by Jane Jenkins
Like hockey and the CBC, Canada’s public health care system often features prominently in narratives crafted to delineate the country’s distinctive national identity, emblematic of a liberal democracy spread evenly across the country. When region or provinces are featured it is often only as birthing grounds for health care policies which then spread outward. So, for instance, a popular history of early public health reforms identifies Ontario as the province where reforms first emerged in the nineteenth century, serving “as a model for other provinces.”  And, it is claimed, early bacteriological laboratories were established in Canada in the 1890’s, by “building on the Ontario model.” 
This is a sweeping national narrative that has ear ly public health reform birthed in Ontario, its emergence there sitting at one end of a line drawn straight back to Britain and its 19th-century sanitary movement, a response to industrialization, urbanization, and centralized state bureaucracies. When projected onto the Canadian landscape this British model maps neatly onto public health developments in major Canadian cities but can’t explain similar developments in rural, agricultural regions. Indeed, such a model would render New Brunswick an unlikely place for innovative health reforms and, perhaps not surprisingly, New Brunswick is rarely mentioned in most accounts of late nineteenth- and early twentieth-century public health institutionalization in Canada.
Such neglect seems perplexing, however, since remarkably innovative and powerfully centralized government oversight of public health was established in New Brunswick in October of 1918 making the Department of Health created by this ground-breaking legislation the first full ministry of health in Canada and the British Empire. The absence of these New Brunswick achievements from national and even provincial narratives reveals the deep persistence of negative regional stereotyping that views New Brunswick as under-developed, tradition-bound, backward, and therefore, incapable of innovative, cutting edge reform. This negative stereotype dovetails with a deeply entrenched back story of the nation and its British roots, normalized to portray a cohesive “Canada,” using a “nationalizing historiography” that diminishes regional variation or American influences.
My research explores the roots of innovative public health reform in New Brunswick by widening the explanatory lens to look beyond British-origins and Ontario-centric assumptions to trace the trajectory of a distinctly American bacteriological model on a group of New Brunswick physicians who were united by their immersion in American medical training and public health ideologies to carry out public health reforms upon returning to New Brunswick. The Public Health Act of 1918 gave sweeping powers to the Minister of Health and within two years, government-financed free clinics controlled tuberculosis and venereal diseases, offered education classes on nutrition and infant care, and mandated smallpox vaccinations. A central laboratory in Saint John ran tests for food and water contaminants.
Recognition of these accomplishments, which garner slim attention in Canadian public health histories, presents a more spatially nuanced history of public health that geographically situates the formation of public health ideology within the broader context of the mass out-migration of people from New Brunswick in the late 19th century. Many factors, including economic depression and alienation from the Dominion, triggered a veritable stampede of a quarter of a million Maritimers between 1860-1900. The joke making the rounds in the 1890’s was that the situation was described best in two books of the Bible: Lamentations and Exodus! Many young men (and a few women) seeking medical degrees were part of this wave, attending American medical schools including the world-renowned Bellevue Hospital Medical College in New York City.
At Bellevue, New Brunswickers were immersed in the new bacteriological model of disease and the radical reform of medical education, by professors like Hermann Biggs, who emphasized the clinical application of laboratory analysis. They gained practical laboratory experience in the state-of-the-art Carnegie Laboratory, opened in 1884, and learned from public health pioneers like William Sedgwick. Following years-long immersion in this distinctive American system, they deployed aspects of it in New Brunswick.
Alban Frederick Emery graduated Bellevue in 1887 and returned to Saint John where he redesigned the hospital’s administration and established nurse training along Bellevue lines.
George Givian Melvin graduated Bellevue in 1887, worked in Saint John instituting public health regulation of housing, and became New Brunswick’s first Chief Medical Health Officer.
William Herbert Irvine graduated Bellevue in 1893, where he had assisted Biggs in the Carnegie Laboratory, and was instrumental in setting up the first bacteriological lab in Saint John, in 1899.
The best example of the international transfer of public health knowledge is William F. Roberts, a Bellevue graduate of 1894 and New Brunswick’s first Minister of Health. Determined to spear-head reforms, he ran in the 1917 provincial election on a public-health platform. Immediately following his election Roberts travelled to New York to hire public health officers and bacteriologists, since, he stated, “such an official does not get the training called for, thus far, in any of our Canadian cities.” He leveraged Sedgwick for feedback on his proposed health act, advertised in the American Journal of Public Health and leveraged social contacts including Mildred Fish, an ex-pat New Brunswicker who recommended the bacteriologist Roberts eventually hired. There are multiple other examples of Roberts drawing on and deploying the American system to institutionalize public health in New Brunswick, right down to the instruments and furnishings ordered for the lab.
This brief historical geography of public health in New Brunswick writes region into the national narrative and sees the shape of Canadian public health as a textured emergence; something that is lost or submerged in homogenized national narratives. Early twentieth-century New Brunswick had only a small community of professional elites, but united by their immersion in American medical and public health thinking, and led by Roberts’s determination, they established innovative reforms. Rather than serving as evidence of its backwardness, it was New Brunswick’s “under-development” that was the very condition enabling innovation.
The public health reform movement in Canada, therefore, emerged in different situations. It is time to move beyond modernizing narratives that emphasize commonality to ones that acknowledge and map difference and variation, something that will re-place and enrich Canada’s public health history.
Jane Jenkins is an Associate Professor of Science and Technology Studies at St. Thomas University in Fredericton, NB.
 Christopher Rutty and Sue C. Sullivan This is Public Health: A Canadian History (Ottawa: Canadian Public Health Association, 2010), 1.8.
 Rutty and Sullivan, 1.12.