Partnership for Excellence

Partnership for Excellence: Medicine at the University of Toronto and Academic Hospitals

EDWARD SHORTER
Copyright Date: 2013
Pages: 992
https://www.jstor.org/stable/10.3138/j.ctt4cgj3w
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  • Book Info
    Partnership for Excellence
    Book Description:

    InPartnership for Excellence, senior medical historian and award-winning author Edward Shorter details the Faculty of Medicine's history from its inception as a small provincial school to its present day status as an international powerhouse.

    eISBN: 978-1-4426-6403-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-2)
  3. 1 Introduction
    (pp. 3-6)

    This book began life one day when I was lecturing to the medical students. “Stem cells were discovered at the University of Toronto,” I said. “What!” They were incredulous and had no idea. This was a group of smart, alert medical students at the University of Toronto (U of T), and they were completely unaware of an important achievement of their faculty.

    I realized that the story of medicine in Toronto was a story that needed to be told.

    I was trained as a historian, not a physician. But I did go to medical school for two years, after I...

  4. 2 At the Corner of College and University
    (pp. 7-12)

    For many years Toronto was considered a kind of dull Puritan enclave, of which American poet John Dos Passos said in 1917 to a friend, “So you’ve been to Toronto – don’t you think it’s a beastly place? Toronto on a Sunday morning … I have been there – and I admit, that I loathe it.”¹ The city was once considered unpromising and uninspiring, the province of Ontario a sleepy hinterland, in which narrow-mindedness was cradled in the arms of parochialism.

    When in March 1909 American educator Abraham Flexner visited Toronto on behalf of the Carnegie Foundation, as part of a continent-wide...

  5. 3 An Afternoon in October 1903
    (pp. 13-26)

    In 1902 there were still several medical schools in Toronto, which made little sense. Late that year it was finally agreed, after fifteen years of intense wrangling between the two major rivals, that the medical school of Trinity University should be amalgamated into the Faculty of Medicine of the University of Toronto. After the new union was consummated in the summer of 1903, it seemed a good idea to schedule a celebration, together with a ceremony marking completion of the new medical building after two years’ construction – the faculty’s first building on the university campus since Dean Bulmer Nicol’s 1850...

  6. 4 Getting Going
    (pp. 27-72)

    In the first third of the twentieth century, Canadians, as a colonial people, had a model before them of all that was excellent and wonderful – and that model was not the United States. It was England and – for the large contingent of physicians born here but with Scottish blood in them – Scotland. (One observer called attention in 1923, amid laughter, to “the dangers of having too many Scotsmen on the University faculty.”¹) When in 1934 President Cody wished to conjure up a model polity, it was not to “our Canadian democracy” that he referred but to “our British democracy.”²

    The...

  7. 5 Big Deeds
    (pp. 73-112)

    After the Second World War, academic medicine in Toronto made several very large strides with worldwide implications. These steps occurred in the areas of neurological surgery, heart surgery, the victory over polio, and – the great medical watchword in the 1990s and after – the discovery of stem cells at the University of Toronto.

    In the background of these strides were the teaching hospitals of Toronto. Just after the war there were three of them, though numerous others later joined the story.

    The queen bee of Toronto medicine is the Toronto General Hospital. Established in 1812, it was the oldest and largest...

  8. 6 Surgery
    (pp. 113-145)

    It was in the 1960s that surgery pivoted from the United Kingdom to the United States; in the 1980s, under the leadership of Bernard Langer, it pivoted from teaching to research. The story is a dramatic one.

    Few today can recall how it once was. Back in the days of surgery without antibiotics – the 1930s – Fred Dewar, later head of orthopedic surgery at the Toronto General Hospital, recalled the infections he saw as an intern at the General. “Some of them, if it really got severe, they would die … This was the time of severe streptococcal abscesses of children’s...

  9. 7 The Surgical Subspecialties
    (pp. 146-179)

    The story of the subspecialties began when William Gallie took office as professor of surgery in 1930 and implemented a number of changes. The three surgery wards of the General had been undifferentiated. Thus one change was organizing the department by subspecialty. In June 1930 Gallie wrote, “During this year an experiment has been tried of placing all the fractures under the care of a small group of surgeons.” Composed of Roy Hindley Thomas from the Emergency Department and one representative from each of the surgical divisions, the group took on the subspecialty of fractures. “The result has been the...

  10. 8 Medicine
    (pp. 180-211)

    Under the leadership of Duncan Graham, the Department of Medicine rested for many years on the laurels of insulin, which the department had introduced clinically. As people looked back on the pre-Hollenberg years before 1970, there was a rather reluctant acknowledgment that all was not as it might have been.

