The merits and deficiencies of the Commission of Government, which lasted from 1934 until Confederation in 1949, are often debated. The British-appointed Commission took office at a time when expenditures far exceeded revenues, the debt load was crippling, and unemployment and poverty were high. Yet during its tenure, the Commission made considerable progress in the field of health care, bringing hospitals and doctors to much of a scattered, rural population that had never before had reliable medical services.
In the pre-Commission era, rural health care was provided mainly by local doctors, who saw patients in their own homes or in their offices. However, there were only 83 doctors in Newfoundland in 1930, a decrease of 36 since 1911, and 31 of these were in larger centres. The remaining doctors served only 62 of 1300 communities, and they worked largely without the support of hospitals or medical equipment. There were good medical facilities available in St. John's, where there were several hospitals and clinics in addition to the sanatorium, and hospitals at Twillingate and Grand Bank. There were also hospitals operated by private paper or mining companies for their workers at Corner Brook, Grand Falls and Buchans. The Grenfell Association operated hospitals and nursing stations at St. Anthony and elsewhere on the Northern Peninsula and the coast of Labrador.
These facilities were largely inaccessible to much of the rural population, and the Commission of Government sought to bring modern medical services to more of the isolated communities of Newfoundland with a new health care service. The cornerstone of this service was the cottage hospital system.
Developed from the recommendations of the 1930 Royal Commission of Health Care and Public Charities and echoed in the Amulree Commission's 1933 report (which also recommended the Commission of Government), the cottage hospital system was loosely modeled after the system of health care in rural Scotland, where the population was similarly scattered and sometimes isolated. In such conditions, small hospitals located strategically around the coast were found to be the best option for providing medical care.
From 1936 to 1954, nineteen cottage hospitals were opened around Newfoundland (Labrador and the Northern Peninsula being served by the hospitals and nursing stations of the Grenfell Association). In most cases the Commission provided funding for their construction, but often not enough to cover the total cost. Local residents were expected to contribute by donating building material, labour, and even land. Other hospitals were built by military forces and later acquired by the Newfoundland government, and one was funded directly by the U.S. government.
Photographer unknown. Reproduced by the permission of the Maritime History Archive (PF-318.300), Memorial University of Newfoundland, St. John's, NL.
The first group of cottage hospitals opened in 1936. These were in Argentia, Old Perlican, Markland, Burgeo, Harbour Breton, Come by Chance, and Burin. Stephenville Crossing opened in 1937, Bonavista and Bonne Bay in 1940, and Grand Bank in 1941. Placentia cottage hospital opened in 1942, to replace the hospital in Argentia which was expropriated to make way for the American naval base. Brookfield opened in 1944, and Gander and Botwood in 1946. The cottage hospital at Gander was originally the Royal Canadian Air Force (RCAF) base hospital, reduced in size, renovated and known as the Banting Memorial Hospital after Dr. Frederick Banting. Similarly, the Botwood cottage hospital was originally a Canadian Army hospital built during the war for the seaplane base, and turned over to the Commission at the end of hostilities.
The cottage hospital at Channel-Port aux Basques was the first to be built by the new provincial government. It accepted its first patients in June, 1952. It was soon followed by hospitals at Fogo and Springdale, opened in the same year.
The nineteenth and final hospital to be administered under the cottage hospital system was the United States Memorial Hospital in St. Lawrence, opened in 1954. It was built with $400,000 donated by the United States government, the result of a campaign by survivors of the February 1942 sinking of the Pollux and Truxtun. These men had been rescued by residents of St. Lawrence and Lawn, and secured the hospital funding to commemorate the tragedy and thank the rescuers.
Cottage hospitals were staffed by at least one doctor, several nurses and various support staff. There were small male and female wards totaling about twelve to 40 inpatient beds, in addition to one or two private/isolation rooms. Most of the cottage hospitals had X-ray machines. Relatively common surgeries such as appendectomies and tonsillectomies were routinely performed, but more serious surgeries were sent to larger hospitals in St. John's or Corner Brook. Maternity care was a major focus of the cottage hospitals, and most were equipped with nurseries and incubators. The hospitals also acted as pharmacies, dispensing medication.
