Title: 100 Years of CJPH: Special historical notes/le centenaire de la RCSP: Notes historiques speciales
Author: MacDougall, Heather
Publication: Canadian Journal of Public Health
Collection Type: Report
Date: Sep 1, 2009
Words: 4228
Topics: Cholera, Development and progression, Diagnosis, History, Cholera toxin, Epidemics, Canada, History

“Truly alarming”: cholera in 1832/<< Vraiment inquietant >> le cholera en 1832.
Today, as citizens and health professionals debate the range and type of preparations being made to fight a possible influenza pandemic, (1) there may be lessons to be learned by examining the impact of the 1832 cholera epidemic in Upper (Ontario) and Lower Canada (Quebec). Epidemics are episodes in the social and political history of nations and communities (2) that “represent a natural experiment, a kind of strength-of-materials test of the precise relationships among society’s social values, technical understanding, and capacity for public and private response …”. (3) Arguably, the many contemporary concerns about issuing warnings and advice; crafting pandemic plans for allocating personnel, facilities, vaccines and equipment; addressing ethical issues; and determining whether preventive or curative measures will be most effective–part of 21st century control efforts–have deep historical roots.

In 1832, the two colonies along the St. Lawrence and Great Lakes were facing the largest potential influx of immigrants since 1825. But the appearance of cholera in Great Britain in October 1831, after it had caused riots and disorder in Russia and the Baltic ports, (4) meant that a new disease would travel the Atlantic along with the newcomers. Although the 550,000 Lower Canadians and their 220,000 counterparts in Upper Canada were accustomed to aiding immigrants after the long and debilitating voyage, (5) the initial reports of cholera’s high death rate and random transmission patterns raised great concern. What could or should the colonial administrators and colonists do to prepare and to respond if the disease arrived? By analyzing the ways in which roles and responsibilities were divided, describing the logistical challenges and evaluating the impact of social values in shaping the public’s reaction to and the extent of support or resistance to government edicts, we will discover that history reveals multiple layers of epidemics recorded as a single event: the one experienced by leaders, the one experienced by health professionals and the one experienced by citizens and immigrants.

When colonial newspapers reported on the 1831 cholera epidemics in western Europe, Lord Matthew Aylmer, the Governor of Lower Canada, (6) began preparations for its arrival. After persuading Bishop Panet to issue a pastoral circular warning habitants not to interact with newcomers who arrived in late fall 1831, (7) Aylmer asked the Quebec Medical Board (QMB) to evaluate options to prevent or control a disease outbreak, (8) including two policies recommended in circulars from the British central board of health quarantine and sanitation. (4) (p.32-34) The QMB supported both, and in February 1832 Aylmer signed legislation passed by the Assembly to create a quarantine station under military direction at Grosse Ile, 30 miles upriver from Quebec City. (9) In addition, boards of health were to be appointed in Quebec City (population 28,000) and Montreal (population 27,000) to encourage the public to clean their premises and to provide hospital care for the sick poor. * This combination of prevention and control measures reflected the unresolved conflict between contagionist and anti-contagionist views of cholera’s causation. (4(p.33-35))

To fund the various activities, the Assembly appropriated 10,000 [pounds sterling] (approximately CAD$50,000) to pay for the immigrants’ medical care and to provide transportation to Upper Canada. (8) (p.6) Handbills listing cholera symptoms in both languages were prepared, and local papers reported on rumours that cholera had appeared in Upper Canada in late March. To combat the rising anxiety that both colonies were experiencing, official days of “Prayer, Fasting and Humiliation” were held in Lower Canada on May 4 and in Upper Canada on May 16. Although these ritual actions were intended to create community cohesion, they did not mask ongoing political opposition to the impact of immigration, especially in Lower Canada. (10)

