175 YEARS A History of the Department of Obstetrics & Gynaecology VISIONARIES, MAVERICKS, AND COLLABORATORS

Writer and Editor Researcher and Writer Editor KRISTEN GANE CHRISTOPHER GEARY JOHN KINGDOM

175 Years: A History of the Department of Obstetrics & Gynaecology

VISIONARIES, MAVERICKS, AND COLLABORATORS

Writer and Editor Researcher and Writer Edited by Kristen Gane Christopher Geary John Kingdom 175 Years: A History of the Department CREDITS of Obstetrics & Gynaecology Michael Browne Visionaries, Mavericks, and Collaborators Researcher

© 2018 University of Toronto Nelson Cabral All rights reserved. No part of this publiation may be Co-editor reproduced, stored in a retrieval system or database, or Kristen Gane transmitted in any form or by any means, without the Writer and Editor prior written permission of the University of Toronto. Christoper Geary Department of Obstetrics & Gynaecology Researcher and Writer Faculty of Medicine John Kingdom, University of Toronto Department Chair 123 Edward Street, Suite 1200 Editor Toronto, ON M5G 1E2

Canada Tel: 416-978-2216 Green Living Enterprises Fax: 416-978-8350 Design Flash Reproductions obgyn.utoronto.ca Printing /uoftobgyn @uoftobgyn #uoftobgyn

Cover images: Toronto General Hospital, 92 College Street, Women’s College Hospital in 2018 Dedications & Acknowledgements

This book is dedicated to the generations of Obstetricians, Gynaecologists, Nurses, and Midwives who over time have made many contributions to advance health care for women in Toronto. Perched female Empress Brilliant fighting off a male Crowned Woodnymph. Credit: Dr. Peter Hawrylyshyn, Mount Sinai Hospital, taken in Anchicaya Valley in Western Colombia Table of Contents

11 OBGYN History Timeline 45 Hendry: A Great Mentor 68 Ritchie: Recruitment Takes the Helm and Integration 17 Introduction Post WWI: Hospitals Dr. Mary Hannah: Maternal, Infant and Sister Vincentia: Still Reproductive Health 19 In the Beginning Striding Down the Halls Research Unit (MIRU)

27 Wright: The First 51 Scott: More than a 71 Bocking: Facilitating Professor of Obstetrics Wartime Caretaker Progress and Growth The Impact of WWII External Review 29 Ogden: The First The Ferguson Reflex AMPATH Professor of The Use of Radiotherapy Connections and Gynaecology Collaborations Medical School 55 Van Wyck: Bringing Mississauga Academy Integration in Toronto Breadth and Depth of Medicine & Trillium Health partners: 35 Ross: Free from Dr. Mathias (Matt) Gysler 57 Cannell: The Welcoming Midwifery into Circumlocution “Cannell Course” the Community of Practice and Ambiguity Hilliard: A Wide The Trials and Triumphs The Union of Obstetrics Spectrum of Care of Managing Fertility and Gynaecology Maloney: Paving From Women’s to

Smillie Robertson: the Way Forward Sunnybrook TORONTO OF UNIVERSITY Keeping the “Mischievous” Boys in Order 92 College Street MacMurchy: The 62 Paul: Lecturer Endowments Influence of Eugenics Extraordinaire Cowell: Pioneer of 83 Our 175th 39 Watson: Inaugural Paediatric Gynaecology Anniversary Year

Chair of a Combined & GYNAECOLOGY OBSTETRICS Department 65 Harkins: Introducing 85 References WWI and No. 4 Canadian Transparency General Hospital 66 Hannah: Rejuvenating Research

