Volume 100 Number 1, 2007 Issue #424

By J.H.T. Connor

Medical services and healthcare in the colony during the early 20th century were surprisingly better developed and organized than might be first assumed given the physical and economic challenges that had to be faced. Indeed, rural and remote medicine in Newfoundland and Labrador can be seen as a colonial success story. The origins and early development of the Notre Dame Bay Memorial Hospital in Twillingate is one measure of this. Such success was dependent on a variety of foreign and native individuals, local voluntarism and international philanthropy, and grand ideas crafted to suit regional circumstances.

Twillingate and the Grenfell Effect

Many ordinary men and women toiled long and hard to bring medical care and comfort to the people of Newfoundland and Labrador, but one man in particular cast a long shadow: (Sir) Dr. Wilfred Grenfell (1865 -1940). Sponsored by London's Royal National Mission to Deep Sea Fishermen as a missionary doctor, Grenfell took up his permanent charge in the early 1890s at the northernmost tip of the island in St Anthony and in adjoining Labrador. Within a decade, Grenfell's reputation for daring exploits, dedicated medical care, evangelism, and charisma were becoming legendary. And, later, as an active selfpromoter through numerous international speaking engagements and articles and books, Grenfell and his blend of "muscular" Christianity and (muscular) medicine became a phenomenon. His founding of his own American-style philanthropic organization (the International Grenfell Association [IGA] created in 1914), his marriage to a wealthy American socialite, and his admittance to affluent circles in New York and New England all but guaranteed him the financial stability to continue to deliver relatively high quality health care to remote settlements.

When the east coast settlement of Twillingate in Notre Dame Bay decided to found a hospital as a memorial to the 200 local men killed during World War I, the Newfoundland–based fraternal order of the Society of United Fishermen raised funds in the hope that the IGA would operate it. Naturally they turned to Grenfell for organizational advice; he suggested an alternative plan, however. Although what would be called the Notre Dame Bay Memorial Hospital (NDBMH) was never part of the IGA enterprise, it did initially fall within Grenfell's sphere of influence. Grenfell was the most prominent and only non-Twillingate member of the NDBMH Association founded in 1920 to oversee the building and governance of this institution. Through Grenfell's influence and connections, he was also instrumental in securing over $50,000 from the Commonwealth Fund (CF), a philanthropic foundation started by the Harkness family of New York City, which gained its significant wealth from oil production.

The CF records show that this Newfoundland hospital was the only one outside of the United States to benefit from its rural hospital aid programme begun in the early 1920s. The retention of the one of the most prominent architectural firms in North America to design the new Twillingate hospital can also be traced to Grenfell. William Adams Delano, senior partner of Delano and Aldrich of New York City, had admired Grenfell since their first meeting in the early 1900s; he also visited Newfoundland in 1926 and traveled on the IGA hospital ship Strathcona.

Despite the critical technical and financial support obtained from the United States, the actual building of the hospital was an intensely community project. For three years, local tradesmen — often trained on the jobsite in the skills of masonry, concrete technology, and plastering — created a monument to commemorate the past as well as an edifice that ushered in the future. The CF annual report for 1925 drew attention to the inordinate efforts of the people of Notre Dame Bay in this regard. The "remote location" led to protracted problems, but the "devotion of the people of Twillingate" and their "generous giving of their time and labor in transporting freight, digging roads, installing the water system...working nights throughout the summer...[and] undergoing every discomfort" culminated in the opening of a fully functioning hospital in September 1924.

Five years later another cheque of $50,000 was forthcoming from this New York philanthropy to add a new wing, including a children's ward. The CF executive "took special satisfaction" in their support of the NDBMH owing to its impressive success and its mission. Not only was it the single hospital serving 50,000 along 300 miles of seacoast, but area residents had repeatedly demonstrated their wholehearted commitment to the institution through their free labour along with the over $80,000 that they themselves had raised. One incident that clearly underscored the spirit of community voluntarism, to say nothing of illustrating the remote and exotic nature of this northern colonial land, was a house haul. The 1929 CF annual report noted, almost incredulously, how 600 men dragged a frame house for two days over three miles of snow and ocean ice in order to provide a home for hospital nurses.

Rhoda Dawson (Bickerdike), Operating Theatre in Twillingate, 1936, oil on canvas, 33.4 cm x 32.3 cm. The Rooms Provincial Art Gallery, Memorial University of Newfoundland Collection, 94.7.59. Image reproduced courtesy of Richard and Susan Wallington.

