Public Health in the Archives: Peter Bryce and the Power of Primary Documents
By: Madeleine Mant & Paul Hackett
Dr. Madeleine Mant is an Assistant Professor in the Department of Anthropology at the University of Toronto Mississauga. Her biocultural research program examines health inequities in marginalized and institutionalized human groups through an interdisciplinary integration of bioanthropological and archival datasets. Her work investigates and amplifies previously unheard voices, demonstrating the powerful legacy of historical health in shaping health consequences and experiences today.
Dr. Paul Hackett is an Associate Professor in the Department of Geography and Planning at the University of Saskatchewan, and a research faculty member in the Saskatchewan Population Health and Evaluation Research Unit. His research focusses on the historical impact of cultural change on Indigenous communities in Canada. Major subjects include the history of tuberculosis and the emergence of type 2 diabetes.
Historical and anthropological research using archival documents can support and extend the legacy of Dr. Peter Henderson Bryce’s ground-breaking exposure of the Canadian government’s criminal treatment of Indigenous children in residential schools. Among the Truth and Reconciliation Commission’s 94 Calls to Action, Number 18 calls “upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian governmental policies, including residential schools” (TRC, 2015, p. 2). Historical health research must respond to this critical Call to Action. Archival records concerning health in Canada are a key source of information in reconstructing health histories and can aid our understanding of the past legacies that influence current healthcare.
What sorts of archival records might a historical health researcher wish to access? Such holdings are rich and diverse, and may include hospital admission and discharge lists, admission health assessments, physicians’ and surgeons’ case notes, notes concerning patient diets, death records, photographs, among others. International historians looking to access patient voice and study histories from below (following the work of medical historian Roy Porter) have engaged with historical medical documents such as patient records, consultative letters, and admission records (e.g., Connor, 2021; Mant & Prine, 2020; Risse & Warner, 1992; Williams, 2005) to uncover patient voices from the past.
What are the ethical implications of using historical health records for research? Working with historical medical documents requires sensitivity, as intimate medical details may be present in such records, information which was acquired in confidence; patients may or may not have shared these details with their networks during their life (Meyer & Montcrieff, 2021). In many cases archived medical records may be embargoed for a period of time (often 100 years) in an archival setting, meaning family members, community members, or other researchers may not have any access to certain sources. Methods used to engage with available sources ethically can include anonymization of sources, presenting results in a summarized format (so no individual patient may be identified), and in some cases consulting the sources for context but not including them in a final analysis. These ethical considerations must be made each time a researcher encounters a primary source to do with health. There is always the possibility that accessing historical health records could do harm to people in the present.
Abonyi and colleagues (2016) reflect upon the ethical challenges inherent in consulting archival records specifically with connections to Indigenous health research, highlighting the National Centre for Truth and Reconciliation, “whose mandate includes truth-telling about the legacy of Indian residential schools.” They discuss how some historic health information is in the public domain where there are no specific mandates or protections placed upon the datasets. The authors therefore undertook anonymization of datasets, reported data in aggregate form, and continued consultations with affected communities, to acknowledge the importance of protections to ensure that records concerning children forced to attend residential schools are used for research “in a manner consistent with contemporary Indigenous health research ethics guidelines in Canada” (Abonyi et al., 2016), which include community engagement, respect for Indigenous governing authorities, and institutional Research Ethics Board review (Government of Canada, 2018).