9

Annual Research Day, May 2015 ,

The is the first H.B. Wyck Van 1947 Geraldine Maloney woman appointed to permanent clinical staffToronto teaching of a hospital and first full-time female appointed member the of Department 1947 The foundational textbook, Essentials of Obstetrics and Gynaecology authored Scott by W.A. (Chair from 1935–1946) and (Chair from 1946–1950) is published 1942 Geraldine Maloney (1906–1985) becomes the firstwoman to receive a commission as a physician in the Royal Canadian Army Medical Corp (RCAMC) 1941 Discovery of oxytocin surge during labour by James Ferguson, later coined the “Ferguson’s reflex” (1907–1964), John Robertson late 1930s is averagingToronto 10,000 births annually with occurring 75% in medical centres late 1930s Introduction of sulfa drugs reduce risk of infection for caesarean sections 1939 Hospital births outnumber home births in Ontario 1939 Waring Gerald Crosbie (1894– 1987) and McArthur along with radiologist Gordon Richards, spearheaded the use of radiotherapy in treating gynaecological cancers. 1926 WesternToronto with amalgamates Grace Hospital to become the busiest obstetrical service in the city John Gallie 1923 John Gordon Gallie opens the first post- natal clinic in the city 1920 Establishment of the first prenatal care clinic to prevent maternal death from eclampsia by 1922 JewishThe Toronto Maternity and Convalescent Hospital opens and later is renamed as Mount Sinai Hospital 1921 Watson establishes a fellowship in Obstetrics & Gynaecology Generalat Toronto Hospital and the specialty’s first programresidency No. in WW1, including 4 Canadian General Hospital future department chair, Dr. William Belfry Hendry 1915 Several members are commissioned with

(1880–1976) (left) and Clinical instruction in Obstetrics & Gynaecology is offered at WesternToronto Hospital 1914 1912 BenjaminDr. Philip Watson appointed as the first chair of the combined Department of Obstetrics & Gynaecology Drs. JennieSmilie enny Gray Wildman 1911 The Faculty of Medicine consolidates the Departments of Obstetrics and Gynaecology 1911 CollegeWomen’s Hospital and established Dispensary by Robertson J (below) leading the Gynaecology Services

1911 HelenDr. MacMurchy (1862–1953), firstwoman appointed to the Department 1906 Faculty of Medicine agrees to accept female students and Ontario Medical College for closes Women offered at Torontooffered at Western and Grace Homeopathic Hospitals 1907 Maternity care becomes Chair 1903 JamesDr. F.W. Ross Gynaecologyof 1895 Ontario Medical College Women for established

1900 The Hospital for Sick Children and St. Michael’s Hospital become teaching hospitals 1890 Widespread use chloroformof births during (1846–1930) (1846–1930) (1828–1910) 1889 Annual number of birth increases to 195 at the Burnside as hospital births gain societal acceptance 1887 Re-establishment of the University of Toronto’s Faculty of Medicine 1887 AdamDr. H.Wright appointed as the first professor of Obstetrics at the University of Toronto 1887 UzzielDr. Ogden appointedas the first professor of Gynaecology at the University Toronto of

1883 MedicalWomen’s College opens at 227 Sumach with aninaugural class of five 1882 Establishment of a dedicated (Gynaecology)Women’s Pavillion Generalat Toronto Hospital ”) Toronto GeneralToronto Hospital with annual 159 births 1877 The Burnside amalgamates with the Burnside 1843 1850 First affiliated teaching maternity hospital at GeneralToronto Dispensary & Lying-in Hospital (later named “ 1843 Inaugural university lecture delivered in Midwifery and Diseases andof Women Children by Dr. George S. Herrick (1789–1863) OBGYN History Timeline 1961 2013 1984 Women’s College Hospital becomes a full teaching hospital with Launch of the Junior Faculty First Gynaecologic the University, due to the tenacity of Anna Marion Hilliard Awards with matched 2016 Oncology Tumour Board (1902–1958) (pictured left) and leadership of Geraldine Maloney funding from hospitals to Launch of the Senior Merit Awards to in Canada – Barry Rosen support research initiatives support mid-career faculty members and Denny De Petrillo in their research endeavours 1970s 2013 2015 Catherine Cowell (1938–2011), pioneer The University Department The Department’s Annual Research 2000 researcher on adolescent development, 1992–1996 moves to its current home Day reaches a record of over 300 attendees First Preterm Birth Prevention establishes one of the first units in North Dr. Mary Hannah/MIRU at 123 Edward Street and over 100 abstracts submitted Clinic in Canada – Rory Windrim America of Paediatric & Adolescent publishes term PROM and Gynaecology, and later becomes the post-dates trials in NEJM 1993 2000 Department’s first female full professor Walter Hannah creates the First fetal cord occlusion for acardiac new Genesis Foundation monochorionic twin pregnancy focussed on supporting and 1972 in Canada – Greg Ryan growing clinical and basic First use of surfactant research in the Department treatment of respiratory 2014 1950 distress syndrome by First worldwide The Midwifery Act is Doug Cannell Goran Enhorning screening program passed making Ontario the (1902–1979) develops for anal dysplasia 1st province to regulate 2002 Canada’s first university- for heterosexual 1981 and fund midwifery First total laparoscopic radical based, integrated, 1969 women – Women’s College hysterectomy in Canada – Al 2008 postgraduate program Legalization of Danielle Vicus Hospital secures Canada’s Covens and Rachel Kupets First ultrasound-guided fetal in Obstetrics and contraception first Regional High- cardiac interventions in Canada Gynaecology, coined as and therapeutic Risk Perinatal Unit – Greg Ryan and Edgar Jaeggi the “Cannell Course” abortion