    Yet there were a few research stirrings, perhaps not in heft comparable to the department’s sheer size, yet advances nonetheless. And in the world of science they were reminders that the colleagues were still players.

    In the 1938–9 session the new sulfa drugs – the first “wonder drugs” – arrived in...

  11. 9 The Medical Subspecialties
    (pp. 212-242)

    The Department of Medicine is only one of many departments. Yet in size and influence “internal medicine” overpowers all others except surgery. The professor of medicine is probably the single most influential clinician in the faculty. In the training of physicians, it is always the internists who do the heavy lifting. Yet the difference between 1900 and, say, 1990 is dramatic. In 1900 the leaders of medicine were distinguished “doctors.” By 1990 they were distinguished “professors.” In 1900 specialists learned their skills in hospitals. By 1990 they were still learning them in hospitals, but in the context of academic divisions...

  12. 10 The Children’s Hospital
    (pp. 243-279)

    The first children’s hospital in Canada was founded in 1875 by a group of philanthropic women, a “Ladies’ Committee” led by Elizabeth McMaster.² Located in a rented house in downtown Toronto, the six-bed Hospital for Sick Children was a charitable institution dedicated to caring for the poor. Initially the Ladies’ Committee managed the institution, but in 1878 a five-man Board of Trustees was added, allowing the hospital to incorporate and to purchase property. Although members of the Ladies’ Committee continued to serve the hospital until May 1899, they were gradually supplanted by the board, especially afterToronto Telegrampublisher John...

  13. Illustrations
    (pp. None)
  14. 11 Research
    (pp. 280-301)

    Gallie was right and wrong. He was right that Toronto had absorbed the English emphasis on clinical excellence and close relations between teachers and students in medical education. He was, however, engaging in wishful thinking in the belief that, before the Second World War, Toronto occupied a prominent position among the world’s research universities. It didn’t. The English tradition was a double-edged sword. As President Claude Bissell reflected in his memoirs, “The tone at Toronto was formed by teachers who had graduated from English universities, and England had always been skeptical of any attempt to pursue scholarship in an institutional...

  15. 12 An Academic Health Sciences Complex
    (pp. 302-323)

    The relationship among faculty, hospitals, and provincial government, as it evolved in the late 1960s, is daunting in its complexity and will not be rehearsed here – any more than is necessary to understand the outcome (and why this book is about much more than a single Faculty of Medicine). What came out of the negotiations was something called an Academic Health Sciences Complex (AHSC), an organic association among faculty and teaching hospitals. There is nothing quite like Toronto’s health sciences complex elsewhere, and it explains a good deal of the distinctiveness of the Toronto story.

    One should gain some distance...

  16. 13 Cancer Care
    (pp. 324-353)

    What once characterized the Toronto approach to cancer was the separation of the surgical treatment of cancer from medical and radiotherapeutic approaches. Cancer surgery took place in the big teaching hospitals. Chemotherapy and radiotherapy were centred in the Ontario Cancer Institute and the attached Princess Margaret Hospital. This separation was overcome only in 1995 with the move of the Ontario Cancer Institute from Sherbourne Street to join the row of hospitals on University Avenue.

    In the Faculty of Medicine, until 1991 radiotherapy (radiation oncology) and diagnostic radiology were united in the same unit, the Department of Radiology. It is here...

  17. 14 Neuroscience and Psychiatry
    (pp. 354-400)

    The University of Toronto had tremendous but scattered strength in neuroscience. Basic, clinical, behavioural: all have their stories, but it took forever for these great resources to come together.

    Psychiatry in Toronto did not have a promising beginning. Psychiatric patients were kept in underground cells of the Old York Gaol on King Street until a new jail was built.¹ Said Mr J.H. Tuke, brother of the noted English psychiatrist Daniel Hack Tuke, who visited the facility in September 1845, “It is one of the most painful and distressing places I ever visited. The house has a terribly dark aspect within...

  18. 15 Anatomy
    (pp. 401-408)

    Until recently, anatomy had always been considered the queen of the medical sciences. Its teaching once formed the fundamental core of basic medical education, and it went without saying that all medical students would dissect a cadaver and memorize the origins and insertions of the muscles, the osteology of the bones, and the course of the major blood vessels and nerves. Acquiring all this information served more ritualistic than practical functions, yet it was part of the ritual of becoming a doctor, in Toronto as well as elsewhere.

    The teaching of anatomy in Toronto goes back to the earliest days...

