Illness
Until the mid-nineteenth century, the staff of Hôtel-Dieu hospitals tended to the bodies and souls of destitute patients in public wards. As much as disease, poverty drove the sick to seek out free hospital care in often appalling conditions. Meanwhile, those who could afford it avoided this humiliation by receiving medical care at home, where they were surrounded by family.
However, perceptions of hospital care started to change in the final decades of the nineteenth century. Facilities began offering specialized medical care, including new surgical procedures. While continuing to serve the poor, hospitals gradually began offering paid medical services to a more affluent clientele.
By the early twentieth century, hospitals were treating patients from all social classes. However, not everyone was greeted, accommodated, and cared for in the same way. Paying patients could rent semi-private and private rooms to avoid the unpleasantness of public wards crowded with destitute patients. In this way, modern hospitals reproduced the social inequalities that plagued industrial society.
Hospitals as Charitable Institutions
At Home or at the Dispensary?
This certificate from a mutual insurance company (the Société des artisans canadiens-français) illustrates the appeal of house calls. It shows a respectable rural family greeting a physician hired by the organization. No one seems the least bit intimidated by the arrival of this medical practitioner. After examining a sick family member, the doctor calculates the weekly salary deduction provided for in the family’s health insurance contract.
The print paints a rather idyllic picture, one that was very far from the reality faced by most working-class households. At times, such families could count on free home visits from nurses or nuns with medical training. But they mainly visited hospital dispensaries that provided tens of thousands of free medical consultations every year. Patients simply had to show a certificate confirming that they were destitute.
The Notre-Dame Hospital
At the end of the 19th century, Montreal had only two hospitals: the Hôtel-Dieu (1642) and the Montreal General (1819). Both institutions were located far from the city’s eastern neighbourhoods. A group of university doctors sought to address this issue by establishing the Notre-Dame Hospital in 1880. The institution was a rare example of a secular Francophone hospital. It nevertheless relied on the Grey Nuns to provide free nursing care and other services to patients. Newspapers hailed the arrival of a facility capable of treating the poor living in the city’s east end, as well as the many people injured while working in factories and at the port.
When it opened in the former Donegana Hotel, the hospital could accommodate a few dozen patients. The number of beds steadily grew until the facility was forced to move to Sherbrooke Street, across from La Fontaine Park, in 1924. With a total of 293 beds in both public wards and private rooms, it was the largest Francophone general hospital in Quebec, surpassing even Montreal’s Hôtel-Dieu.
The Saint-Joseph Hospital in Trois-Rivières
In 1697, three Ursuline nuns from Quebec City arrived in Trois-Rivières to establish a school and a hospital. Running a medical institution was a rather unusual role for this religious community, which normally focused on education. The Ursulines nevertheless remained responsible for the hospital until 1886, offering shelter and care to the city’s poor.
When the Sisters of Providence took over, they enlarged the main building, which housed an orphanage and a hospice. They then proceeded to build the Saint-Joseph Hospital, which primarily cared for destitute patients. Completed in 1889, the new hospital was expanded several times over the years to meet the needs of a growing working-class population. Doctors were also eager to practise in an environment that was better suited to the latest medical innovations. However, during the opening decades of the twentieth century, caring for the destitute remained central to the hospital’s mission.
The Sainte-Justine Hospital for Children
In 1907, two leading Quebec feminists—Irma Levasseur, the province’s first French-speaking medical doctor, and Justine Lacoste-Beaubien, a philanthropist—founded a hospital dedicated to caring for sick children. At its original location on De Lormier Street, it had only twelve beds. After two years of operation, management of the institution was entrusted to a religious congregation called the Daughters of Wisdom.
In 1914, the hospital moved to a larger facility on Saint-Denis Street with 180 beds, in addition to a new dispensary. Starting in 1926, the institution also ran a school for children hospitalized for long periods of time.
The Montreal General Hospital
Montreal’s first Protestant health-care installation was a small House of Recovery opened in 1817 by the Female Benevolent Society alongside its work with widows and orphans. Faced with rising immigration and an increase in infectious diseases, leaders of the English-speaking community petitioned the Legislative Assembly in 1819 for funding to build a larger hospital. When the petition was rejected, the community raised the funds privately. The Montreal General Hospital began in 1819 as a temporary 24-bed hospital on Craig Street (St. Antoine). By 1820, additional funds enabled the administration to purchase land on Dorchester (René-Lévesque) at the corner of St. Dominique. The cornerstone was laid in 1821; patients were transferred to the new 80-bed hospital in 1822. Additional wings were added quickly in response to rising needs. Admission was open to patients of all denominations.
The four Edinburgh-trained physicians associated with the MGH’s founding established the Montreal Medical Institution (MMI) in 1823 to train doctors inside the hospital. The MMI merged with McGill College in 1829 and became the first Faculty of Medicine in Canada, thus establishing the MHG as a teaching hospital. Like all nineteenth century hospitals, medical practice and certainly surgery was limited. Nonetheless, by late century, MGH doctors such as Sir William Osler and Sir Thomas George Roddick made historic advances in medical practice, treatments, and surgery. Alongside resident hospital care general hospitals like the MGH established large outpatient departments and clinics which acted as dispensaries of medicine and advice. Many more people used these services than were hospitalized.
Living with a Disability
Beginning in the mid-nineteenth century, various institutions were established to care for persons with physical disabilities. Most of these institutions were located in the Montreal region. They mainly served children, along with some adults.