2016 1982 92 College Street, previous home 1962 The Cannell Annual 1988 1999 2006 to the Department for 47 years, Mount Sinai Lectureship is The Supreme Court strikes down the First Placenta Clinic First use of middle cerebral artery is demolished on August 22 becomes a fully established, endowed abortion law as unconstitutional in North America Doppler to replace amniocentesis for affiliated teaching by the Cannell Club – Rory Windrim surveillance in Fetal Hemolytic Anemia hospital with the and John Kingdom – Gareth Seaward and Greg Ryan 2018 1988 2010 University Establishment of the first medical disorders The Department spans 16 affiliated hospital First fetoscopic endotracheal sites, has over 300 faculty, performs over of pregnancy program in Canada at Toronto occlusion in diaphragmatic General Hospital – Mathew Sermer 34,000 deliveries and approximately 30,000 hernia in Canada – Greg gynaecologic procedures annually, and teaches 1966 Ryan and Han Keunen 1992 over 120 postgraduate trainees and 260 The University Department Knox Ritchie leads the undergraduate medical students annually. moves into its new home restructuring of service at 92 College Street down to 3 hospitals from 6 1971 2018 and initiates amalgamation John C. Kingdom First use of diagnostic of Toronto General Hospital appointed 2013, renewed aminocentesis in Canada and Mount Sinai Hospital for 2nd term in 2018 – James Goodwin Obstetrics service 2003 Alan Bocking becomes Chief of largest single hospital-based department of 2007 Obstetrics and Gynaecology as a result The Department joins the AMPATH 1983 of the merger between Mount Sinai Consortium and partners with the Hospital and University Health Network First Annual Obstetrics & Department of Reproductive Health and Chair of the University Department Gynaecology Research Day in at Moi University in Eldoret, Kenya Canada – Walter Hannah 2003 Popularization of fertility-sparing surgery (trachelectomy) for early stage cervical cancer in Canada – Al Covens From left: Alan Bocking, Knox Ritchie, Walter Hannah, and John Kingdom, pictured in 2014 Introduction

Welcome to the rich 175-year history of Obstetrics & Gynaecology at the University of Toronto! I hope that you enjoy perusing this publication. Within these pages are descriptions of a remarkably diverse community of people. Each has advanced the delivery of Women’s Health to the best of their ability in their political and cultural times, to the point that today our clinical services, our teaching mandates, and our research impact all far exceed anything that could be imagined by our pre-war pioneers. I therefore hope that you will feel as valued today as they are honored by this book, each of us being an alumnus of one of the greatest departments of Obstetrics and Gynaecology worldwide.

This project was conceived in 2014, following discussions with our three former chairs, each of whom was very supportive of the project. In addition I thank my great friend Stephen Matthews, who as former chair of Physiology (2007–2014) inspired me to undertake this project following his very successful history publication for their department. As a team we took our time to seek out as much diverse information as we could. I am most grateful to Mr. Christopher Geary, a 2015 English graduate at the University of Toronto, for starting the project, especially for his travels around Toronto hospital archives, his personal interviews of an extensive range of physicians, and his trip up to Muskoka where he was warmly received by Mary and Walter Hannah. Much credit for the ultimate success and completion of this project must be given to Ms. Kristen Gane for her expert writing and editing skills in ensuring consistency in tone and voice of the stories told here in this text. The leadership skills of Nelson Cabral, our business officer for 2016-2018, have

been pivotal in ensuring our ultimate success, including connecting us to the expert publication TORONTO OF UNIVERSITY services of Mr. Victor Szeto and his team at Green Living – for a carbon neutral launch!