The Influence of The Johns Hopkins University

Wilfred Grenfell also orchestrated the appointment of Dr. Charles Parsons as the hospital's founding Medical Director. Parsons, a 1919 graduate of Baltimore's Johns Hopkins University, the leading medical school in the United States, had previously served the IGA in Labrador at its Battle Harbour Hospital. Beginning in 1924 he would steer the newly opened Twillingate hospital for ten years. An historical snapshot of hospital activity is available in Parsons' 1928 annual hospital report. For this year, 482 patients were admitted for an average stay of 29 days; 1,500 more people were treated as out-patients. Of interest is the cyclical nature of patients' admittance, which underlines the rural/remote nature of medical practice. On average 39 patients were admitted daily over the year, but this actual figure fluctuated with the seasons: between 50 and 70 patients were admitted per day during the summer and autumn months, but owing to ice conditions during winter when people could not travel, admissions would drop to a daily rate of between 20 and 30.

Another distinct feature of hospital life at this time relates to staffing. Key nursing positions (Head Nurse and Staff Nurses) were also held by Johns Hopkins graduates or by graduate nurses from other American institutions in the New England area. These women had the qualification of R.N. and thus became leaders and role models within the hospital. Assisting them were women identified as "Nurse's Aides in Training" from Twillingate, Fogo, Carmanville, Botwood, and Bonavista. On one hand there was a clear hierarchy established with local women probably performing most of the daily menial chores associated with ward life, while their American superiors directed their activities. But on the other hand, a training system and alternative work opportunities were also being created, increasing the social and professional mobility of these local young women. Indeed, in 1928 at least four Nurse's Aides left Twillingate for a six-month training course at the Englewood Hospital in New Jersey. In time, this process would create a critical mass of technically competent nurses who also had an understanding of local life at the NDBMH.

In 1934, Charles Parsons was succeeded by John Olds. Another Johns Hopkins doctor who had graduated in 1931, Olds had spent the previous summer at NDBMH as a senior medical student when he had taken part in a Hopkins- Twillingate training experience initiated by Parsons. In 1933 he returned for a year to replace Parsons who took leave. Olds would become the public and professional face of the hospital for the next half century.

The timing of Olds' appointment as the hospital's new Medical Director coincided with the onset of the Depression and the era of Commission Government — both events demanded that continued funding for the support of rural medicine had to be both immediate and innovative. Olds had a reputation for being a mechanical tinkerer or inventor of sorts (sometimes with humorous and scary consequences), but perhaps his single most significant invention was his introduction of a local form of socialized medicine.

Olds' scheme was, if not entirely to replace "fee for service" with a new plan based on a blanket pre-paid contract, at least to complement and supplement the standard mode of payment for medical and hospital care. The people of Twillingate and environs had a tradition of sharing and working communally, not only out of necessity (along with their rural temperament to do so), but also from political astuteness, for the Notre Dame Bay area of Newfoundland was also the birthplace in 1908 of the activist and highly successful Fisherman's Protective Union (FPU) along with its founder and long-time leader William Coaker. When Olds canvassed the many families and individuals around the numerous rural outports and isolated settlements in the vast Twillingate-Notre Dame Bay archipelago that the hospital served, his plea was heard.

Olds noted in a circular letter how a subscriber under the "Individual" contract system costing $10 would guarantee "him [sic] and all members of his family Hospital care for one year at no further expenses than half-price for an operation if needed." (At this time in Newfoundland's history, a family typically would consist of both parents, upwards of eight children, and maybe grandparents too.) A second "Community or Blanket" contract was as generous but more complex to reckon as it was based on population settlement patterns. Olds had divided Notre Dame Bay into 39 districts, each of which would elect a Hospital committee that would be responsible for raising funds equivalent to $44 per hundred people in any one district; thus, if a district had a population of 500, then a total of $220 per year would cover their hospital care, excepting the "half price" operation rider. Under this version of the plan, a flat rate of 44 cents for each person was calculated but need not be followed if extreme poverty existed. Similarly, if owing to unequal wealth distribution some people were better off than others, then they might wish to pay more than their fair share.

As Olds explained, "in this way everyone will be pooling a small amount to pay the Hospital bills of everyone in the community. It will be a tremendous saving to anyone requiring treatment and yet the Hospital will have enough money to meet its expenses. If you all stick together and do your bit the cost will pinch no one. If you do not the sick will have to pay large bills...The only answer to this is that you cannot afford NOT TO."

