Acland’s Letters: Appendix
Notes on the Four Atlantic Colonies
Notes on Medical Arrangements of the Four outer Colonies
of N. America 1860 and on the Poor Law System
Asylum, St. John’s
In St John’s or rather in Newfoundland, in Halifax, and in St John’s, N.B. there are good Lunatic Asylums.11 That in Newfoundland is due to the efforts of Dr Stabb, a Devonshire man, M.D. of Edinburgh. It was erected out of Colonial funds, and is administered by Commissioners of Works, and practically mainly by their Surveyor. The Board audits all accounts, pays all, and makes all purchases & contracts – It should be and is not very regularly visited. Great inconveniences arise from the management – for no repair can be done, nor servant engaged or dismissed without this board which is political and as Political bodies in most Governments work, the annoyances to the person who is in truth the manager & worker of all the good in any Asylum (the resident Medical Officer) may be very great. Still I believe that the management here is good, Dr Stabb being a kind, zealous persevering man, though I gather he has no easy task.
Though the Asylum is a very creditable effort, it is not a good model – rooms full small – passages between the rooms, therefore dark, but having an alcove however – and as much window as the arrangement allows. Partitions of corrugated iron not properly riveted with rivetheads – and therefore, a violent Maniac was able to rip up a portion of the iron by manual force and secrete the bit! The system is that of course of as little restraint as possible – I do not know that I saw the worst cases. There were necessarily several wants not worth recording – but I must record a beautiful American Steam Engine for doing work, lifting, pumping from a running stream, fire hose and heating apparatus. I have reports among my papers. There are details of Numbers etc. and the Cost in these.
No books are supplied – and there is a grievous want of amusement.
Patients who are sent by the Government are necessarily admitted. There is a scale of paying patients, but all live together. A certificate by one Medical Man is sufficient, without any further check – This is, in a young Colony, necessary probably.
Contextualized
In Newfoundland, Nova Scotia, and New Brunswick, new or nearly completed asylums implemented the treatment of moral therapy, practiced in England especially since the 1830s, which sought to restore the insane through the patients’ removal from the environment associated with their illness.
Acland also comments on hospital utilities such as steam heating, used in institutions since the 1830s in England. Provision for ventilation and circulation of air through chimney flues and windows was considered essential in preventing the airborne spread of agents of diseases like small-pox, measles, and cholera. In his Memoir on the Cholera, Acland pointed out that the science of air with its recognition of air as a substance or thing was relatively recent. In 1783, for instance, Joseph Priestly discovered oxygen as a constituent not only of air but of water, earth, stones, animals, and vegetables. In medicine, the inhalation of bad air, such as foul air from the diarrhea or vomit of a cholera patient, was considered as one of the probable sources of the spread of such diseases. Like the elimination of polluted water, removal of stagnant air and the dilution of bad air through ventilation were deemed of paramount importance in the prevention of disease.
Acland also reports on several aspects of hospital design important to moral therapy, such as separate wings constructed with windows for the best admission of natural light. Dorothy Dix, the American asylum activist, had visited Nova Scotia in 1853, chosen the magnificent site of the asylum in Dartmouth overlooking Halifax Harbour, and made suggestions for the three-story brick building with a dining room, parlour, and bathroom on each floor.
To have seen this life therefore has been to open up to me new grounds of contemplation – fresh views of life – and an extended sense of the many ways of Man and of his Maker. The questions raised are almost endless, ranging through all the relations of human life – cosmical – climatological – political – social – spiritual.
Asylum at Halifax
The Asylum of Halifax is on altogether a different scale. It has been taken, Dr De Wolf informs me, from the Asylum at Washington. About one half or rather more is complete. In many respects it is admirable. Still its detailed dimensions are too small – 2 feet more of height and width of rooms would have made it admirable. Its corridors are in the middle between the two sets of rooms. I noticed that it was not acceptable for me to see the Men at meals. Their room was in fact small and it must be owned their modus comedende (table manners) not of the most refined. There are all conveniences of lifts, and most admirable baths and closets. Nothing better than some of them. But there was one private W.C. with a window opening only on a staircase – An Architectural fault which is quite inexcusable. The building is on a large basement – which is wholly occupied by a heating apparatus (steam under pressure) and at one end of the passage is a steam work fanner to drive in cold and press on therefore hot. Flues go to the different rooms entering below & the exit for the air is by an upper flue, without an exhausting shaft.