  19. 16 Physiology/Banting and Best/Biochemistry/Pharmacology/Nutrition
    (pp. 409-445)

    There was a time when all these subjects blended together, subsumed before the First World War under the general heading “Physiology.” Today, in historical irony, the boundaries among them are disappearing once again as a molecular revolution prompts the generalization that all basic sciences are essentially studying the same thing: what happens inside the cell. As this is written, we are not quite yet ready for such a general statement because in basic sciences such as physiology the systems approach still counts. One thinks of neurophysiologist Jonathan Dostrovsky’s collaboration with Andres Lozano in surgery and Helen Mayberg in psychiatry¹ on...

  20. 17 Medical Biophysics/Biomedical Engineering/Immunology
    (pp. 446-458)

    The institutions in this chapter are all Johnny-come-latelies. But they show the dynamism of change in medicine. Age-old disciplines such as anatomy wither and become appendages of other departments. New institutions are thrown off by the remorseless process of change and rise up, such as the marriage of physics and medicine, the marriage of engineering and medicine, or the science of the immune system. By the next time someone takes a crack at writing a history of the Faculty of Medicine these departments too, in their turn, will seem antiquated and hoary – in exactly the same way that an anatomy...

  21. 18 Laboratory Medicine (Pathology/Microbiology/Pathological Chemistry)
    (pp. 459-482)

    At the heart of basic science is the chemistry of disease. Pathological chemistry as it was once called – or in its modern garb clinical biochemistry – brings biochemistry to the bedside. At the University of Toronto, chemistry, microbiology, and pathology converged in the 1990s in the Department of Laboratory Medicine and Pathobiology, “pathobiology” being a neologism so recherché that Toronto has the only such department in the world. How these events unfolded illustrates this volume’s theme of leadership lashing the horses ever faster towards research.

    The study of pathology and bacteriology at the University of Toronto went back to 1892, when...

  22. 19 Ophthalmology and Otolaryngology
    (pp. 483-494)

    Ophthalmology began in Toronto in 1850 as S.J. Stratford opened the Toronto Eye and Ear Infirmary, which then vanished in 1863 “when Dr. Stratford left for other parts,” as the official history of the Department of Ophthalmology puts it.² “Two years later, in 1865, Dr. Abner Roseburgh re-established the clinical facility and was shortly joined by his brother-in-law, Dr. R[ichard] A[ndrews] Reeve.” Reeve had just graduated from medicine at Queen’s. In 1872 he was appointed to the Toronto General Hospital, the institution’s first specialist of any kind.³ (Ophthalmology and otology were combined at this time. Only in 1905 did the...

  23. 20 Anesthesia and Radiology
    (pp. 495-520)

    Anesthesia appeared in the British North American colonies shortly after its introduction elsewhere. Ether was first used in St John, New Brunswick, in January 1847, only three months after it was demonstrated in Boston.¹ The use of chloroform soon followed: introduced in Edinburgh in November 1847, it was adopted by physician and pioneer anesthetist Edward Dagge Worthington of Sherbrooke, Quebec, as early as January 1848.² Toronto had to wait a bit longer, yet anesthesia was in use at the Toronto General Hospital prior to January 1863, when its first death from chloroform (and the second in Canada) was reported.³

    In...

  24. Illustrations
    (pp. None)
  25. 21 Obstetrics and Gynaecology
    (pp. 521-539)

    (NB: The history of obstetrics and gynecology at Women’s College Hospital will be found under the main entry for that hospital in chapter 22.)

    In earlier days, obstetrics was the keystone of medical practice. If you as a family doctor assisted the mother in her confinements, you had the family’s custom for life. Accordingly, obstetrics played a fundamental role in the instruction of medical students. Gynecology in those days was more marginal, more a surgical than a medical specialty. Yet in both obstetrics and gynecology, age-old in medical time, lingered past memories of the “accoucheur” and the “women’s doctor” whose...

  26. 22 New Talent: Mount Sinai Hospital and Women’s College Hospital
    (pp. 540-577)

    Dean Hamilton prided himself that the faculty had reached out beyond the lads of the farms and small towns of Ontario to the cosmopolitan quilt that Toronto was becoming in the 1960s. And rightly so: one of the reasons for the faculty’s success lay in enlarging its catchment basin from rural Ontario to a vast entrepôt with thirty-five major languages. The best and brightest from all the world were flocking to Toronto, and they and their children would teem into the Faculty of Medicine, enriching the talent pool on which academic excellence had to draw.

    What a contrast with the...

  27. 23 Rehabilitation
    (pp. 578-598)

    The rehabilitation sector in Toronto came to include physical therapy, occupational therapy, speech-language pathology, and physiatry. Each has its own story.

