Introduction

This section examines physicians’ efforts to practise medicine in widely diverse societies and the duties they envisioned for themselves. In the first case, Sören Edvinsson clearly shows that Dr Ellmin did not see himself as solely a purveyor of modern medicine to a remote area of nineteenth-century Sweden. There is no doubt that Ellmin also believed he was engaged in an adventure that he felt compelled to document. His mission was not only a ‘civilizing’ one; he also wanted his superiors in Stockholm and the Swedish public to learn about the hardships these residents of the north endured. Ellmin was a doctor, an adventurer and, to some degree, an advocate for the Sami people. As such he found himself in the liminal position between state employee with an obligation to introduce academic medicine as defined by his superiors in Stockholm, and social critic who believed that the government had an obligation to improve the physical and economic conditions in which the people lived. Øivind Larsen's contribution focuses more attention on the degree to which doctors were able to direct medical legislation particularly during periods of abnormal morbidity or mortality. He concludes that such legislation was often based upon perceptions held by distant physicians rather than cold scientific or statistical data. We find doctors asking whether certain patterns were unusual and, if so, were they markedly different than what had come before? Were the people themselves responsible for their ill-health or was their condition evidence of government neglect?

The ‘country doctor’ in the twentieth century has been analysed from numerous perspectives, 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. 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. 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.

Introduction

The remote regions of Europe and North America provided an environment in which women were most able to challenge and overcome many of the social and professional restrictions placed upon them. This was as true in nineteenth-century Greenland as it was in twentieth-century Canada or Finland. Mette Rønsager demonstrates that Danish authorities gave midwives tremendous responsibilities not only to bring medical care to the indigenous people of Greenland, but also to train local women to become skilled birth assistants. In this way they were instrumental to bridging the gap between Danish and Greenlandic cultures and in so doing were performing many of the same duties as male explorers and bureaucrats who set out to claim and control new lands and people. Nurses in New Brunswick during the middle third of the twentieth century, who are the subject of Linda Kealey's contribution, were engaged in a particularly complex set of negotiations between local populations and the Red Cross, and between social and professional expectations and their own personal goals. The Red Cross was almost entirely responsible for providing nursing care especially in the more isolated parts of the province and relied heavily on public support for its initiatives. The nurses were charged, not only with responding to medical emergencies, but also improving the health of individuals and, by extension, ensuring the health of the nation.

Introduction

The authors of this section illuminate some of the major challenges states confronted in their efforts to provide medical care in remote areas. One problem was to attract and retain skilled medical practitioners willing to work in such isolated and physically demanding surroundings. Government officials also found it difficult to maximize the medical benefits they could offer while keeping costs firmly under control. This certainly was no easy feat when a small population was dispersed widely over a hostile environment. A sense of suspicion, both on the part of the medical practitioners and the intended recipients of medical innovations further complicated the efforts to introduce a more uniform level of medical care. Those living in the northern-western province of Russia that Steven Cherry and Francis King discuss were particularly reluctant to accept medical ‘outsiders’ and this was a major obstacle to the spread of academic medicine. Taken together, the contributions by Teemu Ryymin and Astri Andresen reveal a long history of state involvement in the provision of medicine to the Sami. During the course of the twentieth century the Norwegian government gradually abandoned its efforts to impose its perception of medical ‘improvements’ upon those living in the far north. Instead, it launched a comprehensive medical initiative particularly during the second half of the century that consisted of large financial expenditures and a new-found respect for Sami culture.