Since historical events in general are incrementally revised, I anticipate future editions will address unintended errors, and include additional individuals. As Chair, I take overall responsibility for this publication, and am sensitive to the reality that such an endeavour may risk disappointment, or require amendments in a future edition. I therefore apologize in advance for any such errors & GYNAECOLOGY OBSTETRICS and hope that you will find the history of our department as intriguing and inspirational as I do.

John C.P. Kingdom, M.D. Gordon C. Leitch Chair 17 Department of Obstetrics and Gynaecology

In the Beginning

From Cork, Ireland to Queen and Bay Streets On June 8, 1843 in the old Front Street Parliament buildings, the historic inaugural lecture of the University of King’s College Medical School was delivered by the first professor of Midwifery and Diseases of Women and Children, Dr. George S. Herrick (1789–1863)1. Although chartered in 1827, the University did not welcome

students until 1843 and the term’s introductory lecture included two matriculated TORONTO OF UNIVERSITY students, several occasional students, and even members of the public. When Herrick entered the hall he was shocked to see several ladies in attendance. As he bravely proceeded with his introduction to Obstetrics and Gynaecology (which included matters of the female anatomy), the ladies’ keen attention gave him so much embarrassment that the incident was included in the faculty’s year-end report.2 OBSTETRICS & GYNAECOLOGY OBSTETRICS

It was Herrick who facilitated the birth of Obstetrics and Gynaecology, and indeed medical education at the University, and he was considered both a highly esteemed obstetrician and an excellent teacher.3 Born in Cork, Ireland in 1789, he studied medicine in Dublin and Edinburgh. After receiving his MD Herrick immigrated to Canada at age 49, and quickly opened “an office for the practice of Physic and Surgery” near Queen and Bay Streets.4 Soon after, he was made a fellow of the short-lived College of Physicians and Surgeons of Upper Canada and four years later was appointed to the University’s Medical School, with a salary of £200 and this 19 was one of the very first cross-appointments at the Toronto General Hospital.5

Toronto General Hospital 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

Dr. Edward Hodder (1810–1878) Dr. John Rolph (1793–1879)