The arrival of 400 ships with 25,000 passengers at the beginning of June quickly overwhelmed the limited facilities at Grosse Ile. As the British had already discovered, quarantine failed to prevent cholera from spreading into the host population. Rumours of cases fueled fear and flight, which took the disease from Quebec City into the countryside, where it killed randomly and speedily. (8(p.7-12)) In the capital itself, the four small hospitals and tents on the Plains of Abraham accommodated the sick and dying. The apparently healthy were sent to Montreal, where lack of available hospitals meant that the board of health took over the Emigrant Sheds to care for those who had become ill in transit. The rest of the newcomers were put on lake boats and sent on to Upper Canada while the disease erupted in Montreal. (8(p.14-35))

When news of the epidemic reached Upper Canada, district magistrates closed access to the colony. This self-protective measure was compounded by the flight of river boatmen, who abandoned passengers on the Lachine Canal and upper St. Lawrence. With commerce and immigration halted, Upper Canada’s Lieutenant-Governor, Sir John Colborne, 11 reacted to the crisis on June 20 by providing the magistrates with 500 [pounds sterling] (CAD$2,500) to set up boards of health to create hospital facilities and provide assistance for emigrants to travel to their final destinations. Public meetings led some towns and villages to prohibit vessels from landing the sick and their baggage while others instituted shipboard medical inspections before permitting docking. But the disease continued to spread and arrived in the capital, York (Toronto, population 6,000), on June 19, where its initial appearance prompted the same reactions that had occurred in Lower Canada: panic, flight and widespread rumours. (8(p.52-64))

Merchant James Lesslie’s diary entries for the epidemic (12) noted that daily reports of cases and deaths resulted in “but few persons … coming in from the Country but many leaving & going to a distance.” Lesslie also commented that the York Board of Health urged cleanliness, sobriety, cleansing and whitewashing homes, and burning tar, pitch and rosin “as an anti-Contagion.” (12) Similar measures had been adopted in Lower Canada earlier but did not stop the epidemic. Only the realization that cholera did not kill all its victims prompted a return to normal routines and the resumption of business and politics.

What did this epidemic reveal about the reaction of administrators, health professionals, immigrants and the colonists? Both governors took an active role in combating cholera using their executive powers to implement the advice provided by the British government. But Aylmer and Colborne were also facing significant opposition from the elected assemblies, with the result that their actions were roundly criticized in reform papers and at meetings called to discuss whether immigration helped or hindered economic and population growth. (10(225-7),13) The colonies did not possess many well-trained doctors or medical students, and this shortage meant that apothecaries, priests, nuns, Protestant ministers and volunteers provided much of the medical care and nursing that both colonists and newcomers received. Conflict among medical practitioners over hospital appointments, therapeutic practices and the expectation by local boards that they would visit the sick poor in their homes gratis, as well as limited reporting of cases and deaths, especially during the height of the epidemic, did little to enhance the stature of the profession. (14) With such limited expertise available, health boards appointed lay health wardens to conduct sanitary inspections and provide medical supplies to the sick.

As the health wardens were generally middle class and most of their activity focused on indigent immigrants and the poor, class and ethnic stereotypes often overrode humanitarian impulses. This led to stringent regulations pertaining to burial and the prohibition of traditional mourning practices. Reacting to these violations of long-established norms and fears of premature burial, immigrants and colonists in both the Canadas dug up family corpses buried in unconsecrated ground. They also refused to go to the hospitals and hid their sick. In response, Colborne had Bishop McDonell consecrate the cholera cemetery, but he did not agree to the York Board of Health’s request for a temporary facility to alleviate the well-founded belief that patients were only sent to Toronto General to die. Echoing policies of the British leaders, who believed in the miasmatic theory that foul-smelling places caused disease, Colborne voiced concerns that the proposed temporary hospital was located in a highly unsanitary section of York. (8(p.5760),12-(p.247-53)) Although there appears to be no final resolution of all issues raised, by September the epidemic had ended, and as James Lesslie recorded: * “Confidence is now restored–people visit Town from distant parts–and all moves on as if it [cholera] had not been.” (12(p.245))

The first cholera epidemic provided the template for future disease prevention and control efforts when cholera returned in 1834, 1849, 1854 and 1866. Lessons learned from 1832 efforts included the importance of strong leadership at the central and local levels, clear communication about the nature of the disease and the steps required to prevent or control it, adequate legal and financial support for front-line workers and volunteers, and recognition that each outbreak would generate a social response commensurate with society’s cultural values and perception of danger. These remain the foundation for current policies and programs.