The Gas is made on the premises, the Retorts being in the Boiler department – the washing is done by steam-driven washers: and the ordinary drying apparatus (horses on rollers). The foul Blankets can be washed, dried and mangled in an hour. The Mangle is also steam-worked. They try to use in the Kitchen an American Charcoal Roasting Notion, which avoid. The coals used are Pictou & Sidney equally mixed. The Gas coal is Scotch Cannel: not the strong bituminous lustrous coal, but dead black brittle, rather dusty to the touch – It costs about £4 a ton which seems to me excessive being £2 in England.
The windows are so hung that whatever you push up of the lower sash, the upper descends also the same.
There is a capital collection of Books of all kinds – They are mostly gifts – Many prints on the walls, very bad by the way generally, stereoscopes, and a piano. Lady Mulgrave often visits the Asylum – and singing beautifully – when last there she sang for an hour: just what I should expect from so clever and so charming a person.
The cost of the Institution was great – near £40,000 altogether. A matter which must depend on mismanagement, intentional or unintentional. The view from this Asylum is splendid looking over the great Harbour, which washes its grounds. A garden is growing up – and it is surrounded by beautiful fir plantations – sicut est mos regionis (according to the custom of the region).
There will be a small Farm – piggeries already flourish. There is no difficulty about drainage.
I have Reports of the Asylum.
Asylum, Saint John, N.B.
The Asylum of St John’s, New Brunswick requires less notice because it is in all respects in advance of either of the above. It is a large partly finished building on the extension semi-detached plan, E shaped. The corridors have rooms on one side alone. Hence they are cheerful to a degree – there is [a]steam apparatus on the same general plan as at Halifax. The vaults for this are large and contain the winter’s stock of wood stacked up so true in respect of the circular saw ends of the split wood as to be quite a sight to see. There was an exhausting shaft for the hot air currents from the rooms but this is found either useless or insufficient – and the Fanner is to be applied. Dr. Waddell, an enthusiast in his Art, seems to treat the patients with much kindness & judgment. His confidence in drugs does not increase with observation and experience. I learnt from another Medical friend, Dr. Bayard, that he puts great faith in the White Hellebore as a sedative. Waddell does not believe in the general Opiate or Morphia Treatment. He says that Insanity in the States depends mainly on two causes, rum and Politics, that everyone thinks he may be President – and lives in a state of intense excitement unrepressed. Commercial reverses sometimes, and commercial success more often cause it. Altogether this is a satisfactory institution – with a magnificent view of the City & Harbour, & Falls.
It seems remarkable enough that in each of these three Colonies there should be an Asylum supported by the government and no Hospital.22 But this is right. The Lunatics cannot be safely cared for in any other manner. A Hospital is not a necessity. The Asylum in these days of knowledge must therefore be first had.
In Halifax, Dr Almon, member of a distinguished local family of medical practitioners, had promoted the cause of building a new hospital.
Hospital, St. John’s, Nfld.
It is not however literally true that there is no Hospital in either place. At St John’s Newfoundland there is a poor house Hospital as it may be called. It is kept by the Government. The Medical Officers are paid £120 a year. There are two. They are as in other cases political appointments. The Hospital was in a very bad state – and in an wholly unfit house. It is now in nice order as regards cleanliness as I saw it – and the Matron a very intelligent pleasing person. The Diet scale very liberal, and good. (A copy in my papers). Detached buildings have lately been built for infectious diseases. They are wholly unfit for the purpose of examples of what such buildings should be, and commit the cardinal and in this case wilful blunder of being built so as to match the old and inferior building.
There is one good arrangement – there is a fire hose to each floor – any fire could probably be instantly extinguished: there is nothing to hinder instant application.
Asylum & Poor House, P.E.I.