    Physical therapy, known at the time as physiotherapy, began in Toronto during the First World War. It followed the English model of the Chartered Society of Physiotherapists, formed in 1894, with an emphasis on diagnosis and massage. It was only later that physical therapists, desirous of enhancing their standing – and of maximizing their ability to do good – embarked upon the diagnosis and treatment of mechanical disorders.

    In 1917 the Military Hospitals Commission established a six-month program, using Hart House...

  28. 24 Family and Community
    (pp. 599-617)

    For the generation of W.E. Gallie, such concepts as “family medicine” and “community risk” did not belong to the core knowledge of medicine. The founders of the faculty tended to be somatic reductionists, and anything that did not involve tissue changes was probably not worth teaching the medical students, however sensitive the founding generation might have been to the “whole patient.” Yet in the 1970s and after, several factors drove such softer concepts as family and prevention onto the radar. Mushrooming medical costs made cashstrapped ministries much keener to supplant specialist care with less costly primary care. As well, many...

  29. 25 Hospitals
    (pp. 618-638)

    The teaching hospitals of Toronto were part and parcel of the academic health science complex. “The academic programs of the Faculty of Medicine are greatly enhanced by the affiliated teaching hospitals,” as the faculty’s “Strategic Directions” report put it in 1993.¹ Although a history of each hospital would take this book too far afield, their contributions to the faculty’s larger mission are important. The Mount Sinai Hospital and Women’s College Hospital are discussed in chapter 22 and the psychiatric hospitals in chapter 14. This chapter is given over to the Toronto General Hospital, St Michael’s Hospital, the Toronto Western Hospital,...

  30. 26 New Ideas
    (pp. 639-647)

    For a faculty so committed to the department structure, the onrush of new ideas was like a one-two punch in the head. The faculty responded by creating new units outside the departments to sort and measure this avalanche of innovation. This volume cannot consider all of these small divisions and “extra-departmental units,” yet some are worth particular mention.

    The Wilson Centre now aims to be the most important research centre in healthcare education and practice in the world.¹

    Brian Hodges, Director Wilson Centre, 2008

    In the 1960s, interest quickened in how to teach medical students and how to convey and...

  31. 27 Student Life and Learning
    (pp. 648-683)

    In the beginning, students learned clinical medicine on the wards and in the surgical amphitheatre of the Toronto General Hospital. “Students shall enter by the rear door under the theatre, and remain in the theatre or students’ waiting-room until required by the medical officer of the day either in the theatre or the wards,” stipulated the hospital in 1891. “No students (except clinical clerks) will be allowed in any other part of the Hospital.” It was also not permitted to spit tobacco on the floor. When, under the supervision of a physician, they were permitted to visit patients, they were...

  32. 28 Molecular Medicine
    (pp. 684-712)

    Genetics has changed medical research comparable to the Parisian Clinical School’s introduction around 1800 of the anatomical-clinical method, which remained the basic motor of medical progress for the next hundred years. The anatomical-clinical method involved reasoning back and forth from premorbid signs and symptoms to postmortem anatomical findings in order to describe the major diseases. Molecular medicine moves the frame from the autopsy suite to the interior of the cell: What is happening with the DNA in disease? How does communication within the cell take place in illness and in health? The anatomical-clinical method led directly to few cures, just...

  33. 29 The Deans
    (pp. 713-738)

    Previous chapters have sketched in the early history of the faculty’s governance and that will not be repeated here. By the time of the First World War the Faculty of Medicine of the University of Toronto was the largest in the British Empire with the exception of Edinburgh, the model to which all the British colonies aspired in those days.² Toronto’s was a faculty that then offered no postgraduate preparation of any kind – the term “postgraduate” meaning post-medical-degree. Gallie said of the time when he graduated from the school in 1903 that there was no provision for the training of...

  34. 30 Epilogue
    (pp. 739-742)

    Some things never change. In 1923 the faculty was mindful of its place in the world, but its world was the Commonwealth. Today as well faculty rankings are avidly scanned to see where the faculty ranks in the pecking order, but its world is the globe. “We are truly a global player,” Dean Whiteside told the faculty in May 2009. “Toronto’s global reach in discovery, translation, and advanced training should never be underestimated … We are one of the top ranked institutions in health and life sciences in North America and globally.”²

    The story started in 1887 with the faculty...

  35. Acknowledgments
    (pp. 743-744)
    Edward Shorter
  36. Notes
    (pp. 745-888)
  37. Index
    (pp. 889-930)