Herrick was a lifelong bachelor, and very schools appeared. The Anglican Bishop the rebels. Returning to Toronto, he popular with students and colleagues. of Toronto, John Strachan, was displeased offered private instruction in medicine He was known for giving dinner parties with the secularization of King’s College. and proved so popular that he hired other for the students, and for his flamboyant He therefore established Trinity College lecturers to form a school.10 Although flagging down of potential guests in in 1851, dedicating it to the education of Rolph was considered a brilliant teacher, the street, which earned him the name Anglican students. Trinity College also his school was a ramshackle arrangement “Old Thumby”.6 It is unclear when he incorporated the new Upper Canada within his stables, with only a thin retired from medicine but surely his School of Medicine as its medical faculty partition separating his students from the energy (and his dinners) was missed. under Dr. Edward Hodder (1810–1878), other occupants: a horse and a cow.11 who was professor of Obstetrics and With popular teachers like Herrick, Diseases of Women and Children.9 The the University’s Medical School grew University Medical School’s other rival Maternity Care for a Select Few quickly, particularly after the University was a private school set up in 1843 by Dr. Clinical instruction for the three schools was removed from the Anglican Church’s John Rolph (1793–1879); its existence was held at Toronto General Hospital, | MAVERICKS, COLLABORATORS VISIONARIES, AND control in 1849 and re-established as would prove instrumental in the abrupt where students often competed for the non-denominational University of dissolution of the University of Toronto’s places on ward rounds and at surgeries.12 Toronto. Classes grew from the original first Faculty of Medicine in 1853. However, the hospital handled relatively two official students to more than 60 a few obstetrical cases and many medical decade later.7 Interestingly, only eight A lawyer and a frequent member of the students graduated with limited students actually graduated in medicine by provincial legislature, Rolph was a well- experience.13 Typically, only very poor 1853. Most students viewed the degree as regarded Toronto physician who had or unmarried women resorted to a an unnecessary expense since certification trained at Guy’s Hospital in London, hospital birth, while most women gave by the Medical Board didn’t require it.8 England. He was deeply involved in birth at home, often with a midwife.14 the 1837 Upper Canada Rebellion, but successfully fled to the U.S., despite the By 1850, the three schools were each Rival Schools Emerge £500 reward offered for his capture. associated with a small maternity hospital 20 While the University’s Medical School He practiced in Rochester, N.Y. until that cared for destitute women and the was thriving, two competing medical 1843, when an amnesty was granted to wives of labourers. The Toronto General Dispensary and Lying-In Hospital, secure the safety of future inmates.”18 A damning report that reflected these established June 1, 1848, was located This incident alone would reinforce views was published in 1852, detailing at Victoria and Richmond Streets. It the desire to birth at home for many the financial mismanagement of the was staffed by doctors associated with women. The hospital’s management also University’s endowment. It was penned Trinity College, such as Hodder, who applied a keen reformatory focus on their by Rolph’s associate, Joseph Workman, gave clinical lectures. One block west on unmarried “inmates”19. The 1857 report who lectured on Midwifery and Richmond Street, the provincial Lying- describes the Toronto Lying-In Hospital Diseases of Women and Children at his In Hospital and Vaccine Institution was as “a house of refuge in suffering… school.24 In 1851, Rolph was elected to under the Governor General’s patronage where the erring sister is brought into the Legislative Assembly and became and was associated with the University’s contact with virtue and respectability, a cabinet minister in Francis Hincks’ Medical School, with Herrick as one of its and being in some measure forced into new Reform government. According to consulting physicians. Clinical instruction the presence of religion, learns to value James Richardson (one of those original was given daily, with regular lectures both as superior to vice and infamy.”20 two medical students, and the first to offered during the winter term. Rolph’s graduate in medicine from the University), school was officially connected with the Hincks only secured Rolph’s support Maternity Lying-In Hospital and General The Demise of the with promises of favourable legislation Dispensary at Adelaide and Bay Streets.15 Faculty of Medicine on medical and educational issues.25 Beyond the hospital walls, the three Annual reports from the Toronto General Toronto medical schools were in fierce On April 22, 1853, the University Act Dispensary and Lying-In Hospital from competition for students, fees, and anatomy was passed. This included a provision the 1850s provide a glimpse of these class cadavers.21 They were also at odds abolishing the University of Toronto’s small charitable hospitals. In addition to politically and religiously. As an Anglican Faculties of Law and Medicine under the maternity cases, they treated the city’s institution, the Trinity school expected rationale that “State institutions ought not poor for a variety of ailments, and most faculty and students to affirm their to train men for the lucrative professions patients were Irish Catholic. In 1852, for membership in the Church of England. of law and medicine at the public expense, instance, there were 354 general patients Having originally been Anglican too, but should leave this to be done by private at the General Dispensary. Of these, 244 most of the University’s medical faculty enterprise, that is, to self-supporting TORONTO OF UNIVERSITY had been born in Ireland and 234 of these were also tied to the conservative Anglican Institutions.”26 The University would were Catholics.16 The maternity wards establishment. Rolph’s school, on the continue to conduct examinations and were modest, with only four or five beds. other hand, was non-denominational confer degrees in medicine, but until The annual reports show 127 maternity and Rolph was a leading figure among 1887, when the Faculty of Medicine was patients in 1850, dropping to only 61 in re-established at the University, medical

the “Clear Grits,” viewed as a radical & GYNAECOLOGY OBSTETRICS 1851, and then to 90 in the following faction of the liberal Reform party.22 students in Toronto would study at “self- year.17 In 1851, there was an epidemic of He particularly disliked the University supporting institutions” such as Rolph’s.27 puerperal fever in the province. Hodder, of Toronto, believing it to be a wasteful the attending physician (who would go on state monopoly over higher education. The Rivalry Escalates to be an early proponent of the antiseptic Its government-allocated endowment methods pioneered by Joseph Lister), “could be more effectively employed… The rivalry between the two remaining reported that all four women on the ward by affording aid to a separate college medical schools continued to escalate.28 died and that he had to temporarily shut than by sinking of the whole amount in In 1851, Rolph incorporated his school 21 the hospital “to purify the house and the dead sea of one great university.”23 as the Toronto School of Medicine 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