In Prince Edward’s island is a Poor House & Asylum conjoined.33 The Medical Officer is now resident – his salary is £40 a year – the Master is an old Sergeant. In his relations to the Inmates I saw no symptom of roughness or dislike. But the place is filthy and ill kept. The Chronic cases except those of mere imbecility were locked up in single cells. One had a long heavy chain to one ancle. Several are down in a damp cellar in separate cells. The ground seemed to be within three feet of the ceiling, a small barred window admitted light & air. So repulsive a spectacle I scarce ever saw – indeed I may say except a chained Maniac at Constantinople never. The ‘Poors’ part of the institution was not satisfactory – It smelt offensively and was very dirty – Each Inmate Lunatic costs about £21.5.0 (currency) £16.0.0 sterling –
The sole remedy for this state of things would appear to be at present union with one of the other islands & transfer of cases at a given rate, unless the Colony can afford an Asylum. I now understand Miss Dix’s horror. I have represented the matter to Judge Peters, Lord Mulgrave, and Governor Douglas [Dundas].
The Sergeant’s wife is ill with sequela of Pleuro-Pneumonia & Bronchitis. Dr Kobkirk, F.R.C.S.E., a pleasing good person, took me to see her. He is not the regular attendant (who is I believe Dr Mackison?)
Dr Kobkirk is a Microscopist.
The squalor of the poor house in Prince Edward Island is representative of the worst conditions for the housing of the indigent insane prior to the introduction of the high ideal of moral therapy and its hope of cure.
General Medical Remarks exclusive of the Hospitals for the Insane
Poor houses & hospitals
II found at Halifax that a new Hospital is erected. Its rules of Management are not yet decided upon. I conversed with Dr Almond and one of the Commissioners of the Poor on the subject, and propose to send to Dr Almond a Memorandum of the objectives to be borne in mind in establishing such an Institution de novo (starting from the beginning). The Poor House at Halifax is at present the Hospital, but practically none come there but the absolutely destitute and the old & infirm.44 I saw there an old Peninsular soldier suffering from a wound of the right tibia got at Vittoria. An old woman who had been [there] since Christmas day insisted on being got up & sit at the window to see the Prince pass – I gave in the Prince’s name 10 lbs of tea to the old woman for the ward. (2/6 currency 2/. sterling per lb.)
At St John’s (N.B.) there is a Military Hospital (or Main Hospital?) on the shore near the battery at the entrance of the harbour – I did not see it. Ce n’est pas grande chose. (It is of no great consequence).
In Prince Edward’s island, as I have written, there is a poor house which may for the nonce serve the purpose of Hospital to some infirm or aged persons.
In Halifax and in Prince Edward Island, poor houses had been established in 1759 to provide shelter for the poor, sailors, orphaned children, mental and medical patients, the disabled, and the elderly.
In 1834, new measures in the English Poor Law divided the country into groups of parishes, each with a workhouse at it centre designed to accommodate about 1% of the population. However, by 1851 after the influx of destitute Irish during the potato famine, the system was stretched to its limits with about 4% of the population in need.
Poor laws
As far as I could learn, (though my information is very superficial) the general principle of poor’s relief in the lower Provinces is to give no out door relief. But I think I understood that in some cases it is given in New Brunswick. The poor so called are really very few. They say almost every able bodied man can get work & maintenance, and so the difficulty is not as with us.
Medical Regulations
Licencing, Boards of Health
The Medical Regulations in these four islands concerning Licence to Practice are very various. In Newfoundland there is no rule or Law whatever. In Nova Scotia, a board of Examiners of Licensers headed by Dr Almond has by his instigation been made. They will license persons who have passed certain Licensing Bodies elsewhere. Of course to have their own school now would be absurd & suicidal. Pupils do however go round with Dr Almond, when he goes to the Poorhouse. I promised to send him 1st a set of the Poor Law Reports – 2nd to give him if he desires it my views on the best regulations for a Hospital, as they are starting theirs with a ‘Tabula Rasa’ (a clean slate)- 3rd to ascertain from the College of Surgeons of London whether they will accept 2 years of United States Education as part of their Curriculum as Almond wishes to get their Students to go to England for part of their Education.55 He says they all go the States now wholly – This of course is very desirable to be done.
