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Putting the "Grenfell effect" in its Place: medical tales and autobiographical narratives in twentieth-century Newfoundland and Labrador.

SOMMAIRE

Cet article aborde l'autobiographie medicale en tant que genre, notamment tous ces recits et memoires rediges par des membres de la profession medicale de Terre-Neuve-et-Labrador durant le vingtieme siecle. On y apprend que, grace a l'influence grandissante des activites et des ecrits de sir Wilfred T. Grenfell (1865-1940) qui contribuerent a propager une nouvelle image du medecin presente comme un aventurier nordique, plusieurs docteurs de longue et de fraiche date se mirent a imiter ce mode de vie et a coucher sur papier leur vecu et leur experience professionnelle dans des autobiographies. Ce phenomene est appele dans cet article <<effet Grenfell>>, lequel explore des themes en relation avec l'antimodernisme, le Nord et l'engagement social. En recourant aux methodes en histoire du livre qui comprend l'etude des ouvrages en tant qu'objets culturels et les divers procedes mis en oeuvre pour les diffuser, il sera demontre que l'examen des oeuvres de Gction et des ecrits documentaires dans leur contexte historique et culturel peut aider a expliquer le nombre en apparence disproportionnellement eleve de ces textes publies par des praticiens venant des provinces maritimes en comparaison des autres regions du Canada. Un ouvrage autobiographique d'un medecin americain, Robert Ecke (1909-2001), fait l'objet d'une etude de cas approfondie en vue d'illustrer cet <<effet Grenfell>>.

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Medical autobiography has been studied mostly within the context of explaining the culture of medicine, including its historical development. (1) Beate Caspari-Rosen and George Rosen have noted that this genre, which began with the "book of life" of the sixteenth-century physician Girolamo Cardano entitled De Vita Propria (1643), typically depicts "successive stages in the development of an individual ... [where] finally there will emerge the structure and significance of the life as a whole." Along the way such writing is "preoccupied with conflict" and "results from the collapse of a frontage in response to personal experience, for the impression of such experience creates a need for sympathy, self-justification, appreciation, or communication." (2) Rita Charon echoes similar sentiments, asserting that the writing of such medical narratives "embroils" physicians in "the public examination of the private self ... in order to justify or cohere or accept choices made and deeds done." Just as significant is her observation of a recent trend of doctors writing autobiographically of their medical school days and early years of physicianhood, periods in which they "undergo dramatic transformations, often in a relatively short time, that render them unrecognizable to themselves." (3) Donald Pollack has categorized "the training narrative" as a subgenre of medical autobiography. He argues that the dominance of this type of memoir during the later twentieth century over the previous pre-Second World War type, which were "self-consciously heroic memoirs of famous physicians," can be traced to the "social disaffection of the 1960s [that] provided the fertile ground for the publication of a new kind of medical autobiography, one that revealed the uncertainties of medicine, the clay feet of physicians, and the potential dangers of medical institutions." (4)

There has been little interrogation of the genre of medical autobiography from an alloy of bibliographical (broadly construed), book history, and literary perspectives. This essay thus examines personal narratives of physicians as bibliographical artifacts which were embedded in their unique historico-cultural milieu, in this case Newfoundland and Labrador--that is, in their "place" intellectually, geographically, and temporally. This approach allows us to identify trends, influences, and relationships that have either gone unnoticed or not adequately explained; and it offers an answer to why the physicians' and allied health workers' autobiographies, memoirs, and diaries relating to Newfoundland and Labrador (and more generally Atlantic Canada), along with what is now broadly recognized as the Canadian "North," appear to outnumber those published elsewhere in Canada.

This discussion adds to our understanding of the ways in which authors, their books, readers, and publishers created an intellectual and economic ecosystem that was greatly shaped by the unique locale (perhaps even mystique) and culture of Newfoundland and Labrador and the "North"; such works helped define a sense of "place" as much as the place provided material for their creation. As will be shown, this feature may be linked to an impetus propelled by a peculiar international amalgam of the antimodernist mentalite (including the arts and crafts movement), Christian missionary work, and medical care. This essay also argues that the numerous medical autobiographies from Atlantic Canada, especially from Newfoundland and Labrador, can be directly and indirectly connected to the context established and nurtured by Dr (later Sir) Wilfred Thomason Grenfell (1865-1940), as well as the non-fiction and fiction print tradition written by others that focused on him. The net cumulative influence of all these publications on successive medical autobiographers I have termed the "Grenfell effect." Finally, a case study of the publication life cycle of the memoirs of a particular American physician (Robert S. Ecke, 1909-2001) who practised in Newfoundland in 1930s, based on archival and other historical records, permits a more detailed glimpse of the larger picture described.

Medical Autobiography: Bibliographic and Historical Context

Atlantic Canada (which embraces the Maritimes and Newfoundland and Labrador) is well-represented in both old- and new-style medical autobiography. Works such as C. Lamont MacMillan's Memoirs of a Cape Breton Doctor, Edmund A. Brasset's A Doctor's Pilgrimage: An Autobiography (described on the book's jacket as "the warm-hearted, humorous story of a courageous young doctor in Nova Scotia"), and Arnold Burden's Fifty Years of Emergencies: The Dramatic Life of a Country Doctor (similarly described as an "account of the active life of a man dedicated to his patients") exemplify the former generation of "old-school" doctors' writing which records the selfless patient care they delivered over many decades of challenging rural practice. (5) In contrast, Shane Neilson's Call Me Doctor, in which the author relates his experience of attending medical school at Dalhousie University, learning, according to the publisher's blurb, "the hard way what it meant to be a doctor while also charged with the task of becoming an adult," (6) is emblematic of "new school" autobiography at the close of the twentieth century.

But it is in Newfoundland and Labrador (and more generally conceptually "the North" including Arctic locales) that the traditional medical memoir has truly flourished. A line of (largely regionally or privately) published doctors' stories and related tales about health care delivery extends from the late nineteenth century and includes at least 20 works that capture the style, content, strengths, and weaknesses of the genre. (7) Considered collectively they allow a few generalizations. Although often anecdotal in nature with events recalled and interpreted perhaps years or decades after their actual occurrence, these works are often the only surviving historical record to help us understand what constituted rural medicine and health care in the recent past in these locales. These reminiscences, recollections, and "eye witness" accounts demonstrate the often intimate and emotional connections between people, institutions, and the communities that nurtured them; because they deal with life and death events along with all the everyday aches, pains, and acute and chronic diseases in between, they present remarkable insights into the lives and times of the people involved. Noteworthy, too, is the relatively large number of autobiographical contributions by women in their roles as doctors, but more typically as midwives and/or nurses. Such gendering of this specialized form of life writing offers a more balanced perspective on how health care was practised in this region and underscores the vital role of women. Rural and remote women practitioners appeared to exercise greater professional autonomy and garner better respect than their urban counterparts; they were also subject to the same challenges that harsh climate and difficult travelling conditions imposed on male colleagues.

Furthermore, just glancing at the titles and cover designs of these works highlights how interwoven are the concepts of medical tales with adventure and place. Modes of transportation such as snowshoes, sleds, ships, and dories (and references to oceans and seas) identified in their titles, coupled with paratextual information such as book jacket images of planes with skis, schooners in full sail, and ex-army Willys Jeeps, along with others depicting the aurora borealis, icebergs, and Inuit snow goggles, all help to locate their authors (and readers) with respect to place. The relationship between "place"--especially in a rural, remote, or isolated context--and the delivery and character of health care is an important one, which is only now being fully explored and explained by medical historians and other scholars. (8) Whether these books were originally authored, or later edited, by men or women who might have been Americans, Britons, Canadians, or Newfoundlanders; whether they were polished memoirs or a series of personal letters or daily journal entries; or whether they were published privately or commercially, all generally do much to convey a sense of place. They not only help to define the region through supposedly accurate first-hand descriptions of land, sea, and people, but they also present a defining theme of a harsh, unforgiving climate that makes survival challenging and travel treacherous.

In these ways, these works aid in "inventing" the "North" while reinforcing a popular stereotype of it. Passages related to folkways, foodways, habits, dress, and other traditions of "native" inhabitants (although they may not necessarily be Aboriginal or indigenous to a region) depict the "other," especially through the eyes of typically well-educated, urban, "middle-class" medical practitioners. Were it not for the occasional use of the term nurse, doctor, or midwife in a title one could be forgiven for confusing these books with other adventure, travel, or exploration literature. It is also not unreasonable to categorize these medical autobiographies along with Victorian and later era treatises connected to Africa (those related to the activities of the Scotsman Dr David Livingstone), or to other exotic and mysterious locales, such as China, where medical missionaries served. (9)

The "Grenfell Effect": The Print Culture Tradition of Dr Wilfred T. Grenfell

In the case of Newfoundland and Labrador, the links between medicine, missionary work, autobiographical and other published writings, and travel and adventure literature are historically inextricable owing to the legacy and legend of Wilfred Grenfell. Indeed, it is the print culture tradition surrounding Grenfell, which resulted from his own voluminous writings as well as the extensive corpus about him, that helps explain why the present-day province of Newfoundland and Labrador is exceptionally represented with respect to this genre of life writing.

An unadorned biographical sketch of the man who cast such a long medical and cultural shadow is as follows. Towards the end of the nineteenth century a freshly minted Oxford-educated and London-trained medical doctor, inspired by a religious meeting in London by the American evangelist Dwight L. Moody and his song leader Ira D. Sankey, Wilfred Grenfell signs up with the Royal Mission to Deep Sea Fishermen (RMDSF) to care for the sick in Labrador and northern Newfoundland. From his base in St Anthony, he becomes instrumental in building a network of nursing outposts, hospitals, hospital ships, and medical services along the coast of this remote locale with the help of voluntary funding, especially from 1914 with the formation of the International Grenfell Association (an umbrella organization for American and British supporters), which network enables him to attract a steady stream of American, British, and other doctors, nurses, and workers. Grenfell involves himself directly in this enterprise as a widely travelling lecturer and internationally published writer, publicizing his cause and his own charismatic persona as a dedicated, energetic, tenacious--and, at times, adventuresome if not reckless--character. One "true tale" illustrates this point: Learning of a boy in a distant settlement who is suffering from an infected wound, Grenfell assembles his dog team, mounts his komatik (sled) and dashes off, heedless of the ominous weather. As he crosses the frozen bay it begins to break up, resulting in doctor and dogs ending up in the icy water. With difficulty, they haul themselves onto a drifting ice pan minus all equipment. To survive the arctic temperatures, Grenfell slaughters several of his trusted team, flays them, and then wraps himself in the dogs' skins to keep warm. Miraculously, a passing rowing boat manned by dedicated Newfoundlanders spies Grenfell and his makeshift flagpole constructed from disarticulated dog leg bones, rescues him, and returns him to his hospital base where he recovers. This escapade on ice became the basis for Adrift an an Ice-Pan (1909), one book in Grenfell's ongoing inspirational autobiography--or, as he referred to it, "this egotistic narrative." (10)

Grenfell's career as renowned medical author began as early as 1895 with Vikings of To-Day, published by the London firm of Marshall Brothers of Paternoster Row, which specialized in religious books and other works for and about missions. The American edition, published a year later in 1896, bore the imprint of New York's Fleming H. Revell, "Publishers of Evangelical Literature," making the book's spiritual orientation more explicit. It is important to highlight the link to this publisher in the United States as it is would become pivotal in the "marketing" of Grenfell and his work; it also helps situate much of the Grenfell print culture in the larger context of the contemporary publishing scene. The origins of the Revell publishing firm date to 1869, when former shoe salesman turned evangelist Dwight Moody (who was the original religious inspiration for Grenfell at the English revivalist meeting of the 1880s) turned responsibility for his religious newspaper over to his brother-in-law, Fleming H. Revell, in 1870. This publishing house was extremely successful and continues today as part of the religious conglomerate Baker Book House. (11) Revell's success was a function of its own good management, but it also underscores the spirit of the publishing scene at that time. A very brief review of the early history of this company also illustrates how certain key publishing personnel moved between companies and from Canada to the United States and Britain, creating a constructive web of enterprise that embraced authors, books, publishers, readers, ideologies, markets, and social and intellectual movements highly beneficial to the Grenfell project and financial bottom lines.