The fourth in a series of five historical articles to commemorate 100 years of CJPH. Guest Editor: Maureen Malowany, PhD

REFERENCES

(1.) Hurst L. Swine flu: How sacred should we be? Toronto Star, July 25, 2009. Available online at: http://www.healthzone.ca/health/articlePrint/671620 (Accessed July 28, 2009).

(2.) Rosenberg CE. What is an Epidemic? AIDS in historical perspective/Explaining Epidemics. In: Explaining Epidemics and Other Studies in the History of Medicine. New York, NY: Cambridge University Press, 1992;278-92, 293-304.

(3.) Rosenberg CE. Siting epidemic disease: 3 centuries of American history. J Infect Dis 2008;197(Suppl 1):S4-S6.

(4.) Morris RJ. Cholera 1832: The Social Response to an Epidemic. London, UK: Croom Helm, 1976;21-23.

(5.) Johnston H. Atlantic migration. In: Hallowell G (Ed.), The Oxford Companion to Canadian History. Toronto, ON: Oxford University Press, 2004;54-55.

(6.) Buckner P. Whitworth-Aylmer, Matthew, 5th Baron Aylmer. In: Dictionary of Canadian Biography Online. Available online at: http://www.biographi.ca/ 009004-119.01-e.php?&id_nbr=3723&&PHPSESSID=5u7m54 (Accessed August 6, 2009).

(7.) Heagerty JJ. Four Centuries of Canadian Medical History, Volume 1. Toronto, ON: The Macmillan Company of Canada Limited, 1928;179.

(8.) Bilson G. A Darkened House: Cholera in Nineteenth-Century Canada. Toronto, ON: University of Toronto Press, 1980.

(9.) Houston CJ. Grosse Ile. In: Hallowell G (Ed.), The Oxford Companion to Canadian History. Toronto, ON: Oxford University Press, 2004;271.

(10.) Ouellet F. Lower Canada, 1792-1840: Social Change and Nationalism. Toronto, ON: McClelland and Stewart Limited, 1980;137-40.

(11.) Wilson A. Colborne, John, 1st Baron Seaton. In: Dictionary of Canadian Biography Online. Available online at: http://www.biographi.ca/009004-119.01e.php?&id_nbr=4359&interval=25&PHPSES (Accessed August 6, 2009).

(12.) Firth E (Ed.). The Town of York, 1815-1834: A Further Collection of Early Documents of Early Toronto. Toronto, ON: University of Toronto Press for the Champlain Society, 1966;240-42.

(13.) Wilton C. Popular Politics and Political Culture in Upper Canada, 1800-1850. Montreal and Kingston, ON: McGill-Queen’s University Press, 2000;118-22.

(14.) Bilson G. Canadian Doctors and the Cholera. In: Shortt SED (Ed.), Medicine in Canadian Society: Historical Perspectives. Montreal and Kingston, ON: McGill-Queen’s University Press, 1981;115-36.

* Lesslie also noted: “It is cheering that no cases of cholera are now heard of … the period of this terrible visitation is perhaps now terminated … Fruit and vegetables are seen in abundance in the market.”

* In the early nineteenth century, hospitals looked after the sick poor who lacked space in their rented dwellings or did not have family or neighbours to care for them. These institutions were funded by local notables, churches, women’s groups, and they occasionally received government donations.