In New Brunswick there is a Board of Health66 – there is also a Licensing Board – and various Acts depending on the exertions of Dr W. Bayard, who has promised to send me the Acts of their Legislature bearing on such points.
In Prince Edward’s Island I learnt nothing of their Medical Statutes.
In Prince Edward’s Island (by the way) Diptheria has been very bad of late – Dr Hobkirk’s treatment tonic & topical appears to be quite right – But he tells me the disease seems to have been misunderstood.
For the education of physicians, since none of the Atlantic colonies had either suitable hospitals or medical schools for their training, medical students usually went to the United States.
Subsequent to epidemics like cholera, in 1848 the Public Health Act in England established local boards of health to take responsibility for sewage, drainage, the supply of water, and clearing out garbage and dung. Acland notes that in New Brunswick there was a board of health and refers to drainage systems in the colonies.
Treatment of diseases
With every practitioner I have seen in the Lower Provinces I have conversed on the subject of Bleeding in Pneumonia and on Bleeding in general. All agree that bleeding is not as necessary as it was. All declare this to be a matter of observed want of necessity – not of faction or of change of opinion. Dr Hobkirk had formerly used large bleedings in Pneumonia with clear advantage – latterly it is rarely suggested to his mind – nor usually could it be borne.
W. Harvey is of the same mind – and not only so but more or less the principle applies to all diseases. He gives Mercury very sparingly in any disease and finds that sores will only heal with Acids, Bark and Sarsaparilla given at a very early period77 so that old lingering disease will now under this treatment, if acute when they come to him, be well in a week or ten days. He thinks I imagine that the Sailors’ stamina are not what they were though so much more attention is paid to their health in all respects than in former years. Harvey is a very sensible fellow & good doctor – and disposed enough to active remedies if I may judge by his giving me two strong black doses in one day and proposing Castor oil the next: and therefore this testimony from him has full weight. He believes in Arnica as a remedy for bruises and says that Prize fighters use it much.
I take it that on the whole these Provinces are very healthy. Much money is being spent in Water Works at Newfoundland. The others are well supplied on the whole as I understand. But the intense winter which lasts 7 months, must be a bar to all ordinary methodical drainage systems. This must be enquired into in Canada.
Because pharmacology was empirical, Acland conferred with Drs William Hamilton Hobkirk and W. Harvey in Charlottetown about their clinical experiences in the use of drugs and their treatment of prevalent illnesses like pneumonia and diptheria.
Notes of General Impressions of the four outer Colonies with respect to resources, and their present social condition and other topics.
The aspect of the colonies was altogether different from what I expected – This proves only my ignorance. There is more state – more advanced social arrangements – greater apparatus of government – more development in almost all things – I had not realized a society of Traders without Aristocracy or person of cultivation exercising influence – nor realized what a people without any dominant or recognized church would be – nor understood how petty politics become a trade, and a ground & cause of demoralization – nor did I know how English their people are – nor did I realize before the great advantages of our present constitution, much as I have deeply dreaded, for long, any radical alteration in it such as a material extension of the suffrage.
There is nothing of course can be said in sum of so large a question as the social condition of this people. But the following are among the points on which I have had much conversation with Inhabitants.
In Newfoundland the Roman Catholics have supreme authority. The Colony is in great danger of attack from the French who possess right of fishing & curing on the coast since the Treaty of Utrecht. The sea Fishing is inexhaustible. The French keep on a bounty 30,000 sailors there as a Nursery for their seamen. The mineral treasures are probably very great. The interior is virtually unexplored. The Indian races have nearly died out. The Colony is satisfied by the connection with England, and is un-American. Education is at a low ebb. But great efforts are being made.
Prince Edward Island is the most like Newfoundland in its social state but not so prosperous. Its exports less, its Agricultural resources greater. Its social arrangements quite in the rough, except the cumbersome apparatus of constitutional Government.