Foundational for the success of this web were the reactions of literate middle-class Protestant Americans to the rise of industrialization, mechanized factory production processes, and rapid urbanization and ethnic immigration, all of which were perceived to have a deleterious effect on individuals and societal values. One significant expression of this sense of social dislocation was the rise of antimodernism, which can be understood to embrace the arts and crafts as well as the outdoors/wilderness movements that blossomed between the 1890s and early 1900s in North America; this aspect will be explored more fully later. Another was the advent of the "social gospel" and the deepening of Christian fundamentalism which exhorted people to repent. Acts of individual repentance would lead to personal salvation; the collective power of these millions of individual acts would in turn lead to the moral correction of society. Demonstrable individual acts of charity also figured in this philosophy. One outcome of this movement was a veritable boom in the publishing industry around the turn of the twentieth century, particularly in religious books and spirituality-inspired novels, which allowed firms like Revell to prosper. As John P. Ferre has noted, in the United States reading social gospel novels became a "national pastime"; sales in the millions for some titles were not uncommon. (12) "Spin-offs" of this trade in inspirational and uplifting books were other works relating to nature, outdoor life, and the "wilderness." (13)

Practising and promoting the social gospel was not an entirely American phenomenon; its advancement can also be attributed to the actions of Canadians both as authors and publishers. Notable is the stream of works by best-selling Canadian authors Ralph Connor (Rev. Charles Gordon of Winnipeg) (14) and Norman Duncan (whose Newfoundland-Grenfell inspired corpus will be discussed more fully below). On the publishing side, George Doran and S. Edgar Briggs, two of Revell's key personnel, began their careers in Toronto at Willard Tract Depository, which specialized in selling religious print materials and would be later bought out by the American firm. (15) Wilfred Grenfell's first book published through Briggs by Revell, Vikings of To-Day, set the mould for the future. Chapters such as "On Dogs and Difficulties," "On Seals and Sealers," "On the Esquimaux," and "The Deeds of Heroes," along with illustrations from "original photographs" depicting caribou, beaver, native dwellings, an Eskimo brass band, and a missionary in winter dress (sealskins and snow shoes), convey a sense of his brand of muscular Christianity and medicine in isolated regions. (16) Paratextual material in this book--notably, the gold embossed image on the front board is of a team of huskies in the wild denoting how people travel in the "exotic" North--further situates it within its locale and era, while also establishing an intellectual framework that many future medical autobiographers of Newfoundland and Labrador both wittingly and unwittingly followed.

Other religious or devotional allusions can be drawn from this Grenfell work to highlight its allegorical nature. The title pages of both editions of this book convey the subtitle: Life and Medical Work among the Fishermen of Labrador. The mention of life among fishermen readily connotes the injunction of Christ to become fishers of men (Mark 1:17). Also on the title page, Grenfell, in addition to identifying his professional credentials as a physician and a surgeon, notes that he is a certified "Master Mariner," thus reinforcing his role as an outdoors man of action: the designation master mariner rightly denotes a person who is a navigator and a leader of men who can manoeuvre around rocks, reefs, and shoals in a literal sense; but so also in the metaphoric or spiritual sense of life. Photographs of Grenfell at the helm firmly in command of a ship wheel emblazoned with scriptural quotations nicely illustrate these commingled roles. Later, the phrase "master mariner" would be incorporated into the title of one of the many biographies of Grenfell. (17)

Other titles in the Grenfell oeuvre which relate his personal life and professional experiences illustrate the connection between tales of northern adventure and the inspirational work of the medical mission; such works include Northern Neighbours: Stories of the Labradar People (1906), Down North on the Labrador (1911), and Labrador Days: Tales of the Sea Toilers (1919). (18) But the pinnacle of this tradition was the appearance of A Labrador Doctor: The Autobiography of Wilfred Thomason Grenfell M.D. (Oxan.), C.M. G. in 1919 when he was 54 years of age. Chapter by chapter Grenfell unrolls his interpretation of his episodic life thus far in which adventures, incidents, experiences, and lessons learned are communicated with some old chestnuts such as the "ice-pan adventure" being reprised. The concluding chapter entitled "My Religious Life" makes explicit Grenfell's spiritual philosophy, which is also suffused through the book as he describes his Christian motivations and many varied accomplishments in Labrador and northern Newfoundland. (19)

The noted Grenfell scholar and his modern biographer Ronald Rompkey considers A Labrador Doctor less a medical autobiography per se and more a spiritual one in the grand tradition of such seventeenth-century Puritan writers as John Bunyan. While a fuller examination of Grenfell's autobiography from a book history perspective would be fruitful, it was beyond the scope of Rompkey's discussion; however, two specific points raised by him are pertinent. First, is Rompkey's picking up on a clue provided by Grenfell that his wife, Anne, probably helped substantially with the writing and editing of the book, which raises the issue of the autobiography's actual authorship. (The revelation that Anne Grenfell wrote several titles published under her husband's name not only explains his prodigious output but indicates the brand power of his name.) Second, is Rompkey's reminder that A Labrador Doctor was an extremely popular and successful book--a bestseller in its day. This work would go through several reprint editions in the United States and the United Kingdom, earning substantial royalties for its author(s) and the Grenfell Mission; for just part of the year 1921 alone, 4,000 copies were sold; it was still in print in 1969, 50 years after its first publication. (20)

The "Grenfell effect" can be explained in part, then, by the one-man (and probably also one-woman) writing/publishing machine that produced a steady stream of articles and books (as well as lectures) for international audiences, making the name and "brand" of Grenfell of Labrador household words on both sides of the Atlantic Ocean for much of the first half of the twentieth century. Equally as important to explain the Grenfell effect was a parallel literary and publishing global system that informed consecutive generations of the inspirational medical and religious deeds and adventures of this remotely located Northern doctor. Ignoring the numerous "one-off" magazine and newspaper articles that appeared in the early 1900s about Grenfell, between 1908 and 1924 at least five book-length "heroic" biographies appeared on Grenfell in America and England. (21) For example, the 1924 volume entitled Wilfred Grenfell, The Master Mariner: A Life of Adventure on Sea and Ice by the English Protestant Christian journalist and apologist of missionary work Basil Mathews, who had previously written works such as Livingstone the Pathfinder and The Argonauts of Faith, reads like a story from the Boy's Own Annual. Complementing the book's text was a series of sketches by noted high-Victorian illustrator Earnest Prater, such as the one captioned, "He dashed to the side and took a header into the Atlantic Ocean," which depicts Grenfell fully clothed and shod diving, off of the gunwale of his hospital ship into choppy waters to retrieve a ball while being watched by a sailor holding a cricket bat. (22)

It was the "non-fiction" (works consisting of "true" but embellished and dramatized accounts and anecdotes) and fiction books of Canadian-born, New York-based author, Norman Duncan (1871-1916), however, that were at the centre of the complementary Grenfell publishing industry. Described by a literary critic in 1905 as Grenfell's "enthusiastic Boswell," (22) Duncan first travelled to Newfoundland to interview Grenfell in 1900, but this meeting never took place as Duncan's trip was truncated in the Notre Dame Bay area where he stayed for the summer. His experiences living there became the basis for 25 articles and stories published between 1901 and 1903 in major American periodicals; they were also the stuff of Duncan's first book, The Way of the Sea, published in 1903, for which he remains known. Also in this year, Duncan and Grenfell met for the first time, not in Newfoundland but in New York City. It was the culture of books and publishing that brought these men together, for the meeting was arranged under the auspices of the Canadian S. Edgar Briggs, now managing editor of the Revell publishing firm, which had previously published Grenfell's first book, Vikings of To-Day. (Briggs would also become a founding director of the Grenfell Association of America which was directly concerned with raising charitable funds for the mission.) In the summer of 1903 Duncan and Briggs made the trip to Labrador and experienced firsthand the life and work of Grenfell's medical mission, his outport hospitals, and shipboard care on the Strathcona. In the following years Revell published two books by Duncan based on material he had gathered in Labrador: the fictional Doctor Luke of the Labrador (1904; reprinted 1934) and the "non-fiction" Dr. Grenfell's Parish (1905) (Figure 1).

From 1906 to 1916 there followed three volumes also published by Revell in the United States of the make-believe adventures of a young Labrador lad named Billy Topsail. In the final one, Billy Topsail, M.D., Duncan has his adolescent protagonist grow up to become a physician just like his hero "Doctor Luke," who also figures in this book (Figure 2). (24)

While Duncan has since largely been ignored, in his time he was an extremely popular and a bestselling author; a current critical evaluation of Duncan's books, based on Grenfell and Labrador as his literary muses, is that he initiated an indigenous tradition of Newfoundland fiction. (25) Grenfell and Duncan forged a relationship based on mutual admiration (which was perhaps strengthened through the efforts of their shared friend William Lyon Mackenzie King who would later become one of Canada's more eccentric prime ministers). (26) There were also good business reasons for this professional relationship. In this instance the Grenfell effect was not without its two-way pecuniary underpinning: Duncan appears to have enjoyed a good living based on the sales of his Labrador-Grenfell-inspired oeuvre, while Grenfell also was an indirect beneficiary. S. Edgar Briggs "safely" promised Grenfell that Duncan's writing would "do more good for your Mission than any one single literary effort that has thus far been made." Grenfell grumbled that he never received any direct portion of Duncan's book royalties for his medical enterprise but conceded that his works were "most helpful agencies" to boost attendances when he was on the lecture circuit in America, Britain, and Canada in order to raise much-needed funds for his mission's activities; both Briggs and Duncan often assisted in arranging lectures. Duncan's full spectrum of readers from children to adults guaranteed that his message was broadly cast, for Grenfell did admit that many meeting attendees told him that "we have learned all about you from the writings of Mr. Norman Duncan." Such tributes were repeated in Grenfell's obituary of Duncan. (27)

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Duncan's three major Grenfell-oriented works cast the man and his mission, whether in fact or in fiction, as truly inspirational and doing God's work in the isolated and primitive North where commitment and service to others was all. And, again, paratextual material such as the books' embossed front boards depicting huskies, icebergs, and sailing schooners set the scene. Readers understood the character of "Doctor Luke" to be that of Grenfell, but this verisimilitude initially peeved the real Labrador doctor because his literary avatar had had a sinful past back in "the city" before his arrival to the Labrador; in time, this tortured character undergoes a spiritual healing and finds himself. Nevertheless, the author of a review in the official mission magazine, Among the Deep Sea Fishers, conceded that "both the fictitious hero and the real man are strong, hearty, self-sacrificing; and in these aspects of his career 'Dr. Luke' is apparently modeled upon Dr. Grenfell." All in all it was a "strong book." In subsequent books Duncan included a disclaimer about his characters not intentionally resembling living persons to avoid any likelihood for confusion amongst readers. (It appears that Grenfell suffered no ill will from the public and he quickly reconciled this matter with Duncan.) (28)

If Grenfell took umbrage over this, it is plausible to argue that he only had himself to blame as Duncan merely articulated a theme that had begun with Grenfell himself in Vikings of To-Day and was underscored by Sir Frederick Treves in his preface to that book. Treves, the prominent London surgeon who was also chairman of the RMDSF hospital committee and "patron" of Joseph Merrick (the "Elephant Man"), was writing at the fin de siecle when the erstwhile field of eugenics with its concern over "race suicide" was beginning to bud. (29) Treves was troubled by the apparent degeneration of the human race, especially the British and other "most civilized people." Yet, he averred, the pages of Vikings of To-Day would bring "wholesome relief" to "those who view with some disgust the fashionable youth of the day, with his many effeminacies and affectations," for Grenfell, who was well known as a "hardy athlete," had written a narrative that would "take the reader away from the heated, unnatural and debilitating atmosphere of the modern city, from the innervated crowd, from the pampered, self-indulgent colonies of men and women who make up fashionable society, and will carry him to a lonely land where all conventionalities vanish, and where man is brought into contact with the simplest elements of life and with the rudimentary problems of how to avoid starvation and ward off death from the cold." (30) In this new found land apparently a man could gain new found skills, strength, maybe even redemption not only for himself but also the Anglo-Saxon race. In short, Newfoundland and Labrador/ the "North" qua place had restorative powers.