A New Deal for Newfoundland

Much has been made of the New Deal initiatives undertaken in rural agricultural regions of the United States during the Roosevelt administration. Federal government agencies such as the Resettlement Administration (RA), and its successor the Farm Security Administration (FSA), have been correctly lauded for bringing medical and financial relief to the needy of the south.

The Farmers' Union Hospital Association cooperative of Elk City, Oklahoma, formed at the beginning of the Depression years, was held up as a model in both contemporary and historical contexts. With the support of the Oklahoma Farmers' Union, a local physician devised a coverage plan in which for a one-time sign up fee, followed up by annual dues, farmers became shareholders and were entitled to medical and hospital care; by 1939 there were almost 10,000 subscribers.

Could Olds have been inspired to do for Newfoundland fishers what he knew had been done for Oklahoma farmers? Perhaps. But what might be more likely is a linkage to his alma mater, the Johns Hopkins University medical school.

Hopkins, the premier American medical school, was already known for its state-of-the-art facilities, technological superiority, research strengths, commitment to education, and the high quality of its faculty and students. Yet another gem was added to the Hopkins' crown in 1932, when the Swiss-born, German-trained, physician-historian of medicine Henry Sigerist became the Director of its recently founded Institute of the History of Medicine. But for Sigerist, medical history was not the study of great doctors and the march of medical progress as it had been pursued in America; rather it was the study of the social organization of medical knowledge and practice — for him, the study of the medical past was to help generate a better medical present and future. Sigerist was a fervent advocate of socialized medicine (or as he referred to it, the sociology of medicine) across the United States and Canada. During the 1930s and early 1940s, this Hopkins' historian became the beacon for a flotilla of leftist intellectual medical practitioners sailing in a sea of capitalist medicine. An important element in their vision of social medicine was the pursuit and practice of rural medicine, for it seemed to be the weakest point in organized medicine in America.

The novelty of the Twillingate medical financial scheme perhaps ought not to be overstated. Its likely roots in the social thinking of the period along with the benefit it brought to Notre Dame Bay subscribers are historically significant, but there was another legacy. The later cottage hospital financial plan of salaried doctors and of prepayment for selected clinical services probably owed as much to the Twillingate contract model as it did to the "book system" adhered to by some Newfoundland doctors who offered a variety of services for an annual fee.

The income based on this socialized or collective medical model helped offset the running expenses, allowing the NDBMH to keep its doors open during the tough times of the Depression and Commission era. Hospital annual reports from the 1930s indicate just under $10,000 was derived annually from direct patient receipts and contract payments, with the remaining $20,000 coming from regular and special government grants (for the care of the tuberculous along with official Medical Officer of Health duties). It appears that there were perhaps about 8,400 subscribers annually.

Enter Dr. Ecke

We may surmise that John Olds learned of the American rural/social medicine agenda either by osmosis and/or from his many fresh associations with Hopkins as a graduate of the medical class of '31 and then "translated" it for use in his own unique rural situation. A more definite historical connection between Hopkins and Twillingate and rural medicine qua socialist-inspired activity can be drawn for Olds' junior Hopkins and Twillingate colleague, Robert Skidmore Ecke, who attended medical school in Baltimore from 1931 to 1935. In all likelihood Ecke was one of the many medical students who attended Sigerist's social medicine classes to imbibe what the new European professor had to say. (Ecke was also one of numerous other American and/or Hopkins doctors who practised for various periods at the NDBMH such as Green, Hardy, Waddell and Chelian.)

Certainly, following one of his working trips to Twillingate, Ecke wanted to know more about socialized medicine. In the spring of 1937 Ecke contacted William Lockwood, research director for the American Council Institute of Pacific Relations in New York City, who advised him to get in touch with Dr. Frederick D. Mott who was assistant to the Medical Director of the United States Federal Resettlement Administration (forerunner of the FSA) based in Washington, DC.

Lockwood sensed simpatico between these two young doctors and urged Ecke to look Mott up because he thought they "ought to know each other." Mott, who graduated in medicine in 1932 from McGill University (which at this time was another hotbed of medical reform owing to the activism of Norman Bethune and his contemporaries), was one of the leaders of American socialized medicine. He, along with colleague Dr. Milton I. Roemer, would write the pioneering and definitive monograph Rural Health and Medical Care in 1948. Mott and Roemer were among Sigerist's social medicine fellow travelers. Shortly after this book was published, Mott moved to Saskatchewan in the Canadian rural west to establish the healthcare plan that had been thwarted south of the border. Roemer also migrated temporarily to Canada. The dream of socialized medicine, although shattered in the United States, survived in Canada. And there was also Twillingate, Newfoundland — the colonial outpost in the Atlantic Ocean that no one really knew about it, but, ironically, could have become the "poster child" for American-style social/rural medicine in the 1930s!

