ABSTRACT

The ‘country doctor’ in the twentieth century has been analysed from numerous perspectives, 1 but it is only recently that historians and other scholars have begun to problematize the concept of ‘rural medicine’. But what constitutes rural or remote medicine as a historical sub-specialty of the history of medicine and health? Even those who currently practice, promote and study health care in the hinterlands remain unclear about the definition of ‘rural’; while proponents may disagree, however, there seems to be a consensus that simply being ‘non-urban’ or ‘agricultural’ is not a satisfactory definition. Sparse population density and isolation are clearly factors to be considered, but so too are social and community mores and conventions (perhaps ‘the people’ and the sense of ‘place’ would be a convenient shorthand for such factors) as well as climatic extremes. 2 The economy (or its collapse) in a region is another element that helps define rural – especially if it is/was derived primarily from the exploitation of natural resources rather than from an industrialized manufacturing base or mixed market economy. 3 Historians, therefore, should consider local culture, climate, geography and the economy in understanding rural medicine along with the usual staples of technology, changing techniques and practice patterns, institutions, and the treatment of disease and injuries. Through study of the isolated Newfoundland outport of Twillingate located in the eastern archipelago of Notre Dame Bay, this paper considers these social and physical factors by focusing on one practitioner and his personal and professional interactions with this community during the 1930s. Basing this study on the detailed and sensitive diary of a young American doctor, Robert S. Ecke, in addition to supplementary archival materials pertaining to the small rural hospital that he was based in, a narrative emerges that is much larger than its individual parts. Although this analysis can be categorized as a micro history and perhaps as biography, it also is useful for exploring the broader evolution of rural or ‘frontier’ medicine and its relations to ‘modernization’.