In light of Treves' "factual" admonition that the modern city was unwholesome and the breeding ground for unhealthy, effete, and effeminate Englishmen, consider the following "fictional" passage from Doctor Luke of the Labrador where the interlocutor notes that there was "virtue for the city-bred ... in the clean salt air and simple living of our coast--and, surely, for every one, everywhere, a tonic in the performance of good deeds." Thus for Doctor Luke, "Hard practice in fair and foul weather worked a vast change ... They gave him health, a clear-eyed, brown, deep-breathed sort of health, and restored a strength, broad shouldered and lithe and playful, that was his natural heritage." With his "new power came joyous courage, indomitability of purpose, a restless activity of body and mind ... [HI e was now in manly qualities, the man the good God designed--strong and bonnie and tender-hearted; betraying no weaknesses in the duty of the day." (31) Later in the novel, Doctor Luke himself expounds on his personal regeneration. When in the city he was a "'dissipated fellow,'" but when he turned his back "'on that old life, when I set out to find a place where I might atone for those old sins, 'twas without regret, and 'twas for good and all. This ... is now my land! I love it for the opportunity it gave me. I love it for the new man it has made me. I have forgotten the city. I love this life!'" (32) Again, the restorative power of place (described here as "a tonic") is identified.

Simply stated, Duncan merely put into literary practice what others were preaching at the time. By 1916, Doctor Luke had been fully rehabilitated when he appeared in Billy Topsail, M.D. In this work the impressionable young Billy becomes Luke's sidekick, and responds favourably to his mentor's "habit of service--the instant, willing, efficient answer to the call of helpless need. Indeed, Doctor Luke appeared to Billy Topsail to be a very great man--the greatest man, in his personality and life, Billy Topsail had ever known ... And Billy Topsail had come definitely to the conclusion that what he wanted to do with his life was precisely what Doctor Luke was doing with his." (33) In his non-fictional account of Grenfell, Dr. Grenfell's Parish: The Deep Sea Fishermen, Duncan makes allusion to Doctor Luke but only in order "to protest that Dr. Grenfell is not the hero of a certain work of fiction dealing with life on the Labrador coast ... The author wishes to make it plain that 'Doctor Luke' was not drawn from Dr. Grenfell." Readers might be forgiven for not being convinced of this "protest" in light of Duncan's own gushing description in this same work of Grenfell as "indefatigable, devoted, heroic" juxtaposed with a frontispiece of the Labrador doctor jauntily leaning against the wheelhouse of his hospital ship with the caption "A doctor ... the prophet and champion of a people." The publisher's advertisement at the back of the book for Doctor Luke of the Labrador, along with glowing reviews from the New York Evening Post, The Congregationalist, the Chicago Record-Herald, and the Toronto Globe, probably did little to further clarify any distinctions that Duncan apparently desired. (34)

The thematic overlapping of factual and fictional texts with respect to the restorative or "tonic" effects of Newfoundland and Labrador needs to be explored further, for it is one that has been only partly analyzed by scholars of the region. This broad intellectual theme is antimodernism, which attracted a mixed group of writers, artists, theologians, physicians, intellectuals, tradesmen, and others loosely coalesced around the idea of a simpler, more aesthetic, more wholesome, and holistic way of living and working as espoused in the arts and crafts and "wilderness" movements. Manifestations of this mindset included "arts and crafts" artist colonies such as that of Elbert Hubbard in East Aurora, New York, or Rose Valley in Pennsylvania founded by architect William Lightfoot Price; both aspired to be utopian communities where books were hand printed and bound, distinctive furniture was crafted (for example that of Stickley), pottery thrown, and fine arts were created, all for sale. Concurrent with this was a desire to exalt the purity of nature and the wilderness in contrast to the toxic city. As noted by historian T.J. Jackson Leafs, braiding these various strands of revitalization, aestheticism, and personal and social transformation led to a "therapeutic world view." (35)

Treves, Grenfell, and Duncan point us in the intellectual "antimodernist" direction in Newfoundland and Labrador at the dawn of the twentieth century; the actions of their contemporaries propel us even further. Recent folklore and historical scholarship has illustrated how both Newfoundland and Labrador were marketed between 1900 and the onset of the First World War as one of the last great wilderness settings that neurasthenic, city-dwelling North Americans could conveniently travel to revitalize themselves. As a contemporary travel guided gushed:
 In the sea-girt isle, the citizens of the United States and Canada
 will find a welcome escape from the burning heat of their summers;
 scenery novel and attractive; and bracing exhilarating air which
 imparts new vigour to the frame and sends back the smoke-dried
 denizens of the great cities with the tide of health coursing
 through their veins, and life made incomparably better worth
 living ... After a few weeks near the coast, inhaling salt sea
 breezes and exposed to the life-giving sun's rays, the invalid who
 has come with shattered nerves and fluttering pulse, returns with a
 new supply of iron in his blood and sense of well-being that makes
 it a luxury to live and breath the pure air of Terra Nova. (36)


Never mind that one of the most popular ways for a man to get a "new supply of iron in his blood" was to pump as much lead into the blood of the sea-girt isle's wildlife as he could, or hook its fish. (37) But while this appeal was primarily designed to exploit antimodernist thinking to attract tourists, it must be conceded that it aided in supporting the image adumbrated by the likes of Duncan.

Less commercial in nature was the antimodernist "wilderness" spirit displayed in the series of books including With Dog and Canoe: A Story of the Big North Woods (1928); The Fur Traders of Kettle Harbor (1931); and The Camper's Handbook (1936) written by Duncan's contemporary Dillon Wallace (1863-1939). Noteworthy is that all these works were originally published by the Fleming H. Revell Company, which also published Duncan and initially Grenfell. Thus this company developed a stable of books that promoted Newfoundland and Labrador within an amalgam of spirituality that spanned the work of the Grenfell Mission, muscular Christianity, and antimodernism. Not surprisingly, Wallace like many others around this time built on these connections when he wrote The Story of Grenfell of the Labrador: A Boy's Life of Wilfred T. Grenfell (1922), which was also published by Revell. Even Wallace's debut book published in 1905 by Revell, The Lure of the Labrador Wild." The Story of the Exploring Expedition Conducted by Leonidas Hubbard, Jr. does not escape the mantle of Grenfell; similarly, its textual allusions to him and his mission underscored the tropes of place and service (see especially chapter 3, "On the Edge of the Wilderness," which opens with what is tantamount to an advertisement or public service announcement for Grenfell's mission). References to Grenfell are integral to Wallace's narrative, yet one cannot help wondering if their placement was not a tactical measure designed to encourage book sales in light of the Grenfell-Duncan-Briggs-Revell "syndicate." Again, the Grenfell effect is at play.

The work and writings of yet another who fell for Grenfell and the various movements of his times further anchor this discussion. The medium of "the book" both as repository of knowledge and as bibliographical object makes it is possible to draw several strands together that might not be immediately obvious from another methodological perspective. The American Jessie Luther (1860-1952) was a dyed-in-the-wool arts and crafts practitioner and also a pioneer in the application of such work for occupational therapy--both literally and figuratively, she valued arts for their therapeutic value. Considering Luther in this analysis is important for three reasons: first, her recorded thoughts from 1906 to 1910 when she worked at the Grenfell Mission help articulate the theme of antimodernism; second, her attempts to get her autobiography of these Grenfell years into print further underscore the Grenfell effect (and its eventual demise); and third, it is instructive to capture her experiences in order to compare them with those of Robert Ecke decades later because they intriguingly parallel them. (38)

As a formally trained and accomplished artist in watercolour and oil, as well as a proficient bookbinder, wood and metal worker, potter, enameller, and also a basket weaver and superb textile weaver, Luther taught and practised variously in atelier, college, and hospital settings as well as at Chicago's famous arts and crafts haven, Hull House. The quality of her crafts spoke for themselves; her philosophy for their production is captured in her own words which succinctly also sum up the tenets of the arts and craft movement and set the context for understanding those that championed antimodern, reactionary sentiments. For Luther, it was a "far cry from the work of primitive man to the modern mill, with its hundreds of looms, its whirring machinery... And now, in the midst of this mechanical age ... there has come a reaction, a reversion to hand industry, to the work of the individual, with its interest in the worker ... and for the development and co-ordination of hand and brain." (39) By the time she published these comments in 1906, Luther had been enticed to work summers in St Anthony to establish an industrial arts and crafts program that would engage local women to produce handcrafted items such as the soon-to-be famous exquisite hooked rugs that sold internationally; it was Luther who virtually created this tradition, helping further boost the revenue and fame of the Grenfell Mission. She would continue to do this work until her resignation in 1915.

For Grenfell, Luther's contributions were a source of income and, just as important, a way for local inhabitants to learn skills and become useful and productive. For Luther, these goals had their merits, but she also could add her own spiritual gloss as this whole experience had a therapeutic value not only for society as viewed from her antimodernist perspective, but also for her personally: she could be considered to suffer from bouts of "neurasthenia" and the Mission can be understood to have afforded her respite as an arts commune. Just as in Duncan's Doctor Luke, the pristine land could revitalize. It is ironic that on her first trip North to Newfoundland from the United States, Luther sojourned in Exploits, Notre Dame Bay, which she deemed beautiful because it was "utterly unspoiled"--the very spot that had inspired Norman Duncan himself during his first trip to the island. She stayed with the same family who informed her "no stranger had been there to stay except the author Norman Duncan and ... an artist from Philadelphia." (40) Once in St Anthony, Luther could enjoy this oasis, but even this place was not immune to progress, as Luther saw when in 1908 the Grenfell Mission was illuminated for the first time by electricity, a development Luther witnessed with mixed feelings. As will be discussed later, Robert Ecke expressed a similar lament for a lost era of simplicity in Newfoundland and sense of ambivalence to modernity.

The print worlds of Grenfell overlap through the page because Luther's recollections eventually were published a half century after her death. Her posthumous editor, Ronald Rompkey, rescued a previously edited manuscript and was able to see it into print. As Rompkey informs us, between 1948 (four years before Luther died at the age of 92) and 1988 various versions of her memoirs and letters describing her Grenfell years were submitted repeatedly by her and her surviving relatives to Houghton Mifflin, Atlantic Monthly, and Scribner's; in all the manuscript was rejected five times for being too specialized and unlikely to elicit a good enough commercial market--in brief, while the Grenfell effect may have prompted Luther to prepare the manuscript, by the time she tried to get it to market the reading public was no longer interested in her antimodern laments, her detailed accounts of a remote locale, or her memories of a man dead for almost a decade. Her work was submitted under several working titles: When the Grenfell Mission was Young; The Uncharted Coast; and Mission to Labrador. It was not until Rompkey got permission from a remaining family member to issue the work in a scholarly edition that was published in 2001 in a Canadian university press series co-edited by an historian of medicine that Luther's goal was finally fulfilled. In this twenty-first-century guise, her words became useful as historical record rather than as inspirational guide. (41) A similar story emerges when we examine the publication cycle of Robert Ecke's Newfoundland memoirs.