Rhoda Dawson (Bickerdike), sketch of Hospital Operation, likely circa 1936, charcoal and mixed media on paper 35.5 cm x 49.5 cm. The Rooms Provincial Art Gallery, Memorial University of Newfoundland Collection, 94.7.19. Image reproduced courtesy of Richard and Susan Wallington.

It is unlikely that the people of Notre Dame Bay ever fully knew the dimensions of the person, or completely appreciated the man they would call "Doc Hackie" as Bob Ecke was popularly called. In contrast with their local hero, John Olds (or rather "Holds"), who spent his entire professional life with them, Ecke made only five visits to Twillingate totaling a few years. But during his days at the NDBMH, first as a visiting Hopkins medical student in the summer of 1934, then as junior hospital doctor intermittently for the period 1937 to 1941, and finally as acting Medical Director from 1947 to 1948 (to relieve Olds temporarily), he was an astute observer and recorder of peoples' medical troubles as well as their lives and times.

His diary, later published in 2000 as Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948, provides a wonderful written account of events, which includes much introspection about his own professional development as a rural doctor. This textual material is supplemented by his still extant colour movie footage (extremely rare for this time and place) as well as his black-and-white still photographs. Fortunately these archival documents are now safely housed in Memorial University. (Ecke himself led an interesting life not only as a doctor, but also medical researcher, military officer, and CIA agent.)

Unlike most other medical memoirists who write at the end of their careers when memories can fail, stories can become embellished, or events are filtered through other life experiences, Ecke's detailed and candid journal and log documents the beginning of his career as physician and surgeon. The rural medical practice that Ecke and his coworkers undertook was of immense breadth and depth, for it embraced almost every facet of interventionist and preventive medical care imaginable at the time. Ecke and his colleagues worked around the clock in the hospital operating room, the outpatient department, the wards, and patients' homes when they made their many house calls.

He traveled by foot (with and without snowshoes), dog team, horseback, skis, dog and skis (skijoring), horse and sled, motor bike, motor boats, dories, and larger vessels, motorized snowmobile, and the occasional automobile. He feared for his life many times as he got lost in blizzards, fell through semifrozen ice, got tossed around in North Atlantic storms, and crashed vehicles he was driving. When necessary he would sleep in the homes of patients on a spare bed, a chair, or on the floor. Often on these occasions he shared their food, drink and hospitality; often he would bring food to them. Typically, any formality and protocol quickly gave way to common sense and/or survival.

As well as land-based practice, Ecke (usually accompanied by a nurse and skipper Elijah Dalley) spent up to a month a year aboard the hospital's nautical clinic, the Bonnie Nell, as they traveled around the coastline and countless islands from Cape St. John to Musgrave Harbour. During these trips about 1,000 patients (which included contract subscribers) were treated at between 60 to 70 ports of call either on board, or on shore calls. The common sense of the NDBMH going to those people who under normal circumstances could not regularly travel to Twillingate is obvious, but again there was an earlier inspiration in Grenfell's various hospital ships that plied the Labrador coast.

Medical and Social Life at the NDBMH

More specifically, the personal journal of Dr. Bob Ecke illustrates the importance of varying clinical aspects of his practice as reflected in the relative frequency of their being mentioned. "Tonsils and things in the morning and I took out another appendix. Tonsils—tonsils—I wish I had never heard the word," declaimed Ecke in a fit of frustration on November 11, 1938. Such comments highlight routine surgical procedures undertaken, which included sophisticated abdominal operations, as well as more routine tonsillectomies (very common), dental extractions (extremely commonplace), and a very high relative frequency of appendectomies. The treatment of infectious and communicable diseases (tuberculosis, typhoid and other fevers, poliomyelitis, meningitis, syphilis) as well as the promotion of public health measures and preventive medicine also figured prominently. Punctuating these general classes of cases was a host of others involving dermatological, neurological, cardiac, gynecological, urological, and mental illness conditions.

