Author Tags: 1850-1900 Physician Author


Articles: 1 Article for this author

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A sample review from BC STUDIES.

From Shaman to Modern Medicine. A Century of the Healing Arts in British Columbia, by T. F. Rose, M.D., Vancouver: Mitchell Press, 1972. $7.50.

Strong Medicine: History of Healing on the Northwest Coast, by Robert E. McKechnie II, M.D., Vancouver: J. J. Douglas Ltd., 1972. $8.95.

The historical development of medical practice is an important part of the social history of British Columbia, as of any community, since everyone in that history-from the autochthonous Indian to the citizen of the welfare state - has been vitally concerned with his health and with his social and institutional relationships with the guardian of that health - the shaman - priest-surgeon - physician - general practitioner - specialist-medical entrepreneur. The historical continuity of these relationships, which the authors of both the books under review note, provides a convenient framework for such a history. But, as with the history of any general topic placed in a local context, there are fundamental problems of narrative structure. The historian will tend to emphasize, either the general background of the topic - in which case his account will appear disjointed and irrelevant to the local scene -; or the parish-pump details of which most of his source consist, - in which case his narrative will seem disjointed and unduly chatty and parochial. Unfortunately both books suffer from this hazard in varying degrees; both lose sight of the central theme which they have identified and range well beyond the permissable limits of irrelevance ; but both, also, in various ways, provide interesting and useful insights into the relationships between medical practice and the communities of British Columbia.
Here the similarities end, for the approaches of the two doctor-historians diflFer widely. For Dr. Rose, the really significant fact is that in British Columbia "modern medicine began with the third decade of this century." His narrative strongly justifies the present (while warning about future dangers to be expected from present trends, such as too-free prescription of "wonder drugs" and too much cosseting of hypochondriacs), and is uneven in the treatment of the past.
Dr. Rose is at his best as an iconoclast. He gives a clear, informative interpretation of pioneer medical practice as crude but adequate to the demands of a rough age, and explains the technical details of Dr. Helm-cken's practice - both preferable to the customary hagiography. Similarly Dr. Rose records a salutary reminder that the first scientific innovations in medicine gave surgeons the means of undertaking all sorts of dangerous and unnecessary operations, physicians the incentive to prescribe dangerous drugs, and amateur anaesthetists the means and the opportunity to help the surgeons kill off exiguous patients. Concerning his other great interest - the relations of the profession with the public and especially government - Dr. Rose is informative and vigorously advocative on the organization of the profession (to regulate the profession and promote public health, not merely to resist medicare), public health, the Workmen's Compensation Board, hospital insurance and pre-paid medicine. He is especially incisive in his analysis of the economic relationships between doctors and their patients, from contract doctoring in company towns to free enterprise fee-levying to hospital insurance and pre-paid medicine, removing the veil of mystery which customarily has surrounded this important question. On such topics as nursing, hospitals, paramilitary medicine, the history of tuberculosis, cancer and mental health and medical education, on the other hand, Dr. Rose either contents himself with a synoptic catalogue of developments, or is wildly confused and anecdotal. The book is vividly written (e.g. his description of anaesthesia in the pioneering age : "When the surgeon was ready to operate, it seems that the fellow leaning against the wall with apparently nothing on his mind was given the chloroform bottle and invited to pour") and has a force and breadth of interest that largely make up for its disjointed presentation.

Dr. McKechnie's book is a less ambitious, less informative and less useful work, but a much tidier and, within its limits, possibly a more reliable one. Where Dr. Rose firmly commits himself to the present, Dr. Mc-Kechnie expresses his enthusiasm for the remote past, in an account of shamanistic medicine among the Indians, and for the heroic period of pioneering medicine, which he sees as extending in diminishing scale from the giant labours of Dr. Helmcken to the 1920's. The best parts of the book are the first section on Indian medicine, which is well constructed, well written and extremely informative, and part of the chapter on medicine in the 1920's, in which Dr. McKechnie gives a fascinating description of "improved" surgery in that era.

Unfortunately Dr. McKechnie is much less effective on other topics. He devotes a section to pioneering medicine in British Columbia, entitled "The 19th Century: Science Takes Hold," in which he gives enlightening accounts of the limited skills of early practitioners, their pragmatism, and the methods current in medicine and surgery toward the end of the nineteenth century. But these are interspersed with accounts of the nonmedical activities of Drs. J. F. Kennedy and W. F. Tolmie, and of three journals of practice from naval ships (both largely irrelevant to the main theme), and a muddled account of Dr. Helmcken's relationship with his patients in which we never do discover what the basis of that relationship was. Nor, indeed, are we told how science "took hold." Perhaps it didn't until much later. Certainly this reviewer remembers as a boy in the up-country of British Columbia, being treated by a well-known G. P. of the day who, when he was unsure of a diagnosis, would place his hand on the child's head and solemnly state: "It must be acid in his system." The diagnosis comes from Galen ( 129-199 A.D. ) and has no known scientific basis.

Nor is Dr. McKechnie much happier in his discussion of the twentieth century. He telescopes much of what he has to say on changes in medical techniques and the treatment of patients into three synoptic chapters that are little more than catalogues of events. Here, too, he appears to be especially anxious to interpret the changes in the doctor-patient relationship, though he seems uncertain how to go about it. Thus in Chapter 23, "A Doctor's Life," he is led in successive paragraphs to picture the B.C. doctor (surely the Vancouver doctor) at the beginning of the century as having to attend in formal dress concerts by Melba or Caruso and ballet performances by Pavlova, as giving "little thought to his fees," as being above material calculations, as being rewarded "in other ways," and as enjoying "worldly comforts and even some luxuries." Later he notes that this idyllic, if somewhat confused pattern of life came to an end with the imposition of income tax during the First World War, which forced the doctor to concern himself with money. Even then, we are assured, "by and large physicians were untrained and inexperienced in the ways of making money," though they found out fast that they could make the odd dollar during prohibition by selling prescriptions for liquor. But Dr. McKechnie is much more concerned with the atrophy of the spiritual relationship between the doctor and patient as a result of this growing materialism. He takes heart in the assumption that since modern scientific medicine has not yet eliminated disease nor made cure a foregone conclusion, there must still be a place for "a powerful faith that can release the self-healing propensities of body and mind."
Finally, it should be noted that whereas Dr. Rose most unfortunately rarely cites his sources and provides no bibliography, Dr. McKechnie provides good, if sometimes discursive, footnotes and his bibliography is extremely useful

Both books would have benefited from some firm editing to eliminate a variety of minor solecisms.

-- JOHN NORRIS