Interest in Grenfell was not completely extinguished with his death, however. In recent decades, the textual treatments of Grenfell have expanded into the commercial/popular and scholarly realms. In 1941, one year after his death, Grenfell became immortalized (with a tag line that "TRUTH is stranger and a thousand times more thrilling than FICTION") in the American True Comics version of Adrift on an Ice Pan. (42) While it cannot be assumed that this genre was only purchased and read by "kids," this adaptation of an aspect of Grenfell's life and activities may have kept him acquainted him with a younger audience; certainly, the readership garnered by this format during the Second World War was probably different than that of a previous generation of aspiring muscular Christian soldiers. (Almost 70 years later another well-illustrated volume on Grenfell identified as "juvenile literature" appeared. This work contains original art graphic panels and historic photographs; its publisher is based in St John's.) (43)

More formal biographical successors during the second half of the twentieth century were less hagiographic, but they still were influenced by, and added to, the Grenfell effect. As Rompkey outlines, the impetus for much of the recent publication history of biographical writing on Grenfell came from various publishers, prospective authors, and finally the executive of the International Grenfell Association, along with its British and American representatives, who had a vested interest in keeping the Grenfell "brand name" topical--all of this suggesting that Grenfell's name still held a certain cachet and, perhaps, too, might hold some cash. Harper, Harrap, Scribner's, Yale University, and Oxford University presses all figured in the story as did many well-known writers and would be physician-authors such as Dr Charles Curtis, Grenfell's right-hand man who became his medical successor in St Anthony. In the 1950s, the IGA commissioned a children's book author, J. Lennox Kerr (writing in this genre under the name of Peter Dawlish), who knew nothing about Grenfell, to write the "official" biography; the manuscript was first considered by Oxford University Press (OUP) but was later dropped. An OUP editor commented that the author's "abilities are those of a writer of schoolbooks ... this could become a good seller if not a good biography ... we may get our money back, but clearly this is not the definitive biography." In 1959 Kerr's biography was published by Harrap in the United Kingdom, Dodd Mead in the United States, and The Ryerson Press in Canada; in that same year he also published a fictional adventure story about Newfoundland and Labrador and Grenfell entitled The Race far Gawrie Bay. Aimed for children, the dialogue of the book's crusty characters was peppered with local dialect and phrases a la Norman Duncan; in an ironic twist OUP chose to publish Kerr's fiction (writing as Dawlish) over his fact. (44) It would not be until 1991, however, when Ronald Rompkey, a senior scholar and a Newfoundlander, would write the definitive biography of Grenfell. Published by a university press it remained unchallenged but was out of print for many years; it is now happily back in print through another university press. (45)

The Grenfell Effect and Medical Lives and Times in Newfoundland and Labrador

The desire to write and publish medical autobiography may have its roots in a "need for sympathy, self-justification, appreciation, or communication," as Caspari-Rosen and Rosen have noted, but examples of this genre that emanate from Newfoundland and Labrador seem to be also motivated and elevated by tropes related to the spiritual and the heroic that are not found in analogous Canadian works. The literary lineage of selected medical autobiographies clearly illustrates the Grenfell effect. The Labrador Memoir of Dr. Harry Paddon, 1912-1938 (2003), although published posthumously, maps out a period coinciding with the explosion of material by and about Grenfell himself. Paddon was one of Grenfell's most enthusiastic and staunchest medical missionaries who worked at Indian Harbour. Succeeding and supplementing this volume is that by Paddon's son, Dr Tony Paddon, Labrador Doctor: My Life with the Grenfell Mission (1989), which, following his father's death, recounts his years in practice from the mid-1940s to late 1970s. The book's foreword is written by Dr Gordon Thomas, who from 1959 was the last medical superintendent of the Grenfell Mission. Thomas himself wrote From Sled to Satellite: My Years with the Grenfell Mission (1987), which covers the period from his arrival in 1946 until the late 1970s when the Grenfell Mission ended its independence and became administratively absorbed by the province. The foreword to this book is written by W. Anthony (Tony) Paddon (now identified as a former Lieutenant-Governor of the province). In this work, Thomas reveals that his "deeply committed" Christian parents read missionary hero stories to him as a child, as a "young boy" he read about Grenfell and his work and was awarded a Sunday school prize of Wilfred Grenfell, The Master Mariner (the 1924 biography by Basil Mathews), and when at university (McGill) he chose a career in medicine over law. After serving in the armed forces, he accepted a post with the Grenfell Mission--as perhaps he seemed destined to do? (46) Many psycho-socio-economic imperatives may be invoked to explain all the interconnections described, but the power of print culture vis-a-vis Wilfred Grenfell ought to be considered a major impetus.

The Grenfell effect was also at work elsewhere in Atlantic Canada, even if it at times expressed in the negative. In his 1951 autobiography A Doctors' Pilgrimage (shades of John Bunyan again?), Edmund Brasset, when learning that he would probably begin his career in Canso, Nova Scotia--a place with the "reputation of being the most desolate, dreary, poverty-stricken and shabby place in the whole country ... Fish and fog, and fog and fish"--remonstrated with a tinge of conscience, "I am no Grenfell." (47) Half a century later Shane Neilson in his "new school" medical autobiography cum training tale, Call Me Doctor, describes his explicit and implied expressions of the Grenfell effect. As a native New Brunswicker who attended medical school in Nova Scotia, followed by post-graduate family medicine training in Newfoundland and Labrador, Neilson truly represents Atlantic Canada. However, as an enfant terrible during his medical school years from 1996 to 2000, Neilson displayed a decidedly "ungrenfellian" character and demeanour--from dying his hair purple and green, to adopting "F--You" as his medical school anthem, and convincing his instructors that he had murdered his younger brother.

Yet for all its late-twentieth-century training tale traits and tropes, Call Me Doctor is, like Grenfell's autobiography, a spiritual one--without the overt Christian allusions and references. Here medical autobiography is an allegory of the lost medical student who later finds his way as a good doctor. Neilson's rerouting appropriately takes place in Newfoundland and Labrador--Grenfell country--with the adventure and cautionary tales of Dr Grenfell reverberating in Neilson's mind to guide and protect the newly minted doctor. During a training rotation in St Anthony in the hospital established by Grenfell, Neilson is reminded of the great doctor's near-death experience almost a century earlier on an ice-pan. "I know that comparison between myself and the foolhardy Grenfell is ridiculous" Neilson mused, "but his misadventure is always on my mind when I'm travelling in this province... At least I know from the example of Grenfell that, should an accident happen, I must avoid the temptation of shortcuts." (48) Later, following a harrowing incident on the Labrador Highway, one with resonances to the famous Grenfell ice-pan incident (but without the dog slaughter), Neilson reflects, "It took a trip into Labrador's interior for me to understand the mechanics of survival, a term that my [wilderness survival] instructor defined in concrete terms as a fire, shelter, and signaling. On the trip I also discovered a spiritual definition of the term." (49)

There is no reason not to take the autobiographical writings of Neilson at face value, although his knowledge of Grenfell the man and the mystique that surrounded him may have inspired some passages directly. Interesting, too, is the spiritual subtext to Neilson's medical autobiography and its grounding in Newfoundland and Labrador as the place of his "awakening," reflection, and apparent personal transformation; in this regard the Grenfell effect is perhaps more subtle but more powerful. More curious, perhaps, is the resemblance of Neilson's saga to that of the fictitious Doctor Luke--the "wrecked ship" who found peace and purpose in Labrador. Neilson grew up in a "rural outpost" with a population of 53, and constantly played Star Wars computer games in which he dispatched "evil Stormtroopers." (50) Not surprisingly, Duncan's century-old tales of Billy Topsail and his heroic Luke (not Skywalker) were not part of Neilson's juvenile development; thus, although resonances between the texts are coincidental, nonetheless comparison between them remains intriguing.

Getting Medical Autobiography into Print: The Case History of Dr Robert Ecke

Exploring the genre of medical autobiography and articulating what has been termed the Grenfell effect--accounting for the relatively rich tradition of medical memoir writing in Newfoundland and Labrador as Grenfell's fictional and non-fictional legacy--coalesce as themes in the case study of Robert Ecke's Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948 published in 2000. A micro analysis (which includes analysis of textual sources as historical documents in light of a bibliographic model that relates evolving content to author-publisher-audience interaction) is possible because in addition to the published autobiography, we also have a major component of the author's personal papers about its creation and publication. (51)

Robert Skidmore Ecke (1909-2001) was an astute American doctor who was educated at Maine's Bowdoin College (BA '31 cum laude in German, biology, and chemistry) and Baltimore's Johns Hopkins University (MD '35), both institutions with strong Grenfell/medical Newfoundland and Labrador connections. The former, which sponsored numerous Arctic and Labrador coast expeditions and had numerous ties to the Grenfell Mission, awarded an honorary degree to Grenfell in 1929 (the year that Ecke was a sophomore student). (52) The Johns Hopkins University, like similar elite institutions such as Harvard (where Ecke also spent time in medical study) and Yale, was used by Grenfell and his colleagues to recruit medical students, young doctors, and others to work temporarily in Newfoundland and Labrador; occasionally, some, such as Drs Charles Curtis (a Harvard graduate) and John M. Olds (also of Johns Hopkins), would make this their life's work. (53)

This educational milieu with its ties to Grenfell likely influenced Ecke in 1934 when he first served at the Notre Dame Bay Memorial Hospital (NDBMH). The NDBMH, in Twillingate, then a successful sealing, fishing, and trading outport located on the mid-northeastern coast of the island, was not actually part of the Grenfell Mission, although Grenfell himself had helped found and fund it. Opened in 1924, this non-religious affiliated hospital became one of the best equipped, best staffed, and busiest in Newfoundland; it served a region covering 300 miles of coastline with a population of about 50,000. Patients would travel to hospital by coastal steamer, schooner, dory, motorboat, foot, and dog sled, as did doctors when on "house calls"; the hospital floating clinic, the Bonnie Nell, also visited remote and isolated settlements throughout much of the Notre Dame Bay archipelago. Environmental conditions and medical challenges at the NDBMH were similar to those associated with Grenfell's operations in the North, but the absence of any religious or missionary dimension created a vastly different social structure and ambience. Between 1934 and 1948, Ecke worked in Newfoundland during five trips as medical student, a licensed physician, and as a medical officer in the US Army; the majority of his time was spent in Twillingate, but there were also tours of duty in Wesleyville (Bonavista Bay) and Quidi Vidi (at Fort Pepperell, an American military post near St John's). During his professional life, Ecke was a civilian doctor, and an army doctor who served throughout the Second World War in the Arctic, the Middle East, and Europe (during which he achieved the rank of Lieutenant-Colonel); he also worked for the Central Intelligence Agency (CIA) for 15 years, as well as serving as a medical editor and medical researcher. In 1979 he retired to Eliot, Maine, where he died in 2001. (54)

Ecke kept a detailed typed and handwritten journal at the time which he updated, if not daily, then at least in close proximity to the time that events happened. A typescript of his memoirs prepared in 1947 has also survived, as has a finished draft prepared in 2000 that would be used for the final published version of the text. Comparing all versions, two points stand out. First, generally speaking, very little of the actual text changed over the different stages of production; second, it was the work's title that changed significantly between 1947 and 2000. The final title, Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, along with the jacket image of an iceberg against the background of the rugged coastline, places the "finished" book within the by now well-established tradition of tales of medical adventure. Internally, Ecke's many accounts of trekking across treacherous terrain, traversing frozen ponds, and crossing rough seas while often fearing for his life, performing tricky operations in patients' cramped houses under extremely difficult circumstances, and dealing with emergency hospital situations are all stirring. But, the term "frontier" in the title gestures to an American sensibility and collective memory of individualism and pushing ahead, an allusion to frontier life that is more likely to conjure an image of Davy Crockett than David Livingstone; it is one that does not register to the same extent with an Anglo-Canadian or indigenous Newfoundland readership, yet all the same there is a sense of the heroic that connotes the Grenfellian. Exactly when this title was composed is unknown, but it likely originated with the twenty-first-century reincarnation of Ecke's opus by his American publisher. The publisher's "blurbs" and promotional material accentuate the rough-and-tumble life of fisher families, the "extreme" poverty of Newfoundland, the remoteness of the place, and the derring-do of Dr Ecke--all supporting the concept of frontier medical practice. Presumably, this "spin" was designed to help in the marketing of the book. (55)

A wholly contrasting "spin" on this text is afforded, however, by Ecke's original 1947 title: Escape to Reality. Using this title as a signpost to authorial intent readers might still enjoy the Ecke's medical adventure tales about the "frontier," but they also may be more appreciative of his many reflective and incisive observations about the practice of medicine and on maturing as a doctor and as a person, and gain insights on life in Newfoundland other than its apparent "extreme" poverty. Indeed, reading these memoirs from this latter perspective one cannot help circling back to the plight and reformation of heroic "Doctor Luke" and the epiphany of the once iconoclastic Dr Shane Neilson. Like these fictional and actual characters who "discover" themselves and become freed, Ecke escapes the corruption of medical practice in New York City along with its scam artists to discover and enjoy Newfoundland fisherfolk and their ways. He opens by describing the New York hospital where he practised in 1939 as a "citadel of private medicine" and a place of "cheapness and fakery." Although committed to 18 months of medical service at this hospital, he could not endure this "bondage until at the end of 40 days and 40 nights my soul was won back to me" when he quit to return to Newfoundland now as doctor, not a medical student as before. (56)

Escaping back to the North--to reality--Ecke could indulge his "strange yearning for the remote and the wild and the lonely inaccessible." Despite his acknowledged appreciation of creature comforts, he also admitted, "I take a perverse delight in circumstances that make travel impossible and in the days when the ice is so bad the mailmen don't dare cross the tickle" (225). He could also take solace in the honesty, integrity, and sincerity of outport society from which he was separate as an urban American, yet with which he was intimately connected as a doctor. Although he recognized that the "framework for social distinction" existed in Twillingate and that "elements are present for prejudice or class feeling," it was Ecke's evaluation that in the community the "true aristocrat is the man who has skippered a ship well or is a good pilot. I'm in complete sympathy here. I look with awe on a man who has taken a forty- or fifty-ton schooner down the Labrador summer after summer and brought her back safely through the buffeting capricious seas and dark threats of unfriendly shores. When he has done that he can stand on his own two feet, supposing he hasn't shoes on them and tell the world to go to hell" (215). Like Grenfell, Ecke concluded that a good man in these parts is the one who is a master mariner.