Heather MacDougall, PhD

Associate Professor, Department of History, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Tel: 519-888-4567, ext. 32903, Fax: 519-746-2658, E-mail: hmacdoug@watarts.uwaterloo.ca

<< Vraiment inquietant >>: le cholera en 1832

Aujourd’hui, a l’heure ou les citoyens et les professionnels de la sante discutent de la panoplie de preparatifs necessaires pour combattre une eventuelle pandemie d’influenza (1), il pourrait y avoir des lecons a tirer de l’impact de l’epidemie de cholera survenue en 1832 dans le Haut- et le Bas-Canada (l’Ontario et le Quebec). Les epidemies sont des episodes de l’histoire sociale et politique des nations et des collectivites (2) qui << constituent une experience dans les conditions naturelles, une sorte d’essai de “resistance des materiaux” sur la nature exacte des relations entre les valeurs sociales d’une societe, ses connaissances techniques et sa capacite d’intervention publique et privee … (3) >>. On peut soutenir que les nombreuses preoccupations actuelles concernant la diffusion d’avertissements et de conseils, l’elaboration des plans d’affectation du personnel, des installations, des vaccins et du materiel en cas de pandemie, la reflexion sur les enjeux moraux et la determination de l’efficacite relative des mesures preventives et curatives–toutes interventions qui s’inscrivent dans la lutte contre les epidemies au XXIe siecle–ont de profondes racines historiques.

En 1832, les deux colonies sur les rives du Saint-Laurent et des Grands Lacs s’appretaient a recevoir leur plus grand afflux potentiel d’immigrants depuis 1825. Mais le cholera, apparu en GrandeBretagne en octobre 1831 apres avoir cause des emeutes et des troubles en Russie et dans les ports de la mer Baltique (4), allait traverser l’Atlantique avec les nouveaux arrivants. Les 550 000 habitants du BasCanada et leurs 220 000 concitoyens du Haut-Canada avaient coutume d’aider les immigrants debilites par le long voyage (5), mais les premiers echos du taux de mortalite eleve du cholera et de ses modes de transmission aleatoires suscitaient beaucoup d’inquietude. Que pouvaient ou que devaient faire les colons et les administrateurs coloniaux pour se preparer a intervenir si jamais la maladie arrivait? En analysant la repartition des roles et des responsabilites, en exposant les difficultes logistiques et en evaluant la mesure dans laquelle les valeurs sociales ont structure la reaction populaire aux decrets gouvernementaux et l’ampleur du soutien ou de la resistance a ces decrets, nous decouvrirons que l’histoire met au jour plusieurs strates de l’epidemie consignees comme un unique evenement : celle vecue par les dirigeants, celle vecue par les professionnels de la sante et celle vecue par les citoyens et les immigrants.

Quand les journaux coloniaux font etat des epidemies de cholera de 1831 en Europe occidentale, lord Matthew Aylmer, gouverneur du Bas-Canada (6), se prepare a y faire face. Apres avoir persuade l’eveque Panet de publier un ecrit pastoral exhortant les habitants a ne pas entrer en contact avec les nouveaux arrivants, qui debarquent a la fin de l’automne 1831 (7), lord Aylmer demande au Conseil medical du Quebec d’etudier des options de prevention ou de maitrise d’une eclosion possible (8), dont deux politiques (la quarantaine et l’assainissement) recommandees dans les circulaires du bureau central d’hygiene britannique (4) (p.32-34). Le Conseil appuie les deux mesures, et en fevrier 1832, lord Aylmer signe une loi votee par l’Assemblee visant a creer un poste de quarantaine sous la direction de l’armee a Grosse-Ile, a 30 milles en amont de Quebec9. En outre, il est prevu de creer des commissions d’hygiene a Quebec (28 000 habitants) et a Montreal (27 000 habitants) pour encourager la population a nettoyer ses lieux de vie et a offrir des soins hospitaliers aux malades pauvres *. Ce melange de mesures de prevention et de lutte contre la maladie s’explique par les differences d’opinion quant a la contagiosite ou non du cholera (4) (p.33-35).