How were the health records created? Why is this important to consider? The context of creation is important to consider, as “those whose information is contained in historical medical records are generally the subject rather than the creators of the archive” (Meyer & Montcrieff, 2021, p. 69) and such records were not created with a future historian or anthropologist in mind. The contexts of creation, and thus the potential ethical implications of accessing and using the documents, are as diverse as the records themselves. Medical reports were generally created with the purpose of addressing specific health issues or challenges, with no thought given to secondary use in the distant future. Others, such as records attached to wartime service, were used to determine combat fitness or adjudicate pension applications and were not envisioned to be used to understand the broader consequences of the wars of the past. Entrance examinations to residential schools of Indigenous children in Canada that included a physical examination component were implemented to weed out potential students with tuberculosis or at high risk of developing the disease but have today been used successfully to draw inferences about the nutritional health of First Nations youth during the first half of the twentieth century (Hackett et al. 2016). Historical public health reports from governments could provide key information both at the individual and community level. Despite being used for a purpose that was never intended, medical records, when considered in context, can provide details on “social experiences and mentalities as well as quantitative information” (Risse & Warner, 1992, p. 185). Other records that contain useful information about past health were not collected as health documents in the first place, a reality which can lead to differing ethical challenges. Fur trading journals, newspapers, and even missionary reports have all provided key data about past health (Hackett, 2002). Some of these may even speak to the past health or other circumstances of living individuals. In these cases, access by health researchers, educators, and students may be readily permitted or possible.
Nevertheless, and despite the broader importance for moving forward our commitment to the goals of Truth and Reconciliation, historical health documents, even those of people who passed away decades ago, may be placed behind a legal firewall, leaving them all but impossible to access. Depending on the jurisdiction, legislation such as PIPEDA (Personal Information Protection and Electronic Documents Act) in Canada and HIPAA (Health Insurance Portability and Accountability Act) in the United States may be invoked to cut off access. Currently, this barrier can apply equally to Indigenous people of the public who wish to more clearly understand the history of medical treatment of their family and community, and academic researchers who wish to shed light on the questionable policies and actions of government, church, or other actors. While the concerns around ethics and the rights of individuals around their data are real and must be addressed, it is nonetheless the case that the current owners of those records, whether government or church, benefit by not having those circumstances revealed.
Where are historical health archives curated? As it stands access to these crucial records is patchwork; the public and researchers may find themselves faced with an array of regulations and barriers depending upon the age of the records, the content of the records, and the rules of the curating institution. An institution, either health-related or religious, might maintain and curate their own records, requiring researchers to apply to view certain documents. They may also impose strict limitations on how the records may be consulted or used in publications or other knowledge translation activities. Others may be curated by larger civic, provincial, or federal archives. Still others might be held by private individuals, adding an additional layer of complexity. Tracking down the appropriate holdings requires collaboration between researchers and archivists.
Historical health research is challenging, and researchers must consider their power and positionality in reference to the individuals they are studying. Nevertheless, history shows that it is imperative that scholars pursue this research since contemporary health challenges have their roots in the past. In the Canadian context, tuberculosis is a legacy of colonialism. Higher rates of tuberculosis exist in First Nations and Inuit than in non-Indigenous Canadian-born people (Health Canada, 2012). The foundation of this current health crisis was witnessed by Dr. Peter Henderson Bryce at the beginning of the 20th century. A pioneer in the emerging area of public health, Dr. Bryce became the Chief Medical Officer for the Department of Indian Affairs in 1904. Part of Bryce’s remit in this role was to inspect residential schools in the prairie provinces and “obtain a statistical statement of the past history and present condition of the health of the children who have been pupils at the different schools” (1907, p. 17). His inspection resulted in the 1907 document, Report on the Indian Schools of Manitoba and the Northwest Territories, in which he outlined the fact that “of a total of 1,537 pupils reported upon nearly 25 per cent are dead…everywhere the almost invariable cause of death given is tuberculosis” (1907, p. 18). The report was presented to the Department of Indian Affairs to a distinct lack of fanfare and failed to find its way into the public consciousness. Frustrated by interference from the federal government’s deputy superintendent of Indian Affairs Duncan Campbell Scott but undeterred, Bryce continued to collect vital statistics up to 1914. Following his forced retirement in 1921, Bryce had the freedom and wherewithal to publish The Story of a National Crime in 1922. Bryce’s careful record keeping and attention to the broader impacts of these vital records were critical to our current understandings of the long legacy of health impacts from the residential school system. Bryce’s reports are not simply ‘snapshots’ of conditions in residential schools, they are revelatory of years of willful neglect.
