Listening to the Dead is History, not Clairvoyance

Keizer, Stirling

My role model is dead. Richard Johnson, the physician who I regard as a benchmark for good professional practice snuffed it. I acknowledge your condolences, but I must admit to you that they are misguided. I never met my role model. My knowledge of him is two dimensional. It is based on a grainy, old photo, on his writings and on what others had written about him. The guy died almost one hundred years ago. This happens when one has a couple of degrees in history. You take more interest in the dead colleagues rather than the living ones. For one thing, historical doctors don’t try to squirm out of call. They have already called in all of their favours.

You are fully excused for not recognizing the name. Osler, the Right Honourable Sir Dr. Charles Tupper and Sir Dr. Andrew MacPhail were all well known Canadian physicians from the end of the nineteenth, and the beginning of the twentieth centuries. Certainly a great academic, a former prime minister and a successful author constitute good choices. Fame does not equal quality. Johnston influenced medical care in a small, provincial city, Charlottetown, P.E.I. He was a good man and good physician. He was also someone to whom a regular, run-of-the-mill family physician can hope to aspire. Johnston practiced medicine and was the Chief Health Officer in Charlottetown during the last quarter of the nineteenth century.

One reason to admire the guy was that he waged an uphill battle against horrible health conditions. Disease outbreaks packed a punch back then. Endemic infections such as tuberculosis and epidemics of killers such as smallpox, diphtheria and typhus were misunderstood and superstitiously treated. Life expectancy was short. Living conditions were unhygienic and genuinely horrible. It was worse than the conditions in the poorest countries in the world today such as Haiti. It was no wonder that Charlottetown possessed a huge number of taverns and bootleggers. Looking at the terrible conditions through the bottom of a shot glass in a cheap boozer probably made them seem a little better.

When Johnson first became the Health Officer, he believed miasmas caused outbreaks of disease. It would be easy to discount him as a medical cave man, because he thought wafting pollutants from the cesspools, contaminated water cisterns, overflowing privies, manure-covered streets and garbage dumped within the city made people sick. If you visit the Osler Medical History Library at McGill, the librarians can show you shelves of treatises by once well-respected physicians who constructed the Miasmatic Theory out of the intellectual equivalent of spit, chicken wire, some twisted paper clips and threads from old and smelly mackinaws. The treatises lacked proof.

When I was in medical school I often thought of Johnston when a hypothesis was presented that seemed more construct than reality. Truth is an absolute until it is replaced. Soon after Robert Koch developed Germ theory, Johnston became conflicted intellectually. He tried to assess and discount the destructive existence of microbes against what he had been taught. The weight of evidence became too much and miasmas drifted away in his mind like unpleasant but harmless flatus. Johnston became an early germ theorist and began to advocate changes to public health care.

Any talk of change gave many Prince Edward Islanders the shakes. They didn't like it and they didn't want it! At public meetings, colleagues confronted the Chief Health Officer by drinking glasses of obviously contaminated water. When they failed to drop dead, they trumpeted that Johnston's idea to develop a water works was bunk. It would also bankrupt the rate payers, they claimed. Reactionaries are timeless. When I deal with nay-saying politicians and foot-dragging patients, I resolve to show courage like Johnston.

The Pure Water Movement was organized and spear-headed, by Johnston. He successfully politicized the need for a water works. He taught gem theory to a newspaper editor, educators, fellow receptive physicians, a small number of municipal politicians and church groups. The support for this important health care reform not only grew, but cut across Liberal and Conservative lines and Protestant and Catholic denominations. In a very parochial community, this diversity of representation was remarkable.

The Pure Water Movement elected a majority in the municipal election of 1886. This was just three years after it began. While I admire Johnston's organizational ability, he was also cagey enough to realize that he needed to make the water works financially important to Victorians. They would rather risk infection and death than have the city go into debt. He convinced the insurance companies that the water works would make it easier to fight fires and thus save them money. The insurers leaned on home owners and businessmen, who elected the supportive municipal government. After the water works was built in 1887, Johnston and his group then began pushing for the construction of a sewer system.

I believe that we still possess this power for change. Tommy Douglas, while not a physician but a minister and populist politician, demonstrated it when he proposed the initially unpopular concept of medicare. The governments apparently do not want to hear our concerns about health care. Physicians are increasingly being marginalized. In P.E.I., physicians recently received their invitations to the presentation of the Corpus Sanchez Report which is a proposed reform of health care, the day after the event. Physician associations are also being splintered by the governments negotiating not with physicians as a whole, but with groups of physicians. When I think of Johnston who informed himself, changed his practice accordingly and then targeted an area for health care reform, I’m inspired. It does not need to be a large issue such as building a life-saving water works. Popular support could be developed to push for a Respiratory Rehab or outpatient counseling or which ever change that is regarded as a need.

In the last year, I decided it was time to get off my duff and become part of the political process. I’m currently working on a committee planning mental health reform. I think that Johnston would give it the nod, which isn't bad for a guy who's been dead almost one hundred. years.

Theme: History | Histoire
Theme: Physicians | Médecins

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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