Pour financer toutes ces activites, l’Assemblee affecte 10 000 [pounds sterling] (environ 50 000 $CAN) au paiement des soins medicaux des immigrants et a leur transport vers le Haut-Canada (8) (p.6). On prepare des feuillets dans les deux langues enumerant les symptomes du cholera, et a la fin de mars, les journaux locaux rapportent les rumeurs de l’apparition de la maladie dans le Haut-Canada. Pour contrer l’anxiete qui monte dans les deux colonies, on organise des journees officielles << de priere, de jeune et d’humiliation >> au BasCanada le 4 mai et au Haut-Canada le 16 mai. Ces manifestations rituelles veulent favoriser la cohesion sociale, mais elles n’arrivent pas a masquer l’opposition politique aux effets de l’immigration, surtout au Bas-Canada (10).

Avec l’arrivee au debut de juin de 400 navires transportant 25 000 passagers, les installations sommaires de Grosse-Ile sont rapidement submergees. Comme les Britanniques l’ont deja decouvert, la quarantaine n’empeche pas la propagation du cholera dans la population hote. Les rumeurs de cas alimentent la peur et font fuir les gens, et la maladie s’etend de Quebec vers les campagnes, ou elle tue rapidement et au hasard (8) (p.7-12). Dans la capitale, les malades et les mourants sont heberges dans les quatre petits hopitaux et dans des tentes dressees sur les Plaines d’Abraham. Les immigrants qui semblent en bonne sante sont envoyes a Montreal, ou en raison de la penurie d’hopitaux, la commission d’hygiene requisitionne les abris pour immigrants afin d’y soigner les personnes tombees malades en transit. Le reste des nouveaux arrivants est envoye dans le Haut-Canada par bateaux lacustres pendant que le cholera fait eruption a Montreal (8) (p.14-35).

Lorsque la nouvelle de l’epidemie atteint le Haut-Canada, les magistrats de districts ferment l’acces a la colonie. Cette mesure d’autoprotection est aggravee par la fuite des bateliers du fleuve, qui abandonnent leurs passagers sur les rives du canal de Lachine et du haut Saint-Laurent. Le commerce et l’immigration etant paralyses, le lieutenant-gouverneur du Haut-Canada, sir John Colborne (11), reagit a la crise le 20 juin en donnant 500 [pounds sterling] aux magistrats (2 500 $CAN) pour qu’ils etablissent des commissions d’hygiene, lesquelles doivent creer des hopitaux et aider les emigrants a atteindre leur destination finale. Des assemblees publiques poussent quelques villes et villages a interdire le debarquement des malades et de leurs bagages, tandis que d’autres instituent des inspections medicales a bord des vaisseaux avant de leur permettre d’arrimer. Mais la maladie continue a se propager et atteint la capitale, York (Toronto, 6 000 habitants), le 19 juin, ou son apparition suscite les memes reactions qu’au Bas-Canada: la panique, la fuite et les rumeurs generalisees (8) (p.52-64).

Dans les pages de son journal qui traitent de l’epidemie (12), le commercant James Lesslie ecrit qu’avec les rapports quotidiens de cas et de deces, << les gens sont rares … a venir de la campagne, mais nombreux a quitter [la ville] pour s’enfuir au loin >>. Lesslie note aussi que la commission d’hygiene de York incite la population a la proprete et a la sobriete et lui conseille de nettoyer les maisons, de les blanchir a la chaux et de faire bruler du goudron, de la poix et de la colophane << contre la contagion (12) >>. Des mesures semblables ont ete adoptees au Bas-Canada auparavant, mais n’ont pas stoppe l’epidemie. Ce n’est que lorsqu’on se rend compte que le cholera ne tue pas toutes ses victimes que les choses retournent a la normale et que les affaires et la vie politique reprennent leur cours.