The Story of a National Crime is a key publication in public health history in Canada. Bryce’s work underlines the criminal nature of the Canadian government’s actions and inactions regarding the horrific conditions at the schools. Bryce’s concern was the high number of tuberculosis cases and deaths found in the residential school system. Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Most commonly spread through respiratory droplets, tuberculosis bacteria can burrow deep into an infected individual’s lungs. A person exposed to tuberculosis may not develop an infection or active form of the disease, though risk factors such as young age, malnutrition, and other co-morbidities can increase their chances of progressing to the active infection. So, too, can overcrowding and poor ventilation. Without proper treatment, tuberculosis can lead to death.
The spread of tuberculosis in the residential school system was not surprising to Bryce when he witnessed the conditions in these institutions. He notes that tuberculosis “under the defective sanitary condition of many schools…has spread, whether through direct infection from person to person or indirectly through the infected dust of floors, school-rooms and dormitories” (1907, p. 17). Bryce saw few attempts to improve ventilation in the schools, instead “double sashes are on the windows in order to save fuel and maintain warmth…we have created a situation so dangerous to health that I was often surprised that the results were not even worse than they have been shown statistically to be” (1907, pp. 18-19). In The Story of A National Crime (1922) Bryce refers to the “the degree and extent of this criminal disregard for the treaty pledges” (p. 14) and “this trail of disease and death” (p. 14), noting that the results of his previous reports were suppressed from public view.
Recently, as further collections of relevant archival materials have been identified and studied, historians, anthropologists, and health geographers have contributed work continuing Bryce’s work in exposing governmental abuses of Indigenous peoples’ health. Historical records have helped uncover the extent of dietary experiments conducted upon residential school pupils between 1942 and 1952 (Mosby, 2013). Physical examination records of children entering residential schools in Saskatchewan and Manitoba between 1919 and 1953 were accessed from the Department of Indian Affairs to investigate the health history of diabetes among First Nations people in Canada (Hackett et al., 2016). Ongoing work by the Manitoba Indigenous Tuberculosis History Project (MITHP) uses historical photographs of patients and staff from Manitoba’s Indian hospitals and tuberculosis sanatoria to “build knowledge of Indigenous TB history by identifying the people and places in the images” (MITHP, n.d.) and to help in the efforts to find missing patients. This important collaborative and community-based work highlights the painstaking effort involved in historical research, alongside the huge benefits to living peoples.
In Labrador, Cathy Ford, a project manager for the Nanilavut (“let us find them”) initiative, is working to find the gravesites of individuals who left Labrador between 1940 and 1960 to seek tuberculosis treatment; many did not return home (CBC, 2021). Drawing upon Moravian missionary records, provincial vital statistics, and obituaries, Ford is helping families to fill in aspects of their own histories that were previously inaccessible. Finally, the authors are currently researching the early history of Dynevor Indian Hospital, Canada’s first tuberculosis hospital exclusively for Indigenous people. Admission records to Dynevor (1908-34) indicate that tuberculosis was the most common reason for admission. Of the total admissions for tuberculosis, 62.4% were children and youth under the age of 20. Many of these individuals came directly from residential schools to the hospital suffering from the effects of tuberculosis. This work demonstrates the importance of digging into individual institution’s records where possible to continue to bring to light evidence of governmental neglect of this health crisis.
Bryce’s reports languished in obscurity until they were examined by historians working for the Royal Commission on Indigenous Peoples in the 1990s. They were first suppressed by the government he worked for, and then ignored or dismissed by the contemporary public. It is imperative this research, and that which has built on it, finds a broader audience. There is perhaps no better way to honour the efforts of Dr. Bryce and to respond to the TRC’s 94 Calls than to bring both this growing literature and its primary sources into classrooms across Canada. In that way students can be empowered to ask difficult questions and see laid bare the connections between the egregious public policies of the past and the health challenges of the present.
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CBC News. (2021, June 12). New program finds the gravesites of Inuit who left Labrador for TB treatment –and never came home. https://www.cbc.ca/news/canada/newfoundland-labrador/nanilavut-program-burial-sites-1.6058480
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