That Ecke was living and practising medicine in "Grenfell country," which did allow him to "escape" from the city like Norman Duncan's Doctor Luke, is noteworthy. These exemplary revelatory statements from Ecke's "Escape to Reality" / Snowshoe & Lancet resonate with aspects of Duncan's work whether or not he was aware of it, but they are not as maudlin or overly sentimental as that author's Doctor Luke or even his literary renditions of Grenfell himself. But it is still possible to discern how the Grenfell effect was at work on Ecke in more ways. On the one hand he occasionally mused that he might quit Twillingate for mission work in St Anthony (which given Ecke's drinking and pill-popping habits would not have ended well) (116), while on the other he recorded on 5 January 1941 that a "link with the past is broken" due to the death of Grenfell the preceding fall and that of Dr Charles Parsons the day before (256). (57) While recognizing that he was part of this Grenfell-Hopkins pedigree line, Ecke fully realized that with the passing of its founders something important was lost with respect to the Grenfell effect.

Another aspect of the medical autobiographical intellectual heritage that can be teased out of Ecke's Newfoundland narrative is the vestige of antimoderinist thought that was identified previously in the thoughts and writings of Jessie Luther. On the one hand it is implicit in his attitude to medical practice: His Twillingate experience allowed him to do real doctoring as compared with the sham and shallow practices he had been involved with in New York City; as a "frontier" doctor he could exercise his skills as a surgeon and as a physician in more honest, true, and direct ways. In some respects, one can draw an analogy between Ecke's attitude and that of the arts and crafts movement that became aligned with turn-of-the-century antimodernist thinking. As much as the woodworking craftsman or fine press printer shunned mass-produced wares in favour of more personalized objects, so did Ecke distance himself from what might be termed a factory style of medicine. Ecke lamented that the "frontier keeps retreating" during his years he stayed at the remote hospital, for "refinement has crept up on us." For example, when an old makeshift diesel generator (which made the hospital's electric lights "glimmer" only and was so unreliable that kerosene lamps were needed as backup) was replaced by a reliable gasoline generator, Ecke noted how he was "threatened by 'efficient' machinery" which "somehow ... makes me feel inferior." These sentiments echo those of Luther, who also lamented the encroachment of electric light.

The second point of discussion revealed through analysis of the various forms of Ecke's text is that there was little actual substantive difference between them; occasionally, the names of female patients and their procedures have been removed, certain epithets such as "son of a bitch" erased, and medical shorthand or other abbreviations expanded. Spelling and grammatical inconsistencies have also been emended. Several hands were at work to edit typographical errors and to clarify, interventions which occurred both in the 1940s and towards the close of the century when the book was finally published. We have Ecke's own testimony to explain these processes. After recovering from war wounds, a hospital stay, and his discharge from the army in 1946, Ecke further recuperated at his brother's California home. There his brother, who was a well-connected Hollywood movie actor and writer, asked Milton Lubewisky, who was an "ace typist," to act as an amanuensis. "I dictated away for dear life," Ecke recounts, "using my assorted journals, notes, letters and papers." At this time Irving Stone, the noted novelist/writer/biographer, put him in touch with the renowned Maxwell Perkins of Scribners, who was not only Stone's editor but also that of Ernest Hemingway, Thomas Wolfe, and F. Scott Fitzgerald. This activity apparently led Viking Press to assign an editor, but one who would quit after a month's work on the project. (58) Ecke's personal motivations to see his memoirs in print at this time are unknown: perhaps he thought of the bountiful royalties that might come his way if he could produce a "bestseller" by capitalizing on the fact that Grenfell and Newfoundland remained very much a part of the American psyche due to a continuing, strong military presence on the island; or maybe he just genuinely wanted to share his doctor's stories as he believed them to be unique and truly interesting--certainly he appeared to have earned a reputation as raconteur at parties and other social gatherings. Coincidentally, it was at this same moment that Jessie Luther was seeking a publisher for her Newfoundland memoirs; we might assume that the reasons she was given for her repeated rejections also applied to Ecke. In brief, their rapturous thoughts about this northern land and their laments about encroaching modernity in the form of electric light no doubt rang hollow to editors in the new age of the atomic bomb.

For the next five decades, thoughts of publishing his manuscript subsided when Ecke embarked on his career with the CIA and pursued other activities; they were revived later, however, at the suggestion of Gary Saunders, a native Newfoundlander who was educated in New Brunswick and later settled in Nova Scotia. Although Saunders worked professionally as a forester, he would develop a reputation as a watercolour artist and author. (59) Around 1989 Saunders undertook a biography of Dr John M. Olds, Ecke's former boss at the NDBMH, based greatly on oral histories of surviving family and friends; he had also learned of Ecke's Twillingate journal and thus sought permission to access it. After reading Ecke's journal in 1990, Saunders encouraged him to publish. (60) Four years later Saunders was again in contact with Ecke to announce the publication of his Olds biography and to acknowledge his assistance: "Your part in John's story was large; and without it my book would have been much weaker. Thank you for letting me quote so extensively from your writings. You are a fine writer, most attuned to nuances of feeling weather, landscape. You helped me bring that time alive on paper, and taught me new respect for what you and your [Johns Hopkins] classmates did for us in [Notre Dame Bay]." (61) Also around this time a local reporter, neighbour, and "computer wizard" in Ecke's adopted retirement hometown in Maine interviewed him and learned of the old typescript. Soon, the publishing project would be resurrected when a transliterated electronic version of the 1940s typescript was completed. Ecke and Saunders continued to correspond as their relationship developed into friendship: the initial salutation of "Dear Dr. Ecke" evolved into "Dear Ecke" then just "Hackle"--a reference to how outport Newfoundlanders pronounced Ecke's name in the 1930s, for local dialect then as now adds an "h" before a vowel which usually also undergoes its own pronunciation change (e.g., ice become hoice). Saunders also wished Ecke to write a foreword for another medicine-related book which was an offshoot of his Olds biography. (62) By early 1997, Saunders became Ecke's de facto literary agent and was in contact with several St John's regional publishing houses hoping to interest them in Ecke's Twillingate memoirs/autobiography. "Breakwater's Mr. Rose never said 'Yes;' he didn't say No either," Saunders informed Ecke in February 1997. He continued, "My guess is he's cash-strapped (laid off most of his staff last Dec/Nov, hired them back in Jan) and may see another T'gate saga [in reference to Saunders' own Olds biography] as superfluous. So, I'll try him once more, then try Killick Press (Robinson-Blackmores imprint). OK? Unless you have a NY or Boston publisher in mind." (63) By fall of that year the likelihood of a Newfoundland publisher undertaking this project looked bleak. Saunders had written to Harry Cuff, the president of Cuff Books, reminding him that he had previously agreed to review some sample pages, but that he had not yet replied: "Does your silence mean 'I pass', 'Maybe' or 'Seriously interested but too busy to reply?' Dr. Ecke and I need to know so that we can shop elsewhere. Recognizing that Breakwater Books was not interested and Cuff probably was not either, (65) Saunders inquired of Ecke if he should "try Upalong" (a Newfoundland reference to mainland Canada). (66)

That the Saunders-Ecke team failed to interest a local Newfoundland press in the manuscript is not so remarkable, but the very fact that such publishing houses existed at this time merits comment. As Roy MacSkimming reminds us, publishing in Canada has been a "perilous trade"; in St John's at this time it verged on the foolhardy. In his national history of publishing MacSkimming felt compelled to include the founders of Breakwater Books, Killick Press, and Harry Cuff Publications under the rubric of a "clutch of dreamers," noting how these businesses began to spring up during the 1970s and 1980s as part of the Newfoundland "renaissance" in arts and culture. Through their effort, especially that of Clyde Rose, founder of Breakwater, multiple outlets were formed that allowed a regional publishing trade to take root. (67) Regrettably, when Saunders approached Breakwater, for example, it was as he noted a time when Rose had laid off many of his staff; even if the financial outlook had been better it is debatable whether this publisher could have countenanced another medical history book which might have undercut Saunders' own Olds book that remained an active seller.

In 1998, after almost a decade of correspondence, Saunders was now referring to Ecke's publication of the journal as "your MS printing project" and was advising him on the need to select a good proofreader and to understand proofreaders' marks, on the merits of perfect binding and side stitching, and on why he should select a Roman type in no less than 8-10 point. (68) All this advice clearly points to a "do-it-yourself" vanity press book, rather than a trade publication as both originally envisaged; the introduction of Peter E. Randall of Portsmouth, New Hampshire around this time admirably fulfilled their needs. Randall Publisher specializes in photographic art books, illustrated local histories, and biographies; its production work is of high quality and has won awards. As a "custom publisher" this company assumes very few of the costs of book production, which are the responsibility of the client (author/editor). Under these terms, the publisher becomes de facto a job printer who handles all production and some distribution matters, but "[a]ll books become the property of the author and all books printed are bound. Books may be published under our name or under a name of the client's own choosing. The book's copyright will be in the client's name." While Randall does not operate exclusively as a "vanity press," it is one facet of its operation.

The mutual respect displayed by Ecke and Saunders towards each other is embedded in the archival record, but the physical object that became the book Snowshoe & Lancet is open testimony to their collaboration. Saunders wrote its foreword and one of his watercolour paintings of an iceberg (again paratextual material underscoring a sense of place) graces the front cover. (69) To complete the cycle of book production, along with Randall his publisher, Ecke undertook promotional tours and launches when in his 91st year of age. He returned to Twillingate almost 70 years after his first visit to do signings, interviews, and "push the product." He also renewed some acquaintances, still living in Twillingate, who had worked at the hospital when he first arrived there in 1934! By all accounts the trip was successful and was well covered by local media outlets; the book was also promoted through his two alumni networks at Bowdoin College and Johns Hopkins University and by local Maine newspapers. Perhaps the most novel aspect of the reception of Snowshoe & Lancet was the direct request to Ecke by the English department head at the local high school to have a class set donated in order that it could be incorporated into a course entitled Literary Heritage 2223, which dealt with local studies. The teacher noted that the school was currently using Saunders' biography of Dr Olds, thus she thought "these two texts would complement each other nicely." Ecke complied. The school in question was named J.M. Olds Collegiate after Twillingate's long-serving "heroic" hospital doctor. (70)

Within a year of Ecke's death in 2001, all extant copies of his memoir were transferred to the local museum in Twillingate, which is now the only place where it can be purchased (with the publishers' website having a link to it). (71) The final marketing fate of Ecke's book is reminiscent of Gordon Thomas' From Sled to Satellite, which may be purchased at some regional bookstores, but is more readily available for purchase online from the Grenfell Foundation arm of the Labrador-Grenfell Regional Health Authority as part of its fund raising and awareness effort to "aid the cause." (72) Saunders biography of Dr Olds is also only available regionally, but it appears to enjoy better sales than these other books as it has become another Breakwater "bestseller."