Run by the Sisters of Providence, the Institute for Deaf-Mutes was designed to educate and house deaf girls and women. The only institution of its kind in Canada, it housed some 300 children and adults in the 1880s. Potential new residents regularly had to be turned away due to lack of space.
The Nazareth Refuge, managed by the Grey Nuns of Montreal, addressed the needs of visually impaired youth. Students learned to read and write using the Braille method. Music was another central component of the institution’s programming.
As for the Protestant community, it opened the Mackay Institute for Protestant Deaf-Mutes in 1869. A legacy from Edward Mackay in 1883 enabled them to admit blind children as well as the hearing impaired. In 1914, the institution was home to 87 children between the ages of 7 and 15, while another 64 attended day programs. Beside education, moral and religious instruction, boys were trained in carpentry, printing, type setting, chair caning, and cabinet making and girls in dressmaking and cooking.
Public Health
The Grosse-Île Quarantine Station
In response to the 1832 global cholera epidemic, the colonial government built a quarantine station on a small island in the St. Lawrence, some 50 km east of Quebec City. Doctors inspected ships sailing upriver for signs of contagious disease among crew members and passengers who had been crammed together for weeks in appallingly unhealthy conditions. Until the 1870s, infected ships were directed to Grosse-Île, whose health facilities remained rudimentary. Tens of thousands of poor immigrants, including many fleeing Ireland’s Great Famine of the mid-1840s, spent time there. And thousands of journeys and dreams of a better life ended in a cemetery on Grosse-Île. The quarantine station was closed in 1937.
Immigrant Hospitals
Colonial and later federal authorities were responsible for providing care to the sick sailors and immigrants who arrived year after year at the port of Quebec. As a result, the government ordered the construction of the Marine Hospital (1834–1890) and the Savard Park Hospital, also known as the Immigrant Hospital (1897–1958). These facilities also housed other destitute groups that struggled to obtain assistance from other institutions. Single mothers gave birth at the Marine Hospital, whereas Indigenous people, military personnel, and tuberculosis patients were admitted to the Immigrant Hospital.
In 1906, new federal legislation banned several categories of “undesirable” immigrants, including the poor, the sick, the insane, the blind, and the deaf. Federal officials were given the power to detain and deport any such individuals who tried to enter the country. In 1914, such efforts were bolstered by the opening of the Immigrant Detention Hospital near Windsor Station. This four-storey facility contained waiting areas, disinfection rooms and dormitories, along with a few cells in the basement. It played a key role in the crackdown on enemy aliens during the First World War. It then served as a temporary shelter and detention centre for immigrants until the early 1960s.
The Unequal Impacts of Contagious Disease
The smallpox epidemic of 1885 killed about 6,000 people in Quebec, half of them in Montreal. It prompted the provincial government to give municipalities the power to post warnings on infected homes and forcibly confine patients to a civic hospital. Such restrictions on individual freedoms aimed to protect society from the spread of disease, but they mainly affected working-class and poor families. This was the case at the Moreau Civic Hospital in Montreal, which operated from 1886 to 1928. Meanwhile, the Quebec Civic Hospital, located on Des Prairies Street in Quebec City’s Lower Town, admitted its first patients in 1891. By contrast, wealthier patients could receive treatment in the comfort of their own homes, without worrying about having to visit an overcrowded hospital with a very poor reputation.
The fight against epidemics also led to the creation of various facilities specialized in the treatment of contagious disease. For example, in Montreal, the Saint-Paul Hospital (affiliated with the Notre-Dame Hospital) opened in 1905, the Alexandra Hospital in Pointe-Saint-Charles opened the following year, and the Herzl Hospital and Dispensary opened in 1912. This last institution specialized in caring for members of the Jewish community suffering from tuberculosis.
Public Subsidies for Hospital Care
The Hospital Tax
Access to health care for working-class families was a pressing issue in the early twentieth century. The poor increasingly turned to hospitals for free treatment. Meanwhile, hospital administrators and doctors regularly complained of people falsely claiming to be destitute so they could receive free treatment.
In fact, the pervasiveness of wage labour and low incomes for working-class families were the real reasons behind the high demand for free health care. With no solution in sight, some institutions began to demand that municipalities pay for a portion of the care provided to destitute residents.
In 1915, Montreal introduced a one-cent municipal tax, dubbed the Hospital Tax (le sou du pauvre). It was added to the price of admission at parks, cinemas, theatres, etc. Half the revenue was given to large hospitals, a third to specialized hospitals, and a sixth to charitable institutions like hospices and orphanages. Not only was this a regressive tax on workers’ leisure activities, as pointed out in La Presse, but it failed to generate sufficient revenue. As a result, hospitals began calling on the provincial government to intervene after the First World War.
The Public Charities Act
The Hospital Tax provided inspiration to Louis-Alexandre Taschereau’s Liberal government, which ushered in the Public Charities Act of 1921. This legislation required municipalities and the provincial government to reimburse a large part of the costs associated with accommodating destitute patients in general hospitals, as well as in other types of institutions providing care and assistance.
The Public Charities Act also aimed to provide a legal framework for declaring people destitute, thereby addressing concerns that the public was abusing services offered by charitable organizations. In fact, municipalities regularly abused their powers under the legislation by refusing to recognize their poorest residents as destitute for economic or moral reasons.
Initially viewed with suspicion by ecclesiastical authorities, the Public Charities Act quickly came to symbolize the collaboration between Church and state in matters involving care and assistance for the destitute. As the cornerstone of twentieth century social policy, the legislation was a key source of economic support for the institutional network that defined social assistance in Quebec until the 1960s.