Que nous revele cette epidemie sur les reactions des administrateurs, des professionnels de la sante, des immigrants et des colons? Les deux gouverneurs prirent une part active a la lutte contre le cholera en invoquant leurs pouvoirs executifs pour appliquer les conseils du gouvernement britannique. Mais Aylmer et Colborne furent aussi confrontes a la vive opposition des assemblees elues, avec pour resultat que leurs actions furent vertement critiquees dans la presse reformiste et lors d’assemblees tenues pour determiner si l’immigration aidait ou entravait la croissance economique et demographique (10) (225-7), (13). Les colonies possedaient peu de medecins bien formes et d’etudiants en medecine, et cette penurie faisait en sorte que les apothicaires, les pretres, les religieuses, les ministres du culte protestant et les benevoles offraient la plupart des soins medicaux et infirmiers aux colons et aux nouveaux arrivants. Les differends entre praticiens au sujet des charges dans les hopitaux et des pratiques therapeutiques, le fait que les commissions locales voulaient qu’ils visitent les malades pauvres gratuitement a domicile, ainsi que les rapports incomplets des cas et des deces, surtout au plus fort de l’epidemie, ne firent rien pour rehausser le prestige de la profession14. Ayant peu de specialistes a leur disposition, les commissions d’hygiene confierent les inspections sanitaires et l’approvisionnement des malades en fournitures medicales a des coordonnateurs non professionnels.

Comme ces coordonnateurs sanitaires etaient generalement de la classe moyenne et que le gros de leur activite visait les immigrants sans le sou et les pauvres, les stereotypes relatifs a la classe sociale et a l’ethnie l’emporterent souvent sur les mobiles humanitaires. Il y eut donc des reglements tres stricts sur l’inhumation des morts, et les pratiques de deuil traditionnelles furent interdites. En riposte a ces violations de normes bien ancrees et par peur d’enterrer des gens encore vivants, les immigrants et les colons des deux Canadas deterraient leurs proches inhumes en sol non consacre. Ils refusaient aussi d’aller a l’hopital et cachaient leurs malades. En guise de reponse, Colborne demanda a l’eveque McDonell de consacrer le cimetiere des morts du cholera, mais il refusa d’accorder a la commission d’hygiene de York l’etablissement temporaire qu’elle demandait pour dementir la rumeur (fondee) selon laquelle les patients n’etaient envoyes a l’hopital general de Toronto que pour y mourir. Faisant echo aux politiques des dirigeants britanniques reposant sur la theorie miasmatique (on croyait que les endroits nauseabonds etaient la cause des maladies), Colborne invoqua la raison que l’hopital temporaire serait situe dans un quartier tres insalubre de York (8) (p.57-60), (12) (p.247-53). On ne semble pas avoir trouve de solution definitive a tous ces problemes, mais en septembre l’epidemie etait terminee, et comme en temoigne James Lesslie dans son journal * : << La confiance est maintenant revenue; des gens viennent de loin pour visiter la Ville, et tout se deroule comme si [le cholera] n’avait jamais existe (12) (p.245). >>

Cette premiere epidemie de cholera deviendra le modele des mesures de lutte et de prevention a venir lorsque la maladie reapparaitra en 1834, 1849, 1854 et 1866. Des interventions de 1832, on a tire plusieurs enseignements : l’importance d’exercer un leadership solide en haut lieu et au palier local, de communiquer clairement la nature de la maladie et la marche a suivre pour la prevenir ou la maitriser, d’offrir une aide juridique et financiere adequate aux intervenants de premiere ligne et aux benevoles, et de reconnaitre que chaque eclosion suscite une reaction sociale correspondant aux valeurs culturelles de la societe et a sa perception du danger. Ces elements sont encore les fondements des politiques et des programmes actuels.