Photographer unknown. Reproduced by the permission of the Maritime History Archive (PF-318.290), Memorial University of Newfoundland, St. John's, NL.
There were around 200,000 people in the coverage areas of the cottage hospitals when they began operation, and at their peak they admitted an average of almost 17,000 inpatients a year. Outpatient procedures were even more common. Old Perlican cottage hospital, for example, admitted about 1,000 patients a year during its heyday, but treated approximately 20,000 outpatients annually.
Although the cottage hospitals were scattered around the island in a way intended to make them available to the largest possible number of residents, the extreme isolation and lack of transportation services still limited the number of people who could take advantage of the new hospitals. To fill the gaps, the Commission of Government established small nursing stations, and made some medical services mobile by using ships as traveling clinics and dispensaries.
During the period when the cottage hospitals were being established, Newfoundland had a district nursing system, which recruited nurses and posted them to isolated communities. This was a continuation of the system begun by the Grenfell Association in 1908 and by the Newfoundland Outport Nursing Industrial Association (NONIA) in 1920. In 1934 district nursing became the responsibility of the Department of Public Health and Welfare. When the Department instituted the cottage hospital system in 1936, many of these nurses transferred to the new hospitals. There were 54 district nurses on the Department's payroll that year, and by 1940 there were 96. These nurses were often posted to smaller communities without cottage hospitals or doctors to extend the reach of health care services, where they learned to administer anesthesia, remove teeth and perform simple procedures such as tonsillectomies. In 1947 there were five nursing stations with from two to six beds, and 32 district nurses working in communities without resident doctors.
To provide medical service to even more people, the Commission of Government purchased the MV Lady Anderson in 1935. A converted yacht, this boat was staffed with a doctor and one or more nurses, and provided medical service to the south coast, one of the most isolated regions of Newfoundland. Later, after the Government purchased five small cabin cruisers to handle south coast medical needs, the Lady Anderson was transferred to Placentia Bay, where it stayed in service until 1967. The five medical cabin cruisers (CCs), CC Robert Bond, CC William Carson (later CC Richard Squires to avoid confusion with the new ferry MV William Carson), CC John Kent, CC William Whiteway, and CC Philip Little were all named for former Newfoundland Prime Ministers, and were put into service between 1950 and 1962. The cabin cruisers carried medical staff to isolated communities to hold onboard clinics. The last cabin cruiser was taken out of service in 1983.
A distinguishing feature of the cottage hospital system was the creation of a type of health insurance. In order to receive treatment, a family or individual had to be “on the books” of the hospital, meaning they had paid a fee which entitled them to treatment. This fee was originally $10.00 per family or $5.00 per individual per year, which eventually increased to $15.00 and $7.50, respectively. In areas with nursing stations but no hospitals the fees were $3.00 for individuals and $6.00 for families. This was a variation of an outport practice where families would pay a fee to the local doctor every year through the merchant, which would cover the costs of the doctor's visits. The fees covered all medical procedures except for childbirth and dental work.
In the last decades of the twentieth century, the cottage hospitals were gradually replaced by more modern and centralized medical facilities, made more accessible because of improved transportation. Many communities that once had a cottage hospital are now served by medical clinics that focus on routine outpatient procedures, with inpatients being sent to larger regional hospitals. Although they are now mostly gone, the cottage hospitals provided an unprecedented level of medical service to the people of Newfoundland, and became important community institutions.
Rural medicine is a popular topic for memoirs and histories. Wilfred Grenfell's writings about working in the north are still popular today, and there are many works available that demonstrate both the importance of the cottage hospitals to the people that they served, and the ways in which people remember and interpret their history.
1. Argentia (1936-1941) – Taken over during the construction of the American Naval base at Argentia and operated as a hospital for construction workers until demolished in November and December 1942.
