Conceptualizing Health Care in Rural and Remote Pre-Confederation Newfoundland as Ecosystem

Historical attention to the broad topic of health care for the island of Newfoundland (that is, excluding Labrador) has focused mainly on the period after Confederation with Canada in 1949.1 Even though services for health care delivery formed an important part of discussion leading up to Confederation, knowledge of all pre-Confederation health care activities around the island of rural (mostly coastal) residents is fragmentary. Various historical studies of individuals or organizations and of particular social concerns have given us only partial glimpses of the state of health care before Newfoundland joined Canada: studies of health care practitioners may describe their work in local communities but overlook the extensive medical and surgical work of the prominent itinerant physician Wilfred Grenfell aboard ship, on the island, and in Labrador; 2 studies of public health usually focus on the major urban centre of St. John’s and the legislative or governmental aspects of the subject; 3 studies of nutrition are not contextualized for the whole island or global settings; 4 and studies of single institutions such as the asylum and cottage hospital highlight organizational matters.5 Indeed, with respect to the internationally recognized medical mission of Grenfell, we know far more about the man, the homebased “industrial” work, nurses, and organizational affairs than we do about the mission’s delivery of health care to actual patients in Newfoundland communities for the several decades before Confederation. Similarly, as this quick overview indicates, owing to a pervasive view of medicine from the top of society as a matter for the state and state regulation, much (if not most) of the literature about Newfoundland explicitly and implicitly equates health and health care services with public health measures.6 More recent studies of Newfoundland before 1949 begin to offer new perspectives (as we will show), but they still focus on only one aspect of health care services, such as the practitioners or organizations that delivered health care services. Study of the history of medicine for the whole island has yet to be done.