Studying Ecke's personal experience of getting his medical autobiography into print is instructive as a micro study of book history, but it also allows a recapitulation of the overarching concerns of this discussion. Understandably, many book history studies focus on "important" authors, genres, works, and processes, but the Ecke example is a reminder that the study of the trials and tribulations of "amateurs" also have their place. Study of the world of custom publishing or vanity press can augment our understanding of the motivations and challenges in this field; it also reminds us that those works that might end up in remainder bins can have a history as intriguing as any "bestseller." Considering also Ecke's half-century journey from journal writing into print from a broader perspective of the nature of historical evidence, especially in light of schema developed by I.S. MacLaren and other critics of travel and exploration literature, (73) is useful when evaluating documents such as medical autobiographies as valid and reliable historical sources; under such circumstances bibliographic methods, broadly construed, can aid historians. Although based only on this single example (but augmented by the work of MacLaren and others, including Sasha Mullally's study of how a Nova Scotia doctor's manuscript was greatly edited to conform to his publisher's view of what readers likely expected (74)), it may be postulated that the more sophisticated the publication process the less reliable the finished product, as both author and publisher become conscious of their market and the desire to appeal to it. In Ecke's case, we can say with some certainty that his original journal notes match up to the printed volume because neither he nor his custom publisher was overly concerned about "doctoring" the manuscript to suit the tastes of prospective readers (the concession of the change of title notwithstanding). Thus this book's usefulness as a historical source seems sound. A reviewer of Snowshoe & Lancet in a scholarly journal who was quite unaware of the existence of the original documents on which the book was based unknowingly drew attention to this fact when she noted that the "most striking feature of these memoirs is the vivid sense of experience they project. They have the freshness and candor of recently recorded reminiscence.

Another review of Snowshoe & Lancet remarked in passing that "[m]emoirs of foreign physicians in Newfoundland are commonplace," (76) implying that their number in Newfoundland and Labrador differs from elsewhere. The "Grenfell effect" accounts for this perceived ubiquity, for, as has been explained, Sir Wilfred Grenfell--role model, missionary, adventurer, physician, and writer--and the medical and lay colleagues who followed him (one is almost tempted to call them disciples or acolytes) created a culture of medicine, healing, and autobiographical writing which in turn became part of the larger culture and mystique of Newfoundland and Labrador. Their steady stream of words entertained, enlightened, and engaged a broad readership across the Anglo world for much of the twentieth century. Such works helped create a picture of Newfoundland and Labrador as the "North" which was rugged and remote, yet romantic and therapeutic--therapeutic in a metaphoric sense, but also given the medical themes of the literature described here it could be interpreted in a literal sense, too.

Central to this enterprise was the culture of print--many activities described were only able to cohere through books along with those persons who were instrumental in their production and reception. Although it weakened over time, Grenfell's was a tightly bound network and tradition, in which key publishing personnel played a part. S.E. Briggs of Revell not only produced and distributed works by Grenfell himself, but was also the glue that cemented the relationship between the two men and Norman Duncan; Briggs, as Grenfell director, also engaged in other promotional activities that benefited all parties. With the death of Grenfell the man, it was Grenfell the corporation that mediated in the commission of later print enterprises. By the latter decades of the twentieth century the charm of the North and allure of antimodernism had become attenuated, so that authors such as Jessie Luther and Robert Ecke had difficulty publishing their manuscripts. Similarly, with the demise of muscular Christianity and the eclipsing of the enthusiasm for the social gospel by other religious movements later in the twentieth century, the passion for reading inspirational fiction and non-fiction accounts waned and further eroded the readership for the genre of books described here. To be sure, medical autobiographies continued to be written--including those that can be seen to be in the "tradition" of Grenfell--but a later generation of readers of old doctors' medical tales were more likely to categorize them along with the personal narratives of old soldiers or old politicians. These books may be instructional and revealing in their own ways, but they are perhaps more likely to be read today as curiosities related to a bygone era; or, perhaps, their authors or subjects have became so identified with particular communities that the resultant books are perceived to be constituents of the collective memory and thus they become much like "souvenirs." Such interpretations also help explain why publishers of later medical autobiographies are typically "regional" houses with marketing that caters to a local audience or even the tourist trade. Nonetheless, such works can take a place alongside others in the genre as they often have great value as primary historical sources. The bibliographical methodology employed here which considered the individual works studied as a genre, as well as the books themselves as artifacts, has great historical merit as it yields interesting results that might not be so obvious without the adoption of such an interdisciplinary interrogation. Mixing (presumably) factual narratives with fictional accounts, considering contemporary works in conjunction with current ones, and thinking "historically" through the prism of print culture illustrates how central is "the book" when trying to explain particular aspects of the past that otherwise would appear to be quite unrelated. In the case of medical autobiographies related to and/ or inspired by Grenfell within the context of Newfoundland and Labrador culture, such an approach is especially informative.

(1) S.E.D. Shortt, "'Before the Age of Miracles': The Rise, Fall and Rebirth of General Practice in Canada, 1890-1940," in Health, Disease and Medicine: Essays in Canadian History, ed. Charles G. Roland (Toronto: Hannah Institute for the History of Medicine/Clarke Irwin, 1983), 123-52. See also Sasha Mullally, "Rural Medicine: Exploring the Lives of Country Doctors in the Maritime Provinces and Northern New England States, 1900-1950" (PhD diss., Department of History, University of Toronto, 2004).

(2) Beate Caspari-Rosen and George Rosen, "Autobiography in Medicine Or The Doctor in Search of Himself," Journal of the History of Medicine and Allied Sciences I (1946): 290-99.

(3) Rita Charon, "Narrative Medicine: Form, Function, and Ethics," Annals of Internal Medicine 134 (2001): 83-87. These character changes insert an "obligatory discontinuity into any medical autobiography." Charon continues: "The publication of many memoirs about medical school suggests the urgency to tell of these transformations--and to tell of them in sadness, rage and contrition. The width of the alienating discontinuity opened by medical training suits physicians particularly well for writing autobiographies and even suggests that they, more than other professionals, need to write them."

(4) Donald Pollock, "Training Tales: U.S. Medical Autobiography," Cultural Anthropology II (1996): 339-61; see also Pollock, "Physician Autobiography: Narrative and the Social History of Medicine," in Narrative and the Cultural Construction of Illness and Healing, ed. Cheryl Mattingly and Linda C. Garro (Berkeley: University of California Press, 2000), 108-27. It is worth noting the male bias of most medical autobiographies which reflects the gendered nature of this profession, but for a countervailing perspective see Marjorie S. Sirridge and Brenda Pfannenstiel, "Daughters of Aesculapius: A Selected Bibliography of Autobiographies of Women Medical School Graduates," Literature and Medicine 15 0996): 200-16, http://www.med.umkc.edu/teams/cml/womendrs. html, accessed 2 December 2009.

(5) C. Lamont MacMillan, Memoirs of a Cape Breton Doctor (Halifax, NS: The Book Room Limited, 1993) (originally published by McGraw-Hill Ryerson in 1975); Edmund A. Brasset, A Doctor's Pilgrimage." An Autobiography (Philadelphia: J.B. Lippincott, 1951); Arnold Burden with Andrew Shafer, Fifty Years of Emergencies: The Dramatic Life of a Country Doctor (Hantsport, NS: Lancelot Press, 1991). For a sophisticated discussion of medical autobiography primarily of Nova Scotia, see Sasha Mullally, "History, Memory, and Twentieth-Century Life Writing: Unpacking a Cape Breton Country Doctor's Black Bag," in Essays in Honour of Michael Bliss, ed. E.A. Heaman, Alison Li, and Shelley McKellar (Toronto: University of Toronto Press, 2008), 435-69. While focusing on the Maritimes, Mullally does cast her net wider to make reference to approximately 130 medical autobiographies from elsewhere in Canada, as well as the United Kingdom, the United States, and New Zealand, but makes no reference to Newfoundland and Labrador apparently because she excludes "[m]issionary-type rural practitioners who travelled to isolated communities, such as William [sic] Grenfell" (458).

(6) Shane Neilson, Call Me Doctor (East Lawrencetown, NS: Pottersfield Press, 2006), http://www.pottersfieldpress.com/ authors/neilsons.html, accessed 23 March 2009.

(7) Ronald Rompkey, ed., Labrador Odyssey: The Journal and Photographs of Eliot Curwen on the Second Voyage of Wilfred Grenfell, 1893 (Montreal: McGill-Queen's University Press, 1996); Gordon Thomas, From Sled to Satellite: My Years with the Grenfell Mission (n.p., 1987); Chris Rolton, Doin' the Locum Motion (St John's: Creative Publishers, 2000); H. Gordon Green, Don't Have Your Baby in the Dory: A Biography of Myra Bennett (Montreal: Harvest House, 1973); Noel Murphy, Cottage Hospital Doctor: The Medical Life of Dr. Noel Murphy (St John's: Creative Publishers, 2003); Celesta Gerber Acreman, For the Love of Labrador--My Story (n.p.: [Robinson Blackmore], n.d.); B.J. Banfill, Labrador Nurse (Philadelphia: Macrae Smith, 1953); Nigel Rusted, It's Devil Deep Down There: 50 Years Ago on the M. V. Lady Anderson, a Mobile Clinic on the S. W. Coast of Newfoundland (St John's: Creative Publishers, 1987); W.A. Paddon, Labrador Doctor." My Life with the Grenfell Mission (Toronto: James Lorimer, 1989); Ronald Rompkey, ed., The Labrador Memoir of Dr. Harry Paddon, 1912-1938 (Montreal: McGill-Queen's University Press, 2003); Harrison J. Hunt and Ruth Hunt Thompson, North to the Horizon: Arctic Doctor and Hunter, 1913-1917 (Camden, ME: Down East Books, 1980); Elliot Merrick, Northern Nurse (Halifax: Nimbus Publishing, 1994 [1942]); Rhoda Maude Piercey, True Tales of Rhoda Maude: Memoirs of an Outport Midwife, ed. Janet McNaughton (St John's: Faculty of Medicine, Memorial University, 1992); Margaret Giovannini, Outport Nurse, ed. Janet McNaughton (St John's: Faculty of Medicine, Memorial University, 1988); Robert S. Ecke, Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948 (Portsmouth, NH: Peter E. Randall, 2000); Brian P. Harris, Good as the Sea, Rural Newfoundland." Medical and Other Experiences, 1955-1958 (St John's: Faculty of Medicine, Memorial University, 1990); James Graham Gillan, Through Northern Eyes (Calgary: University of Calgary Press, 1991); J. Karen Scott and Joan E. Kiser, eds., Northern Nurses: True Nursing Adventures from Canada's North (Oakville, ON: Kokum Publications, 2002); and Kirby Walsh, ed., A Trip to the Labrador: Letters and Journal of Edward Caldwell Moore (St John's: Breakwater, 2009). Also of note in this context is the essay by J.T.H. Connor, "Rural Medical Lives and Times," Newfoundland and Labrador Studies 23, no. 2 (2008): 231-43.

(8) Megan J. Davies, "Mapping 'Region' in Canadian Medical History: The Case of British Columbia," Canadian Bulletin of Medical History 17 (2000): 73-92; Peter L. Twohig, "Written on the Landscape: Health and Region in Canada," Journal of Canadian Studies 41 (2007): 5-17; David R. Philips, "Islands, Health and Development," Health & Place 1 (1995): 195-97; and Jayne Elliott, Meryn Stuart, and Cynthia Toman, eds., Place and Practice in Canadian Nursing History (Vancouver: UBC Press, 2008).