Accident and occasional cancer cases rounded out this picture of an all-encompassing general rural medical practice. Very infrequently were patients referred to St. John's or elsewhere for additional or more advanced treatment; more typical was the transfer of difficult cases from more northern settlements to Twillingate (often these were lost causes involving extremely sick people who would die shortly after their arrival at the NDBMH). The hospital was adequately equipped to undertake bacteriological and radiological testing, basic blood work, and commencing in 1939 it acquired an ECG machine for cardiac examinations (putting it at the forefront among similar rural institutions).

An overview of some basic quantitative measures of hospital activity illustrates how much busier the NDBMH had become a decade after 1928. Examining hospital annual reports for the years 1937, 1938, and 1939, for which we have complete data and which is also a period corresponding with Ecke's practice in Notre Dame Bay, shows that total days of patient care rose from just under 15,000 to just under 17,000. Although the hospital was nominally a 70-bed institution, there were typically from 80 to 90 patients there at any one time; total number of admissions also rose during these years from 437 to 510 annually. Over these years the mortality rate averaged 3.6%, with medical and tuberculosis mortalities accounting for the majority of deaths. Out-patient Department annual visits almost doubled from 2,066 to 3,752.

As society in Twillingate and environs became "medicalized," its people "hospitalized," so too did the hospital become increasingly "technologized." The number of diagnostic procedures increased from 1,821 in 1937 to 2,615 by 1939, with laboratory tests (blood, urine, bacteriology, and so on) leading the way. The totality of these statistics shows that the NDBMH had become an institution comparable to most rural hospitals in North America; indeed, it seems reasonable to surmise that given the diversity of its case load, the high quality of its medical staff, and its technological sophistication, this particular hospital ought to be considered a leader among its peers at this time.

The overwhelming majority of Ecke's time, however, was spent dealing with pregnancy and obstetric cases, including a number of caesarian sections — perhaps not surprising when Newfoundland had one of the highest birth rates across North America and northern Europe. Ecke's numerous accounts of his obstetric escapades, however, are the most illuminating with respect to the trials and tribulations of both rural doctor and patient. Such accounts also illustrate how the hospital increasingly came to be seen as an essential service, but in so doing it might give rise to other clinical dilemmas.

[June 1, 1938] I was sent down to Manuel's Cove to see a Mrs. [G—-]. The name didn't mean anything to me. I wandered down and it seems she has been pregnant for years. She has been in a kind of mild labor for three days...They must be the poorest people in Twillingate, but their house is the one where I would take a visitor to see a really lovely fisherman's home. Clean, neat, attractive garish wallpaper. Curtains of bleached flour bags with colorful bits of cloth appliquéd to make borders. The kitchen has lots of hooked rugs, a well-shined low stove, a few homemade chairs, and a good-looking sideboard, also homemade.

Upon seeing the patient Ecke remembered who she was owing to the missing leg that had been amputated four years previously because of tuberculosis of the knee. He continued to note that she was a hard-working, honest woman, but no merchant would advance the family food; there was not a crust of bread in the house.

She lay there quietly in bed…I examined her and the baby seemed to be huge. I felt we would never be able to do anything in the house. In fact, I was sure she would need a caesarean. I explained to her that she couldn't have a baby without an operation. There was none of the frequently encountered hysteria. She was silent for a moment while her eyes became moist. "All right, doctor," she said quietly, "do what you can to help me but remember, life is sweet." I was deeply stirred by this woman's plain faith in the world — in the face of the little it had done for her. I got out of the house quickly, so her husband wouldn't wonder why my eyes were wet.

The result of the caesarean procedure was the birth of an extremely hydrocephalic baby that forced Ecke to wonder what would have been the outcome had he attempted a home birth as was usual. But the family situation pushed him to reflect further on the child's chances of subsequent survival. "I told the nurses not to urge it to breathe but, of course, it came to life at once and thrives," he entered in his diary. Ecke further noted how a little later he "leaned over it in the nursery several times and wondered if I should pop a morphine tablet into its mouth. But it is not nursing too well, so I don't believe it will really survive." Ecke's contemplation of active euthanasia in this case may reasonably be viewed as an example of the paternalistic nature of medicine at this time, but by the same token his potential action was grounded in the ultimate well-being of a destitute fisher family. In some respects his intimate knowledge of economic and social matters due to his access to this tight rural community was a drawback as it ensnared him in this moral dilemma. Presumably, nature resolved this situation as there are no more entries about this case.

