itself an American custom. In theend,the meritsof thenarrative areundermined byinterpretive weaknesses as well. In terms of the big picture,the important advance in sixteenth-century nauticaltechnique wasnot somuchthat ships werecapable of crossing theAtlantic butthattheycould reliably returnwithin a season. The RoyalNavywasnot supreme at seaafter •588, nor was it so until afterthe defeatof the Dutchin •674. On morerestricted issues, thereisverylimitedevidence of an earlyEuropean fur trade in Newfoundland and no evidence of a seventeenthcenturyfisheryin HudsonBay.Finally,it is anachronistic to suggest that peas,biscuit,saltmeat,and soon are inappropriately perishable for useat sea:theywerestandard seavictuals precisely because they were,for centuries, theleastperishable foodsavailable. Therearepassages of interest in Litalien's survey - forexample, on theportof SaintMalo,onChamplain, andon Pacific coast exploration, aswellasmapsanddocumentary extracts. Although it will notbecome oneof thewell-thumbed workson theshelves of scholars workingon the period,it wouldmakea nicegift for a youngpersonstudying French Canada. PETER POPE MemorialUniversity ofNewfoundland Surgeons, Smallpox, andthePoor: A Histo• ofMedicine andSocial Conditions in NovaScotia, •749-•799Arra• EVERErr lYeARetE. Montrealand Kingston: McGill-Queen's University Presst993. PP.xvi,356,illus. $39.95 In diligently combining newspaper andotherprimedsources with a wealth of manuscriptmaterial (from archivesin Canada,France, Ireland,the United Kingdom, the UnitedStates), Marbleprovides a fine resource volume. It reflects and contributes to the current interest in medicineand healthcarein the eighteenth century.Indeed,the century isemerging fromitsonce cinderella position in medical history - wedded between theglamorous seventeenth andnineteenth centuries - to assert a vigorous ratherthana passive contribution to thefield. Because ofthischanging role,anyeighteenth-century specialist faces a challenge in organizing a broadaccount. Marblepresents an essentially chronological storyin hisfivechapters from 'Arrival, Settlement,and an Initial Concernfor Health Care, BookReviews443 x749(o.s.)- x753(n.s.)'to 'HealthCareandPoorReliefat the Endof the Centuryx784-x799.'He places muchemphasis on numbers(and names)of medical personnel: militaryandnaval(somucha partof Halifax'shistory),civilian,and Loyalists who arrivedfollowingthe outcome of theAmerican War of Independence. Marble'sattention to practitioners, along with, for instance,accountsof often limited hospital facilities andreference toaverage lifespan (approximately fortynine for Nova Scotians in the last twentyyearsof the eighteenth century compared withseventy-five for•98•), frameswhatseems tobe Marble'smain 'thesis': thatnumbersof qualifiedsurgeons andphysicians , as well as the nature of medical facilities, correlate with appropriate standards of health(admittedly givena sufficiently sound economy). ThusMarblewrites:'In x783, forthefirsttimein thehistory of Nova Scotia,there was a sufficient number of well-trained doctorsin thecolony. At thesametime,however, therewasnocivilianhospital ... and manyof the inhabitants of NovaScotia, old and new,couldnot affordto paymedicalattendance. An adequate levelof healthcarehad yetto beachieved' (x44). It is a truism to saythat the healthof any communityin the eighteenth century(as at any time) is shapedby sociocultural and medicalfactors.Marblegivesa senseof someof these,particularly epidemics suchas smallpox and the effortsto controlthe disease throughinoculation. Unfortunately, heisunableto offermuchinsight intohowindividualpatients facedandcoped with the uncertainties of healthandillness. Somesense ofthisattitude mighthavebeengiven withampletdiscussion of,say,inoculation - including thenewspaper advertisements for it (notedby Marble)andits variableeffectiveness. The author,too,mighthavediscussed various aspects of therapeutics in the context of the longlistsof imported medicines (givenin the book)andtheirrolein healthcare.Evenwiththegapsandlimitations in the available datafor NovaScotia, secondary writingscouldhave beencalleduponmorereadily,albeitwith circumspection, to 'round out'the story. These comments are not raisedas criticism of Marble's work, but to ask whetherhis task has been poorlyservedby a chronological approach,since it leadsto a fragmentation of themes. For this reviewer, theapproach almost predetermines aWhiggish interpretation of progress. That is notto saythatsucha focuson medicalimprovements ,asonsocial conditions, isnotcentral tothestoryofhealthcare, but it tendsto hide the richness of the eighteenth-century medical enterprise. At itscorewerestruggles for a conceptual framework amid emphasison empiricismand new trendsin clinicalcare. Marble's 444 TheCanadian Historical Review book,asgood localhistory oftendoes, contributes skeletal material for this context. l.•C. cu•rr• Memorial Universit 3,ofNewfoundland Lacroix etlescaipd: Histoire des Augustines etdeI'Hbtel-Dieu deQuebec, tome2:•892-•989. raA•qotSUOUSSSAU. Sillery, Qu&:LesEditions du Septentrion x994.Pp.492, illus.$35.00 Le second tome de l'histoiredesAugustines et de l'H6tel-Dieude Quebecde Francois Rousseau ne d&evrapasceuxqui ont eu l'occasiond 'appr•cier le premier:il s'agitlh d'un ouvrage tr•s bien •crit, fond• sur une documentation riche et fort bien exploit•eet d'une grande finesse...