2. Old Perlican (1936-1986) – Renamed the Dr. A. A. Wilkinson Memorial Hospital in 1986, and replaced with a new Dr. A. A. Wilkinson Memorial Health Centre in 2001.
3. Markland (1936-1984) – Replaced in 1984 by the Whitbourne Community Health Centre. The building is now the Rodrigues' Markland Cottage Winery.
4. Burgeo (1936-1993) – Replaced in 1993 by the new Calder Health Care Center in Burgeo. Serious cases and surgeries are sent to Western Memorial Hospital in Corner Brook. After the old cottage hospital closed, the building was used as offices, a community college, and a grocery store.
5. Harbour Breton (1936-2000) – Replaced in 2000 by the Connaigre Peninsula Health Center, also in Harbour Breton. The building was demolished in 2006.
6. Come by Chance (1936-1986) – Closed in 1986 and medical care taken over by the Dr. G. B. Cross Regional Health Centre in Clarenville. The building was torn down the same year.
7. Burin (1936-1988) – The Burin cottage hospital closed in 1988 and services moved to the new Burin Peninsula Health Centre. The building was torn down in sections in 1991 and 2002.
8. Stephenville Crossing (1937-1967) – When the Ernest Harmon USAF base closed in 1966, the government took over the base hospital and converted it for civilian use. The Stephenville Crossing cottage hospital was then closed. A new hospital was opened in Stephenville in 2003. Part of the original cottage hospital was torn down in 1980, but other parts have been used as a clinic and by the Department of Social Services.
9. Bonavista (1940-1984) – The Bonavista cottage hospital was closed in 1984 when the Bonavista Regional Hospital was opened. The cottage hospital was demolished the same year.
10. Bonne Bay (1940-2002) – Replaced by the Bonne Bay Health Centre, the Bonne Bay Cottage hospital in Norris Point was closed in 2002, and is now the Julia Ann Walsh Heritage Centre which contains a museum and public library.
11. Grand Bank (1941-1989) – Although the cottage hospital closed in 1989, the building housed reduced medical services until 2008, when the new Grand Bank Health Centre was opened. The building was scheduled for demolition as of 2010.
12. Placentia (1942-1996) – The Placentia Cottage Hospital was replaced by the Placentia Health Care Centre in 1996. Often subject to flooding, the old hospital has since been removed.
13. Brookfield (1944-1992) – After several renovations and changes in health care management, the Brookfield cottage hospital is still in existence in 2010, and operating as the Brookfield-Bonnews Health Centre.
14. Gander (1946-1964) – Originally constructed in 1941 by the RCAF and known as Banting Memorial Hospital, the Gander cottage hospital closed when the new James Paton Memorial Hospital was opened in 1964.
15. Botwood (1946-1989) – Originally constructed in 1942 by the Canadian Army, the Botwood cottage hospital was taken over by the Newfoundland government in 1946. It operated until 1989 when the new Dr. Hugh Twomey Health Care Centre in Botwood was opened.
16. Channel Port aux Basques (1952-1984) – Opened in 1952, the Channel- Port aux Basques hospital was the first cottage hospital to be built after Confederation. It was replaced by a new facility, the Dr. Charles L. LeGrow Health Care Centre, in 1984.
17. Fogo (1952-2004) – Opened in September 1952, this was the second cottage hospital built by the provincial government. It was also the last of the cottage hospitals to be closed (excepting Brookfield and Springdale, both still in operation), when it was replaced by the Fogo Island Health Care Centre in 2004. The building was demolished in 2007.
18. Springdale (1952-1977) – Springdale cottage hospital opened in November 1952, the last hospital built by the Government of Newfoundland. Its name was changed to the Green Bay Community Health Centre in 1977, and is still in operation as of 2010.
19. St. Lawrence (1954-1994) – Built with money from the U.S. government in memory of those who died in the Pollux and Truxtun disaster and as a thank you to the rescuers, the United States Memorial Hospital in St. Lawrence was opened in 1954. It closed as a hospital in 1989. The emergency clinic remained open until the replacement facility, called the United States Memorial Health Centre, was ready in 1994. The building was later demolished.