Quatrieme d’une serie de cinq articles historiques commemorant le centenaire de la RCSP. Directrice scientifique invitee : Maureen Malowany, Ph.D.

REFERENCES

1. Hurst L. Swine flu: How sacred should we be? Toronto Star (25 juillet 2009). Sur Internet : http://www.healthzone.ca/health/articlePrint/671620 (consulte le 28 juillet 2009).
2. Rosenberg CE. What is an Epidemic? AIDS in Historical Perspective/Explaining Epidemics. Dans Explaining Epidemics and Other Studies in the History of Medicine. New York, Cambridge University Press, 1992;278-92, 293-304.
3. Rosenberg CE. Siting epidemic disease: 3 centuries of American history. J Infect Dis 2008;197(suppl 1):S4-S6.
4. Morris RJ. Cholera 1832: The Social Response to an Epidemic. Londres, Croom Helm, 1976;21-23.
5. Johnston H. Atlantic migration. Dans Hallowell G (ed.), The Oxford Companion to Canadian History. Toronto (Ontario), Oxford University Press, 2004;54-55.
6. Buckner P. Whitworth-Aylmer, Matthew, 5e baron Aylmer. Dans le Dictionnaire biographique du Canada en ligne. Sur Internet: http://www.biographi.ca/009004-119.01-f.php?&id_nbr=3723&& PHPSESSID=5u7m54&PHPSESSID=5u7m54 (consulte le 6 aout 2009).
7. Heagerty JJ. Four Centuries of Canadian Medical History, Volume 1. Toronto (Ontario), The Macmillan Company of Canada Limited, 1928;179.
8. Bilson G. A Darkened House: Cholera in Nineteenth-Century Canada. Toronto (Ontario), University of Toronto Press, 1980.
9. Houston CJ. Grosse Ile. Dans Hallowell G (ed.), The Oxford Companion to Canadian History. Toronto (Ontario), Oxford University Press, 2004;271.
10. Ouellet F. Lower Canada, 1792-1840: Social Change and Nationalism. Toronto (Ontario), McClelland and Stewart Limited, 1980;137-40.
11. Wilson A. Colborne, John, 1er baron Seaton. Dans le Dictionnaire biographique du Canada en ligne. Sur Internet : http://www.biographi.ca/009004- 119.01f.php?&id_nbr=4359&interval=25&PHPSES&PHPSESSID=u42ugvq2orcipql4ii ipprf220 (consulte le 6 aout 2009).
12. Firth E (ed.). The Town of York, 1815-1834: A Further Collection of Early Documents of Early Toronto. Toronto (Ontario), University of Toronto Press pour The Champlain Society, 1966;240-42.
13. Wilton C. Popular Politics and Political Culture in Upper Canada, 1800-1850. Montreal et Kingston (Ontario), McGill-Queen’s University Press, 2000;118-22.
14. Bilson G. Canadian doctors and the cholera. Dans Shortt SED (ed.), Medicine in Canadian Society: Historical Perspectives. Montreal et Kingston (Ontario), McGill-Queen’s University Press, 1981;115-36.

* Au debut du xixe siecle, les hopitaux prennent soin des malades pauvres qui manquent d’espace dans leurs logements loues ou qui n’ont ni famille, ni voisins pour s’occuper d’eux. Ces etablissements, fondes par des notables locaux, des eglises et des groupes de femmes, recoivent parfois des dons du gouvernement.

* Lesslie ecrit aussi : << e plus parler d’aucun cas de cholera … cette plaie a peut-etre finalement fait son temps … On trouve des fruits et des legumes en abondance au marche. >>

Professeure agregee au Departement d’histoire de l’Universite de Waterloo, 200 University Avenue West, Waterloo (Ontario) N2L 3G1, tel. : 519-888-4567, poste 32903, telec. : 519-746-2658, courriel : hmacdoug@watarts.uwaterloo.ca