Nova Scotia & New Brunswick stand on a very different level. The former has wholly English, the latter considerably American tendencies. The latter is most energetic – Its timber trade is still most important & flourishing – Its Education progressing. The University has become wholly unsectarian, that is no ‘denomination’ has any special voice and no religion is taught. The Cathedral of Fredericton is the finest building in the Colony and admirably conducted. The Clergy are poor. The Sanitary arrangements ahead of all the Lower Colonies. The Proximity to Maine has given it a very American tone. By which I mean selfishness and vulgarity and dissatisfaction at restraint. But the sense of the able men is wholly against this course – They see the United States to be unhappy – the social condition of the people in all but that which has regard to material prosperity to be such as they do not desire for themselves or their families: and all the system to be based on the designs of selfish coarse politicians for personal purposes. Even the New Brunswickers therefore ardently desire connection with the respectability of the Monarchy.
In Nova Scotia is a first class Normal Training School for Schoolmasters & Mistresses in which Mental Arithmetic, as I learnd, in an Examination is conducted certainly to a very high pitch.
The Climate of all is a bar to a complete and first class social state. Seven months of Winter obtains more or less in all – Only two ports, Halifax & St Johns N.B., but closed by ice for months – The warm spring brings up crops with rapidity in the summer but the stall feeding in the winter is a grave difficulty.
The Indians die out slowly – they are treated with much kindness, indeed petted. The Micmacs are the chief tribe in the Eastern. There are also Melicetes – and some others. But of these hereafter. On the whole the people are not immoral – They are business people wholly given to material advancement – struggling, that is, with and for life. The abler men, who are in their hearts above this, drift into politics, and become utter partisans, or disgusted with their vocation. But against this trade of public life there is now evidently a strong reaction: and I believe a real desire to promote all institutions which will conduce to the development of man’s higher mental qualities – What of real spiritual life there is I have no means of knowing. I am myself perhaps too backward to see. And in the scurry of cheers – and the dazzle of entertainments it is not easy to form a judgment of any one. But in almost every place I have met some earnest soul – Carteret Hill, Fordyce, & Nelson at Halifax – Medley at Fredericton – The Governor and his wife at Prince Edward’s Island – these are deeply Christian people, striving to live in the temper of the Gospel in all things – Cheerful, pleasant & merry withal as is the wont of the best. To have seen this life therefore has been to open up to me new grounds of contemplation – fresh views of life – and an extended sense of the many ways of Man and of his Maker. The questions raised are almost endless, ranging through all the relations of human life – cosmical – climatological – political – social – spiritual.
Contextualized Notes
In Newfoundland, Nova Scotia, and New Brunswick, new or nearly completed asylums implemented the treatment of moral therapy, practiced in England especially since the 1830s, which sought to restore the insane through the patients’ removal from the environment associated with their illness. The restoration of alienated minds was to be effected in spacious, light-filled surroundings through the therapeutic understanding of a resident physician, recreational activities, and the occupational therapy of manual work. The new asylum near Halifax had cost £40,000; Newfoundland’s had cost £3,000. At Halifax the resident physician was Dr DeWolf, a graduate of Edinburgh and the first colonial member of the Royal Medico-Psychological Association of London. However, he proved to be a poor administrator and in spite of his qualifications was the subject of complaints to Joseph Howe, the provincial secretary, just months prior to the tour. In Saint John, New Brunswick, Dr John Waddell, a native Maritimer and graduate of Glasgow, exhibited the good judgement and kindness essential to moral therapy.
Acland also comments on hospital utilities such as steam heating, used in institutions since the 1830s in England. Provision for ventilation and circulation of air through chimney flues and windows was considered essential in preventing the airborne spread of agents of diseases like small-pox, measles, and cholera. In his Memoir on the Cholera, Acland pointed out that the science of air with its recognition of air as a substance or thing was relatively recent. In 1783, for instance, Joseph Priestly discovered oxygen as a constituent not only of air but of water, earth, stones, animals, and vegetables. In medicine, the inhalation of bad air, such as foul air from the diarrhea or vomit of a cholera patient, was considered as one of the probable sources of the spread of such diseases. Like the elimination of polluted water, removal of stagnant air and the dilution of bad air through ventilation were deemed of paramount importance in the prevention of disease.