(9) For comparative studies of missionary medicine, see Karen Minden, Bamboo Stone: The Evolution of a Chinese Medical Elite (Toronto: University of Toronto Press, 1994); Yuet-wah Cheung, Missionary Medicine in China: A Study of Two Canadian Protestant Missions in China Before 1937 (Lanham, MD: University Press of America, 1988); Michael Gelfand, Godly Medicine in Zimbabwe; A History of its Medical Missions (Gweru, Zimbabwe: Mambo Press, 1988); see also John Ross, Ugandan Diary [1990-1994] (St John's: n.p., 1994), http://www.med.mun.ca/getdoc/ 7c83ba32-21d9-49a2-bc68-eo2041458417/ ugandan_diary.aspx, accessed I April 2009. For studies of the tradition of medical and other missionary narratives as they specifically relate to print culture, see Rennie B. Schoepflin, "The Mythic Mission: Medical Missionary Literature, American Children and Cultural Identity," in Religion and the Culture of Print in America, ed. Charles L. Cohen and Paul S. Boyer (Madison: University of Wisconsin Press, 2008), 72-104; and Sarah Robbins, "Woman's Work for Woman: Gendered Print Culture in American Mission Movements Narratives," in Women in Print." Essays on the Culture of American Women from the Nineteenth and Twentieth Centuries, ed. James P. Dankey and Wayne A. Wiegand (Madison: University of Wisconsin Press, 2006), 251-80.

(10) Wilfred T. Grenfell, Adrift on an Ice-Pan (Boston: Houghton Mifflin, 1909). This work originally published as A Voyage on a Pan of Ice (Boston: The Grenfell Association of America, 1908); in 2004 it was "reprinted" as an audiobook in compact disc format by Rattling Books, St John's, NL.

(11) Wilfred T. Grenfell, Vikings of To-Day Or Life and Medical Work Among the Fishermen of Labrador (London: Marshall Brothers, 1895). The American edition bore a slightly different title on its front cover, but the title page remained the same; see Wilfred T. Grenfell, Vikings of To-Day: Labrador and its People (New York: Fleming H. Revell Company, n.d. [1896]). A good overview of the history of the Revell the publisher, including its absorption by Baker, is available at http://www.revellbooks.com/ME2/Audiences/ dirmod.asp?sid=9FC2E1F4E24 64E5EADE1430BB2DF94Eo&type=gen&mod=Core+Pages&gid=AAE7EBD 9D6A94zD89Eo9DC5A26o234D4, accessed 21 May 2009.

(12) John P. Ferre, A Social Gospel for Millions: The Religious Bestsellers of Charles Sheldon, Charles Gordon, and Harold Bell Wright (Bowling Green, OH: Bowling Green State University Popular Press, 1988), 9. Supplementing Ferre's argument concerning the publishing success of this genre at this time are Joan Shelley Rubin, "The Boundaries of American Religious Publishing in the Early Twentieth Century," Book History 2 (1999): 207-17; and Erin A. Smith, "'What Would Jesus Do?': The Social Gospel and the Literary Marketplace,' Book History 10 (2007): 193-221.

(13) Eric Lupfer, "Before Nature Writing: Houghton, Mifflin and Company and the Invention of the Outdoor Book, 1880-1900," Book History 4 (2001): 177-204; see also Nick Mount, When Canadian Literature Moved to New York (Toronto: University of Toronto Press, 2005), chap. 4.

(14) On Ralph Connor as author and his role in early twentieth-century North American culture and his astounding publishing success, see Ferre, Social Gospel, chap. 3; Daniel Coleman, White Civility: The Literary Project of English Canada (Toronto: University of Toronto Press, 2006), passim; and Marion McKay, "Region, Faith and History: The Development of Winnipeg's Visiting Nursing Agencies, 1897-1926," in Place and Practice, ed. Elliot et al., 70-90.

(15) The Toronto Willard Tract Depository was founded in 1877 by social reformer, philanthropist, and politician William H. Howland; four years later S.R. Briggs operated it. Briggs' son, S. Edgar Briggs, was also employed there. In 1884 Briggs junior (then about 20 years of age) hired a 14-year-old boy named George Doran. Doran would later relocate to the United States in 1892 to become employed by the Fleming H. Revell publishing company; S.E. Briggs would also do so after Revell bought out the Willard Tract Depository in 1893. Later Briggs would manage the active New York branch of the company and Doran would successfully branch out as a publisher in his own right and in partnership with such important houses as Hodder & Stoughton and Doubleday. The Canadian religious publishing roots of both men, along with their American connections, help explain their ability to attract the likes of international bestselling Canadian authors such as Duncan and Connor. And in Briggs' case, initially also Grenfell. On the founding of the Willard Tract Depository and Revell and its author-publisher relationships, see "Howland, William Holmes," Dictionary of Canadian Biography (Toronto: University of Toronto Press, 1990), 12: 453-55; George H. Doran, Chronicles of Barabbas, 1884-1934 (New York: Harcourt Brace and Company, 1935); George Parker, "Distributors, Agents and Publishers: Creating a Separate Market for Books in Canada, 1900-1920," Papers of the Bibliographical Society of Canada 43, no. 2 (2005): 7-65; and Clarence Karr, Authors and Audiences: Popular Canadian Fiction in the Early Twentieth-Century (Montreal: McGill-Queen's University Press, 2000), especially chap. 4.

(16) An excellent introduction to "muscular Christianity" and its cultural and literary context is Coleman, White Civility, chap. 4. Coleman explains that Charles Kingsley's Victorian notion of thumos (derived from classical Greek thought) underpinned this concept and was a "kind of rage or primitive vigour that could reanimate the man enervated by the decadence of modern Victorian society." Thus a "mythos of Anglo-Saxon aggressiveness" could be enlisted in the "service of patriotism" or Christianity allowing the muscular Christian (including the Boy Scout) to bring "British enlightened principles to the darkened, backward world," an enterprise which in turn "firmed up his own character and found a productive outlet for his volcanic energy" (135-37).

(17) Basil Mathews, Wilfred Grenfell, The Master Mariner: A Life of Adventure on Sea and Ice (New York: George H. Doran Company, 1924). In 1892 Grenfell

was photographed at the helm of the Alice Fisher on the wheel of which is the phrase "Jesus saith follow me." See Ronald Rompkey, Grenfell of Labrador: A Biography (Toronto: University of Toronto Press, 1991), following p. 74. There is also the connection to the Galilean fisherman, who would become St Peter. (Of course, there is also the link to St Anthony, the patron saint of fisherman and the name of the town that was Grenfell's headquarters.) And it is not too much of a stretch to make a link between Grenfell as physician/ medical missionary and St Luke, the patron saint of physicians and surgeons (such a connection was made in the fictional representation of a Grenfellesque character by Norman Duncan in his Fleming H. Revell publication Doctor Luke of the Labrador).

(18) See Rompkey, Grenfell of Labrador, 335-39; and R.G. Rompkey, "Sir Wilfred Thomason Grenfell: A Selective Bibliography" (unpublished manuscript submitted for English 417, Memorial University, 1965), copy available in Centre for Newfoundland Studies. Also useful in this context is Patricia O'Brien, The Grenfell Obsession: An Anthology (St John's: Creative Publishers, 1992).

(19) Wilfred T. Grenfell, A Labrador Doctor." The Autobiography of Wilfred Thomason Grenfell M.D. (Oxon.), C.M.G. (Boston and New York: Houghton Mifflin Company, 1919).

(20) Ronald Rompkey, "Elements of Spiritual Autobiography in Sir Wilfred Grenfell's A Labrador Doctor," Newfoundland Studies 1 (1985): 17-28; reprinted in Rompkey, Literature and Identity: Essays on Newfoundland and Labrador (St John's: DRC Publishing, 2006), 12-24. Contrary to Mullally, who claims that the 1938 volume Horse and Buggy Doctor by Arthur Hertzler was the first medical autobiography to reach a mass audience in North America, I would contend that it was in fact Grenfell's; see Mullally, "History, Memory and Twentieth-Century Medical Life Writing," 438.

(21) Ronald Rompkey, "Heroic Biography and the Life of Sir Wilfred Grenfell," Prose Studies 12 (1989): 159-73; reprinted in Rompkey, Literature and Identity, 36-52.

(22) Basil Mathews, Wilfred Grenfell, The Master Mariner: A Life of Adventure on Sea and Ice (New York: George H. Doran Company, 1924), frontispiece.

(23) Public Opinion, I April 1905, quoted in Elizabeth Russell Miller, The Frayed Edge: Norman Duncan's Newfoundland (St John's: Harry Cuff Publications, 1992), 70. On Duncan, see also Elizabeth Russell Miller, "Norman Duncan: A Critical Biography" (PhD diss., Memorial University of Newfoundland, 1987).

(24) Norman Duncan, Doctor Luke of the Labrador (New York: Fleming H. Revell Company, 1904); Norman Duncan, Dr. Grenfell's Parish (New York: Fleming H. Revell Company, 1905); and Norman Duncan, Billy Topsail, M.D. (New York: Fleming H. Revell Company, 1916).

(25) See Patrick O'Flaherty, The Rock Observed." Studies in the Literature of Newfoundland (Toronto: University of Toronto Press, 1979), 95-102. O'Flaherty notes that "Duncan's deficiencies as a writer, too conspicuous to need discussion, are sentimentality and a liking for melodrama. His achievement was to embody the ancient ways of Newfoundland people in living literature" (100-101). But see also Nick Mount, who concentrates on Duncan's ethnic writings about New York in When Canadian Literature Moved to New York, 123-28.

(26) Norman Duncan and William Lyon Mackenzie King were students at the University of Toronto in the 1890s; they remained friends until Duncan died (Miller, Frayed Edge, 11-13). King, owing to his social reform propensities, greatly admired Grenfell (Rompkey, Grenfell of Labrador, 110). See also "Dr. Grenfell's American Tour," Among the Deep Sea Fishers, April 1905, 5-10.

(27) Rompkey, Grenfell of Labrador, 115-16; "Dr Grenfell's American and Canadian Tour," Among the Deep Sea Fishers, July 1905, 12-35 at 24; "Dr Grenfell's Appreciation of Norman Duncan," Among the Deep Sea Fishers, January 1917, 152.

(28) Duncan, Doctor Luke, passim. On the mini public relations skirmish between Grenfell and Duncan, see "Dr. Luke of the Labrador," Among the Deep Sea Fishers, January 1905, 19-21; "The Real Doctor Grenfell," Among the Deep Sea Fishers, January 1905, 21-22; and "Dr Grenfell's Appreciation of Norman Duncan," Among the Deep Sea Fishers, January 1917, 152.

(29) On Treves and the "Elephant Man," see Peter W. Graham and Fritz H. Oehlschlaeger, Articulating the Elephant Man:Joseph Merrick and His Interpreters (Baltimore: Johns Hopkins University Press, 1992); and Michael Howell and Peter Ford, The True History of the Elephant Man (Harmondsworth: Penguin, 1980). The work by Christine Sparks entitled The Elephant Man (New York: Ballantine Books, 1980) deals with a character named John Merrick and is classified as a novel; it is also connected to the movie of the same name, but is distinct from the Broadway play; see http://www.imdb.com/title/tt0080678/ and http://www.ibdb.com/production.php?id=3938 respectively, accessed 30 March 2009.

(30) Frederick Treves, preface to Vikings of To-Day, ix-x. The contemporary belief of the ability of a harsh climate to allow development of hardiness and ingenuity in men along with the enhancement of the desirable character traits of "manliness" and that of a "gentleman" (both of which Grenfell would become to personify) are examined in Michael F. Robinson, The Coldest Crucible: Arctic Exploration and American Culture (Chicago: University of Chicago Press, 2006), especially chaps. 5 and 6.

(31) Duncan, Doctor Luke, 176-77.

(32) Duncan, Doctor Luke, 243.

(33) Duncan, Billy Topsail, M.D., 280-81.

(34) Duncan, "To the reader," in Dr. Grenfell's Parish, n.p.

(35) On antimodernism, see T.J. Jackson Leafs, No Place of Grace: Antimodernism and the Transformation of American Culture, 1880-1920 (New York: Pantheon Books, 1981). The Rose Valley Association is a good example of an arts and crafts "utopian community," see http://www.rosevalleymuseum.org/index.html, accessed 22 May 2009; also see Donald Richard Stoddard, "Horace Traubel: A Critical Biography" (PhD diss., University of Pennsylvania, 1970), especially chap. 7.

