Island Doctor: John Mackieson and Medicine in Nineteenth-Century Prince Edward Island (review)

Reviewed by: Island Doctor: John Mackieson and Medicine in Nineteenth-Century Prince Edward Island Paul Berman Island Doctor: John Mackieson and Medicine in Nineteenth-Century Prince Edward Island. David A.E. Shepard. Montreal and Kingston: McGill Queen's University Press, 2003. Pp. 208, illus. $44.95 John Mackieson was born in Scotland in 1785 and graduated from the University of Glasgow with a degree in medicine in 1815. He arrived in Charlottetown, Prince Edward Island, in 1821 and remained there until his death in 1885. He wrote two case books; a 'Code of Medical Experience' also known as the 'Codex,' and a formulary, and he kept a personal diary. The first casebook, 'Sketches of Medical and Surgical Cases,' covers the period 1826 to 1858 and contains 257 case histories on general medical, surgical, and obstetrical subjects, which illustrate Mackieson's caring and compassionate nature as well as the difficulties of practising medicine in the mid-nineteenth century. The second casebook details the diagnosis and treatment of 115 mental patients between 1868 and 1874 when Mackieson was medical superintendent of the Charlottetown Lunatic Asylum. The three remaining texts are the 'Code of Medical Experience' or 'Codex,' a formulary, and the diary. The 'Codex,' eighty-five pages in length, summarizes many local clinical issues and displays Mackieson's intellectual pursuits, noting the various journals and medical texts he read to keep up to date. The formulary lists fifty-nine classes of therapeutic agents and thousands of prescriptions accumulated from various authorities. The diary, which extends from 1847 to 1885, contains little information about his daily life, confining itself to weather, temperature, and a few political and social events. This magnificent collection is a rare find in rural nineteenth-century medical practice. Most historians in the field are lucky to discover a daybook (not in this collection), which may list patient names, diagnosis or procedure, and fee charged or collected. Casebooks do not give much detail; probate records may yield estate finances and in rare instances the actual texts in a medical library. Formularies list various concoctions, and a diary gives information similar to that found in Mackieson's. Sometimes letters and writings of spouses or acquaintances give insights into a practice. But to find all of these primary materials for one particular individual are what makes this collection so unusual. [End Page 159] Shepard not only provides the positive aspects of Mackieson's practice, but details two major episodes that marred his professional life: the Lady Constable affair in 1847 and the 'indictment' of 1874. In 1847 the Lady Constable arrived with an epidemic of typhus on board. Mackieson, who was a member of the central board of health, did not properly quarantine the patients. He was reprimanded for his actions, but no official charges were brought against him. However, in 1874 as administrator of the Charlottetown Insane Asylum, he was indicted for neglecting his patients. The inmates were found living in squalid conditions. Twenty years earlier, when he first arrived at the asylum, he had advocated reforms to improve patient health and welfare, but they failed to materialize because of outside political and economic pressures. In the Lady Constable affair, misdiagnosis of typhus as measles, as well as communication lapses, led to the improper response and placed the general population of Charlottetown at risk. Mackieson was not entirely culpable, but he did play a prominent role. The 1874 case is more daunting, and Shepard admits that he cannot provide comfortable answers for the doctor's behaviour. One wonders if the diary could have provided insights into Mackieson's state of mind in 1874. David Shepard is the perfect individual to examine the Mackieson manuscript collection. He is not only a medical historian but also a retired Charlottetown anesthesiologist knowledgeable about the town's history and that of Prince Edward Island as well as Canadian politics and medical practice in Canada. The book is well organized, and an easy read. The footnotes are a gold mine of information as is the list of secondary sources. Island Doctor is an important contribution to the growing literature of rural medical practice in mid-nineteenth-century medicine. Paul Berman University of Massachusetts School of Medicine...

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