Acland also reports on several aspects of hospital design important to moral therapy, such as separate wings constructed with windows for the best admission of natural light. Dorothy Dix, the American asylum activist, had visited Nova Scotia in 1853, chosen the magnificent site of the asylum in Dartmouth overlooking Halifax Harbour, and made suggestions for the three-story brick building with a dining room, parlour, and bathroom on each floor.
In Halifax, Dr Almon, member of a distinguished local family of medical practitioners, had promoted the cause of building a new hospital. However, since physicians visited most patients in their homes and because removal of the insane to asylums was considered essential to their treatment, Acland was not dismayed by the lack of hospitals in the colonies which had new asylums. In addition to comments already included in his letter from Newfoundland, Acland mentions Riverhead Hospital’s intelligent matron who supervised staff, ordered supplies, and cared for the most serious cases. Like Florence Nightingale, Janet Cowan, a Scots immigrant, was educated, devoutly religious, kind, and caring in a period when nurses were often rough and illiterate.
The squalor of the poor house in Prince Edward Island is representative of the worst conditions for the housing of the indigent insane prior to the introduction of the high ideal of moral therapy and its hope of cure. Its physician, Dr John Mackieson, deplored the asylum’s physical condition and its lack of funds even for adequate heating or an exercise yard. He was not an adherent of moral therapy but a medical materialist subscribing to the theory that insanity was a material or organic condition of the brain which required the chemical treatment of drug therapy. Believing that the best remedy for the situation was the removal of patients to one of the new colonial asylums, Acland spoke on this matter to George Dundas, lieutenant governor of Prince Edward Island, to Lord Mulgrave, lieutenant governor of Nova Scotia, and to Judge James Peters, son-in-law of the Nova Scotia shipping magnate, Samuel Cunard. In 1876 the Prince Edward Island legislature approved the construction costs for a new building and the new asylum was opened in 1880.
In Halifax and in Prince Edward Island, poor houses had been established in 1759 to provide shelter for the poor, sailors, orphaned children, mental and medical patients, the disabled, and the elderly. In his visit to the poor house in Halifax, Acland met a veteran of the battle of Vittoria in northern Spain where Wellington defeated Bonaparte in 1813. In Newfoundland, a workhouse was not built until 1861. Instead, the permanently poor were accommodated variously in Riverhead Hospital, boarding houses, and the wooden sheds built for the homeless after Newfoundland’s great fire in 1846. Here the poor slept on beds made of hay and wood shavings and had little heat in the winter. In contrast to the indoor relief provided for the permanently poor, Newfoundland had long favoured a public works program of road building as a form of outdoor relief for the able-bodied poor whose livelihood was often dependent on the rise and fall of fortune in the annual cod fishery.
In 1834, new measures in the English Poor Law divided the country into groups of parishes, each with a workhouse at it centre designed to accommodate about 1% of the population. However, by 1851 after the influx of destitute Irish during the potato famine, the system was stretched to its limits with about 4% of the population in need.
For the education of physicians, since none of the Atlantic colonies had either suitable hospitals or medical schools for their training, medical students usually went to the United States. Acland’s authority within medical circles not only as Regius Professor of Medicine at Oxford but as a representative on the General Medical Council facilitated his inquiry promised to Dr Almon about equivalences in England for medical education in the United States.
Subsequent to epidemics like cholera, in 1848 the Public Health Act in England established local boards of health to take responsibility for sewage, drainage, the supply of water, and clearing out garbage and dung. Acland notes that in New Brunswick there was a board of health and refers to drainage systems in the colonies.
Because pharmacology was empirical, Acland conferred with Drs William Hamilton Hobkirk and W. Harvey in Charlottetown about their clinical experiences in the use of drugs and their treatment of prevalent illnesses like pneumonia and diptheria. The controlled use of morphine used in specific doses was made possible after morphine was isolated as a separate substance around 1803. White hellebore, today considered a potentially dangerous poison, had been used since antiquity to treat gout, epilepsy, depression, and other illnesses. Mercury was used to treat typhoid, parasites, and as an ointment for syphilis. In mid-nineteenth century, it was also a favourite pill for gastric problems. Arnica is still used as a remedy for bruises. Sarsaparilla was used globally by indigenous peoples for skin and joint problems.