Historicist: Guarding A City's Health

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Historicist: Guarding A City’s Health

Every Saturday morning, Historicist looks back at the events, places, and characters—good and bad—that have shaped Toronto into the city we know today.
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Dr. Hastings, M.O.H., in his office (January 13, 1925). City of Toronto Archives, Series 372, Sub Series 32, Item 749.
In the late 19th century, Toronto’s booming growth and industrial development brought with it the problems of slums, pollution, epidemics, poverty, and ill health. Following trends in Britain and the United States, reformers agitated for public health and social welfare policies to address these new urban ills. Although Dr. William Canniff was appointed the city’s first permanent, salaried Medical Health Officer in 1872, rate payers and property owners objected to the growing state interventionism. As a result, civic politicians only begrudgingly instituted the most gradual of reforms. In this hostile political environment, it would take a strong personality to successfully campaign on behalf of the city’s neglected health department. Such a personality emerged in 1910, and under the guidance of Dr. Charles Hastings, Toronto became the Canadian leader in public health reform.


2008_08_16HastingsPortrait_642.jpgAlthough he’d done some post-graduate studies on public health in Britain, Hastings’s true passion for public health rose from personal tragedy. His baby daughter was killed by contaminated milk that was later traced to a dairy farmer who had typhoid fever. That was the reason why, at age 52 and nearing retirement from his practice in obstetrics, Hastings switched careers. Upon his appointment as Medical Health Officer in 1910, Hastings took over an operation that, according to a Star retrospective, was so haphazard that his first office, in the Division of Meat Inspection, “consisted of a radiator with a board on top, for sitting or writing reports.” With a budget of $85,000 and a 70-person staff—few of whom had professional qualifications—the department occupied itself with investigating complaints about unsanitary food and managing two hospitals. With a commanding personality but a congenial air, according to the Star‘s description, Hastings “argued, wheedled, conned and bullied” city council into adopting measures of reform. He later recalled how his department never backed down from a fight:

In bringing about these reforms, we were submitted to all sorts of criticism and abuse, but criticism has about as much effect on me as water on a duck’s back. When I went to the Department, I knew I had a duty to perform and I went determined to perform it though all hell should order me silent.

Unlike his predecessors, Hastings actually succeeded in convincing the city that spending money on public health was an investment, not an expenditure. By the time he retired nineteen years later, he had a skilled staff of 500 operating with a $1 million annual budget.
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Daily operation (May 1913). City of Toronto Archives, Series 372, Sub Series 32, Item 212.
In 1910, Hastings set about addressing what he saw as the two most outstanding sources of disease transmission: milk and the water supply. Babies and children were especially vulnerable to the common threat of milk-borne diseases, such as infantile diarrhea, typhoid, diphtheria, septic sore throat, and bovine tuberculosis. Hastings used strict supervision of dairies, veterinary inspections of livestock, and sedimentation tests to ensure Toronto’s milk was free of barnyard contamination. Adopting a scientific view to the problem, Hastings insisted that dairies heat their milk to 145 degrees for thirty minutes to kill any remaining bacteria. And so, in 1911, Toronto became the first Canadian city to enforce pasteurization.
Turning his attention to the water supply next, Hastings convinced the city to become one of the first in North America to chlorinate its water and helped convince the city to modernize the indoor plumbing and sewer system. He also took the sanitation of the food supply seriously by ordering full inspections of slaughterhouses and requiring medical examinations of food handlers at grocery stores and restaurants. With time, the department began inspecting health hazards in factories and took over the board of education’s duties for school inspections. With these and other reform initiatives, Hastings expanded the mandate of the health department to include broader aims of social welfare.
Addressing the Canadian Club on December 11, 1916, Hastings justified his department’s expenditures by detailing evidence of its successes. Deaths from diseases like diphtheria, scarlet fever, and typhoid fever had dropped from 107 per 100,000 in 1910 to only 19 per 100,000 in 1915. Furthermore, the infant mortality rate in 1915 was 33% lower than in 1910. That rate had been 139 deaths per 100,000 in 1910, but it was only 93 per 100,000 by 1915.
Speeches like this demonstrated Hastings’s understanding of how to employ publicity and the media as educational tools in the service of reform. He said:

In order to accomplish these reforms, we have had to secure the co-operation of those with whom we have to deal. This means education. We are fortunately living in an age when people no longer want to be treated as machines. When they are told to do things, they want to know why. Therefore, the first duty of the Department of Public Health is to educate the public. We are consequently endeavoring to enlighten the public through the press, health bulletins, public addresses, leaflets, and in every other way that we can hope to reach them.

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Visit from public health nurse—medical check-up for school boy (May 6, 1914). City of Toronto Archives, Series 372, Sub Series 11, Item 110.
In addition to running well-baby clinics and other clinics, the health department’s nursing staff were sent into the community to have “heart-to-heart conversations” with members of the public. Their wide mandate was to teach and reiterate the best practices for hygiene and health and the prevention of the spread of disease. Their duties encompassed tuberculosis, child welfare, pre-natal child hygiene, and social service. The medical establishment sometimes objected to nurses dispensing medical advice without a medical license, but their services were an undeniable benefit to the city. The quarantine service organized by Hastings, for example, treated people with infectious disease, then fumigated their homes.
Hastings blamed much of the illness in the city on poverty. After his department’s 1911 report on slum conditions shocked the middle class, he became a pioneer advocate for public housing. Numerous studies during Hastings’s tenure had also concluded that many of the children in Toronto’s low income neighbourhoods suffered severe malnourishment, which he tried to counter-balance by distributing free milk. While Hastings emphasized an individual’s personal responsibility in his or her own health, he also emphasized that society as a whole had to care for all its citizens irrespective of class or origins. Speaking passionately to the city’s elite at the Canadian Club, Hastings emphasized their responsibility to care for the community’s less fortunate:

It is only when we bring these matters home to ourselves that we can realize what the saving of one human life means; what the saving of one case of sickness in a home means, and we must not forget that the infant and the little boy and the little girl in the humblest home in Toronto is as precious to their parents as our infants and children are or ever have been to us.

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Health Service – Oriole Park School (September 18, 1934). City of Toronto Archives, Series 372, Sub Series 32, Item 852.
Modern-day critics, such as historian Mariana Valverde in The Age of Light, Soap, and Water (McClelland & Stewart, 1991), have re-evaluated whether the health department’s wide-ranging activities were entirely benign. Going into people’s living rooms on the inherent assumption that low income women did not know how to care for or cook nutritional meals for their children could sometimes make the department unpopular in low income neighbourhoods. It also showed how the department’s reform impulse carried within it a regimen of moral regulation. In the 1930s and beyond, growing bureaucratization meant the department lost some of its early reformist zeal. Some critics, such as historian Heather Anne MacDougall in Activists and Advocates (Dundurn, 1990), felt the department became too closely aligned with politicians and too concerned with minimizing budgets, so outside agencies and reformers reemerged as a force providing social services.
At the age of 71, Hasting retired in 1929 after nineteen years at the head of the city’s health department. Upon his death two years later, he was eulogized by the Canadian Medical Association Journal: “It may be said, without the slightest exaggeration, that as a public health administrator Charles Hastings was without a peer on the continent.” At a time when public health encompassed much wider social welfare initiatives than just health and hygiene, Hastings’s unceasing efforts made Toronto a shining example for the rest of North America.
Portrait of Charles J. Hastings, M.D., Medical Health Officer, Toronto (March 15, 1922). City of Toronto Archives, Series 372, Sub Series 32, Item 642.

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