(36) Reid Newfoundland Company, Newfoundland and Labrador." Unrivalled Resorts for the Tourist, Health Seeker and Sportsman ([St John's, ca. 1910]), 4-5, quoted in Gerald L. Pocius, "Tourists, Health Seekers and Sportsmen: Luring Americans to Newfoundland in the Early Twentieth Century," in Twentieth-Century Newfoundland: Explorations, ed. James Hiller and Peter Neary (St John's: Breakwater Books, 1994), 47-77, with quotation on p. 55.

(37) Allan Byrne, "'Where the gamely salmon and lordly caribou abound': Anti-Modernism and Tourist Promotion of the Newfoundland Wilderness During the 19th and Early 20th Centuries," Aspects: A Publication of the Newfoundland Historical Society 44, no. 3 (2009) in Newfoundland Quarterly 101, no. 4 (2009): 39-45.

(38) This material is based on Ronald Rompkey, ed., Jessie Luther at the Grenfell Mission (Montreal: McGill-Queen's University Press, 2001).

(39) This passage by Jessie Luther originally appeared in the May 1906 issue of House Beautiful, a magazine devoted to the arts and crafts movement; quoted in Rompkey, Luther, xxvii.

(40) Rompkey, Luther, 16.

(41) Rompkey, Luther, xi-xiv.

(42) "Adrift on an Ice Pan," True Comics 10 [1941]: 26-31; see http://www.grenfellproperties.com/comic_strip.html, accessed 25 March 2009. For context on heroic medical figures in comic books, see Bert Hansen, "Medical History for the Masses: How American Comic Books Celebrated Heroes of Medicine in the 1940s," Bulletin of the History of Medicine 78 (2004): 148-91; and Bert Hansen, "True-Adventure Comic Books and American Popular Culture in the 1940s: An Annotated Research Bibliography of the Medical Heroes," The International Journal of Comic Art 6 (2004): 117-47.

(43) Colleen Shannahan and Raidel Bas, Mission! The Extraordinary Adventures of Sir Wilfred Grenfell (St John's: Belle Isle Press, [2006]). Roughly in the same genre is Tom Moore, Wilfred Grenfell (Don Mills: Fitzhenry and Whiteside, 1980), an illustrated biography that has been derived from previous publications and is aimed at children in the publisher's celebratory and heroic "The Canadians" series (despite the fact that Grenfell was very, very English and that Newfoundland had absolutely no political connection to Canada until 1949, about a decade after his death).

(44) Rompkey, "Heroic Biography," 39-48. While Grenfell's passing reduced some of the lustre of the International Grenfell Association (IGA), the organization remained pivotal for the delivery of health care in northern Newfoundland and Labrador. Even after confederation with Canada in 1949, the newly formed provincial government delegated the administration of medical services to the IGA and provided it with funds; it was not until 1981 that the IGA sold all medical care assets (hospitals, nursing stations, land, and equipment) to the government for the nominal sum of one dollar. At this time the IGA's involvement with medicine formally ceased, but the organization stills exists and is still governed by an international board of directors; see http://www.iga. nf.net, accessed 6 July 2009. See also Gordon W. Thomas, "The International Grenfell Association: Its Role in Northern Newfoundland and Labrador. Part I: The Early Days," Canadian Medical Association Journal 118 (1978): 308-10, 326; Thomas, "The International Grenfell Association. Part II: The Benefits of Newfoundland's Entry into Confederation," Canadian Medical Association Journal 118 (1978): 446-49, 459; and Sheila Gushue, "Long-serving International Grenfell Association Physicians Share $50,000 Royal Bank Award," Canadian Medical Association Journal 117 (1977): 389-99.

(45) Rompkey, Grenfell of Labrador. Unlike most previous biographers of Grenfell, Rompkey realizes that for "people growing up in Newfoundland and Labrador in the latter half of this century, the life of Wilfred Grenfell presents ambiguities" (ix). The new printing of Rompkey's biography published by McGill-Queen's University Press in 2009 is identical to the earlier University of Toronto Press version, except a change of cover which has replaced Grenfell as muscular Christian at the helm with an image of him as caring doctor in a white coat at a patient's bedside. Such a choice of image conveys a vastly different paratextual message for a current readership.

(46) Thomas, From Sled to Satellite, 1-2.

(47) Brasset, A Doctor's Pilgrimage, 12.

(48) Neilson, Call Me Doctor, 57.

(49) Neilson, Call Me Doctor, 67, 70.

(50) Neilson, Call Me Doctor, 12-13.

(51) On how these papers were finally deposited at Memorial University, see Bert Riggs, "The Journey of the Ecke Papers," Newfoundland Quarterly 100, no. 1 (2007): 35.

(52) On Bowdoin and Bartlett and fellow travellers, see http://www.bowdoin. edu/arctic-museum/biographies/bartlett.shtml. Grenfell's doctorate citation is available at http://library.bowdoin.edu/arch/subject/bowdoin/honorary. shtml#1930; see also http://library.bowdoin.edu/arch/subject/bowdoin/honors/ gould46.pdf, accessed 1 April 2009.

(53) Rompkey, Grenfell of Labrador, passim; and Gary Saunders, Dr. Olds of Twillingate: Portrait of an American Surgeon in Newfoundland (St John's: Breakwater Books, [1994]).

(54) For biographical details see Shaina Goudie, "The Papers of Robert S. Ecke, Coll-355" [finding aid] (Archives and Manuscripts Division, Queen Elizabeth II Library, Memorial University, St John's), 3-7. See also J.T.H. Connor, "Twillingate," Newfoundland Quarterly 100, no. 1 (2007): 12-15, 30-33; and J.T.H. Connor, "'Medicine is here to stay': Rural Medical Practice, Frontier Life, and Modernization in 1930s' Newfoundland," in Social Medicine and Rural Health Care Delivery in the North in the 19th and 20th Centuries, ed. J.T.H. Connor and Stephan Curtis (London: Pickering and Chatto, forthcoming).

(55) Reviews and Articles, 2000, file 10.02.001, The Papers of Robert S. Ecke, Coll-355, Division of Archives and Special Collections, Memorial University of Newfoundland, St John's. All further archival references are to this collection.

(56) Ecke, Snowshoe & Lancet, 1-3, 186. Hereafter cited in text.

(57) Parsons, like Ecke, was a Johns Hopkins graduate in medicine (in 1919) who originally was recruited by Grenfell to work in St Anthony. When the NDBMH was in its planning stages, Parsons was released by Grenfell to oversee its design and construction; he was its first medical director until his resignation in 1934-35 to accompany Dr Norman Bethune to China. Parsons would recruit another Johns Hopkins doctor, John Olds, who would succeed him and remain associated with the same hospital until his death in 1985 (See Saunders, Doctor Olds, passim; and Notre Dame Bay Memorial Hospital: 50 Years in the Life of Our Hospital, 1924-1974 (n.p., [1974]).)

(58) Ecke, Snowshoe & Lancet, x. It is possible that Ecke was in contact with Perkins at the end of his career, although he would die in 1947 and was "going down hill" at this time; see Charles Scribner, Jr, In the Company of Writers: A Life in Publishing (New York: Charles Scribner's Sons, 1990), 40-47. There is no record of any correspondence between Perkins and Ecke, see John Hall Wheelock, Editor to Author: The Letters of Maxwell E. Perkins (New York: Charles Scribner's Sons, 1950). On Perkins, see A. Scott Berg, Max Perkins: Editor of Genius (New York: Riverhead Books, 1997).

(59) For examples of Saunders' artistic and literary talents, see http://www.heritage. nf.ca/arts/agnl/saundersi.html and http://www.writers.ns.ca/Writers/gsaunders. html, accessed 8 April 2009.

(60) Saunders to Ecke, 4 February 1990, file 10.03.001.

(61) Saunders to Ecke, 17 October 1994, file 10.03.001.

(62) Saunders to Ecke, 17 September 1996 and 19 November 1996, file 10.03.002; Saunders to Ecke, 1 September 1998, file 10.03.004. The second book Saunders was referring to was Doctor When You're Sick You're Not Well: Forty Years of Outpatient Humour From Twillingate Hospital (St John's: Breakwater Books, 1998), which is based on medical folk expressions, phrases, and malapropisms gleaned form Olds' and Ecke's notes from the Twillingate hospital's outpatient department. See also Saunders to Ecke, 17 September 1996, file 10.03.002.

(63) Saunders to Ecke, 8 February 1997, file 10.03.003.

(64) Saunders to Cuff, 6 October 1997, file 10.03.003.

(65) Saunders to Ecke, n February 1998, file 10.03.004.

(66) Saunders to Ecke, 9 October 1997, file 10.03.003.

(67) Roy MacSkimming, The Perilous Trade: Publishing Canada's Writers (Toronto: McClelland & Stewart, 2003), 265-67. See also Sandrine Ferre-Rode, "Atlantic Canada," in History of the Book in Canada, Volume Three: 1918-1980, ed. Carole Gerson and Jacques Michon (Toronto: University of Toronto Press, 2007), 181.

(68) Saunders to Ecke, 1 September 1998, file 10.03.004.

(69) Corrected drafts of the foreword by Saunders (September 1999), file 10.04.001. The original painting also dates from this period and is of a "growler" (small iceberg) from Wild Cove, Twillingate.

(70) Clippings file, file 10.02.001.

(71) On Randall as publisher, see http://www.perpublisher.com/; for the Twillingate Museum and Craft Shop, see http://www.tmacs.ca/, accessed 3 April 2009.

(72) Labrador-Grenfell Health, "Books That Aid Our Cause," http://www.lghealth. ca/index.php?pageid=175, accessed 8 July 2010.

(73) I.S. MacLaren, "Exploration/Travel Literature and the Evolution of the Author," International Journal of Canadian Studies 5 (1992): 39-68; see also Lize Kriel, "From Private Journal to Published Periodical: Gendered Writings and Readings of a Late Victorian Wesleyan's 'African Wilderness,'" Book History II (2008): 169-98; and Lisa Laframboise, "'Just a little like an explorer': Mina Hubbard and the Making of A Woman's' Way," Papers of the Bibliographical Society of Canada 39, no. 1 (2001): 7-44. I.S. MacLaren has demonstrated within the field of travel and exploration literature (a genre that not unreasonably can embrace the medical tales as described here) that an author's narrative may evolve as it goes through the "four stages of composition" that he describes: (1) field notes, (2) journal writing, (3) draft manuscript, and (4) finished publication. With each stage of editing, raw material can drop out, the narrative can become more definitive (either prospectively or retrospectively), and the author (or editor) become more conscious of the work's intended readership or audience. Within this algorithm, the observations of the original writer/traveller/explorer (perhaps with an imperialist outlook) become transformed to conform to the needs and expectations of others such as publishers and domestic readers. In the end, this process raises the question of the reliability of the final published work as a valid historical source. MacLaren's bibliographical (broadly construed) insight raises an extremely important methodological/historiographical issue with respect to medical autobiography, especially those works past and present dealing with Grenfell and others of Newfoundland and Labrador in that tradition. As has been argued, these books are tightly connected to a sense of place--the North. While they may be spiritual and/or medical in intent, the locale of the action often results in these books also having an adventure-exploration-travel narrative quality. Accordingly, MacLaren's argument is apposite.

(74) Mullally, "History, Memory and Twentieth-Century Life Writing," passim.

(75) Nancy McCall, "Review of Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948," Bulletin of the History of Medicine 76 (2002): 175-77.

(76) J.K. Crellin, "Review of Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948," Canadian Historical Review 82 (2001): 578-79.

J.T.H. Connor *

* J.T.H. Connor is John Clinch Professor of Medical Humanities and History of Medicine in the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador; he is also a Professor of History, Faculty of Arts. He has published widely on nineteenth- and twentieth-century medicine in North America.
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Author:Connor, J.T.H.
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Date:Mar 22, 2010
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