Activists and Advocates: Toronto's Health Department, 1883-1983

John H. Gryfe is an oral and maxillofacial surgeon practicing in
Toronto.

In the past 150 years, the international public health movement has
evolved through various stages. The “Sanitary Idea” philosophy of
1830 was based on the concept of disease caused by the release of
noxious vapors from rotting animal and human wastes. Sanitation,
however, gained credibility with the discovery in the 1870s of a
microbiologic basis for the etiology and spread of infection.

By the twentieth century, health education was recognized as the means
of controlling epidemics. Concerns about the sources of diphtheria and
small pox diminished with the discovery of vaccines, and were replaced
with instruction on proper sanitation and waste disposal. As well as
direction in reducing the risks of contracting venereal diseases and tb,
officials found themselves discussing the merits of family planning,
teaching expectant first-time mothers proper baby care, and warning
against substance abuse.

No health department was further ahead in these fields than the
municipal department created by Toronto in 1883. This was the product of
a grant from the federal government to collect, ironically, mortality
statistics in Canadian cities with populations greater than 25,000.

The introduction of socialized health care in the early 1960s primarily
as a government-sponsored interceptive treatment modality, moved the
health system to an increasingly aggressive program stressing
prevention. Environmental issues and their impact on health and
well-being ushered in current trends of public health education through
politically encouraged health promotion.

Commissioned to write a history for its centennial, MacDougall has
penned a thorough but colorless account of this progressive municipal
agency. Facts and figures may be the mean of scholars and academics, but
they do little to flesh out the personalities of the controversial and
dogmatic bureaucrats who molded the department into the innovative world
leader that it continues to be. One has little to complain about in the
amount and authenticity of the information presented. Sometimes,
however, “a little bit of sugar helps make the medicine go down.”