Clinical activities occupied much of the day and night time of the medical staff at the hospital, but the social pastimes which took place in the hospital compound were also important. There were seasonal dinner parties (Thanksgiving and birthdays, for example); bridge, chess, reading, listening to classical music and opera on the gramophone and the BBC as well as American radio stations, playing Beethoven on the piano, and intense conversation were year-long pursuits, all depicting a bourgeois existence within the enclave of the hospital and its micro-environment.

The extent of the general social and intellectual gulf between hospital life and that of patients in this northern, rural setting is evident from Ecke's writing, but he further distinguishes the gap by noting how people living on isolated islands were different yet again from those of Twillingate, who had "been spoiled a little by the near civilization we have here" (February 23, 1939).

The "near civilization" of Twillingate owed much to the creation and operation of the hospital. How? Hospitals, as those who write their history, and those who work in them know, are not just purpose-built structures — merely bricks and mortar. No matter how impersonal they might appear, they are actually microcommunities with personalities that often impress themselves on their host environment. The NDBMH was the largest and only non-wooden structure in Twillingate; it had its own internal plumbing system; electricity was supplied through a hydro-electric plant on hospital grounds; it housed exotic, complex scientific apparatus; life-saving events happened inside its walls. In short it was a technological palace that announced that modernity had arrived. Similarly, those in white coats who ran the hospital symbolized the new and the progressive. These men and women were highly educated, hailed from bustling metropolitan centers, ate different foods, engaged in cultured activities, even dressed formally for dinner on occasions. In short, they were urban, urbane and civilized.

An undated section of Ecke's journal that is especially reflective in tone and intent, perhaps written during the fall of 1940 (but before 1942), explores these issues of mixed social status and society, along with rural medical practice.

This privileged lifestyle, augmented by the fact of being the only hospital and doctors available for "most of the bay people" meant that they were all but indispensable. The total effect was that it gave "our ensemble a slight 'manor' quality." But keeping everyone grounded was the local system of social and community values which held that "[u]nearned income or even large, earned income does not especially increase a man's stature…The man who is respected is the man who works hard, who fishes well, who can build a house or a boat. The true aristocrat is the man who has skippered a ship well or is a good pilot."

Innovation, Change and Tradition and the NDBMH

In the beginning the NDBMH was funded in both traditional and innovative ways — indeed, the Twillingate hospital can be viewed as a North American pioneering model of sorts that has gone virtually unrecognized historically. Much of this had to do with Newfoundland's unique North Atlantic geographic and political location that allowed easy exchange of ideas and people from both Britain and the United States. The hospital at Twillingate and the extended healthcare it provided throughout the region was in many respects "high tech" for such a rural institution of the era, but its culture was grounded in that of the people it served. Nevertheless, general technological "progress" — one guise of modernism — was an almost impossible force to arrest once it had been unleashed. "When I first came here [summer of 1934] there wasn't an operating radio on this island [Twillingate]," Ecke wrote in his journal. He continued, "Gradually refinement has crept up on us. We used to have poor lights in the hospital, the diesel had to be conserved and was always getting cut off in the middle of a poker game. I liked the flurry of getting out kerosene lamps to continue the game...Now we have an efficient gasoline generator ready at all times. I feel threatened by "efficient" machinery and somehow it makes me feel inferior. We used to have to settle down to very plain food in the winter. Now [the local merchant]...imports fancy canned goods and takes the risk of bringing in fresh tomatoes in the middle of winter."

Similarly, the new brand of medicine qua technology and practice further effected social change. Again, quoting the ever observant and reflective Ecke: the "older fellows who didn't take the doctor too seriously are heavily outnumbered by the younger folk who have come to realize that medicine is here to stay [emphasis added]."

And they were right! Parts of the original hospital would be destroyed by disastrous fires during the 1940s. But the hospital never stopped functioning. The entire original 1920s architectural landmark would be razed. But this made way for the building of an entirely new Notre Dame Bay Memorial Hospital structure that opened in 1976. The series of innovations initiated in the early 20th century by Parsons, Olds, and their successors brought change that altered some local traditions, but they also created a totally new tradition of regional medical service with the hospital as its keystone.

Acknowledgements
I would like to thank my colleague, Dr. Jennifer J. Connor, who along with our students in our history of rural medicine graduate seminar (Shaina Goudie, Conor O'Dea, and Heather O'Reilly), helped shape the contours of this paper.

J.T.H. Connor is John Clinch Professor of Medical Humanities and History of Medicine at Memorial University.