Toronto General Hospital (College Street)

and later affiliated with the Methodist dismissed. Soon after, a series of partisan secure new staff.35 Meanwhile most of his Victoria College in Cobourg as its inquests produced accusations of negligence former staff set up their own “Toronto medical faculty.29 Victoria students concerning the deaths of several patients.32 School of Medicine,” eventually securing routinely complained of being treated “as However, dramatic events the following the legal rights to the name in a lawsuit dirt” by hospital staff, who were mostly year put an end to the rivalry. At Trinity, against Rolph.36 One of those former associated with the opposing Trinity the medical faculty repeatedly clashed faculty members was Dr. Uzziel Ogden School.30 The supply of cadavers was an with the college authorities over the issue (1828–1910), who would later become | MAVERICKS, COLLABORATORS VISIONARIES, AND ongoing point of contention. Indeed, of religious tests. The professors, reliant the University of Toronto’s first professor one of Rolph’s colleagues, W.T. Aikins, on students’ fees for their salaries, had of Gynaecology when that school was complained that most of the attending been admitting non-Anglican students to absorbed wholesale as the University’s re- physicians at Toronto General Hospital increase enrolment. When the issue came established Faculty of Medicine in 1887.37 handed over their dead to the Trinity to a head in 1856, the medical faculty School, and that their own anatomy resigned en masse and the school closed.33 room was kept supplied “chiefly through New Schools of Medicine the aid of students” (which alluded One week before the start of the fall term The new Toronto School of Medicine to the habit of body snatching).31 that same year, the entire medical faculty quickly affiliated with the University of of Victoria College, furious at Rolph’s Toronto. Freed from Rolph’s control, the In 1855, the feud between the schools increasingly autocratic leadership, also faculty created a modern and rigorous escalated further when Drs. W.T. Aikins resigned.34 Unfazed, Rolph simply taught curriculum. Many of the teachers who had 22 and A.H. Wright, the only Victoria faculty every subject himself for the first two resigned from the Trinity School came on staff at Toronto General Hospital, were weeks of the term until he managed to onboard, including its former Dean, the obstetrician Edward Hodder.38 Hodder took of Toronto’s maternity hospitals had Austria.49 In a letter from London dated over from Ogden to teach Midwifery and closed or amalgamated with the Lying- November 19, 1878, he expressed outrage Diseases of Women and Children while In Hospital at Richmond and Sheppard at the stark deficiencies of contemporary Ogden continued instruction in Materia Streets. The hospital eventually became Canadian medical education: Medica and Therapeutics. In 1861, the known as “the Burnside” after a generous Toronto School moved into the University’s bequest from Dr. Alexander Burnside.46 If we had some of our old professors here or old medical building.39 That same year Rolph some of the members of the medical council, suffered a stroke, but steadfastly continued we might use strong language towards them as Dean of the Victoria Medical Faculty Standards Improve for the sad way in which they neglect the until 1870, when he was forced to retire. In the late 1860s, efforts were made to education of the medical student in Canada. Just think of men licensed to practice, unable improve and standardize the quality of to amputate a finger or dress a toe, never The following year, Trinity College re- medical education in the province by having performed any operations on the established its medical faculty and Hodder setting more rigorous requirements for cadaver, having had no education in the use 40 became the Dean again. Ogden once the provincial license to practice. The of the microscope. The clinical material at more taught Midwifery and Diseases of Upper Canada Medical Board conducted the Toronto General Hospital is large, but Women and Children for the Toronto examinations to license practitioners but the teaching at the bedside is utterly nil. School.41 In 1874, having struggled without the standards were low and unevenly We are much disgusted with our Canadian Rolph and with renewed competition applied. In 1865, the General Council of medical schools. We find ourselves deplorably from Trinity, the students and faculty of Medical Education and Registration was ignorant when we get here. The stethoscopes the Victoria school moved over to the established. This body no longer held we used have long since been discarded Toronto School.42 The Toronto School examinations, but only accepted degrees here. They were good in their day but we subsequently moved into the Victoria and certificates from the medical schools. should have been taught to use the best… buildings on Gerrard Street the following It had short-lived powers to set the schools’ Over here they pluck half of the students year and became affiliated with Victoria entry requirements and approve the and think nothing of it. They will not let College in addition to the University curricula. It was replaced in 1869 when a man through who is poorly up in his of Toronto. Students could then take the College of Physicians and Surgeons work. The anatomy pass does not mean 43 TORONTO OF UNIVERSITY their degrees from either institution. of Ontario was officially incorporated, a minimum knowledge of anatomy, but with responsibility once more to rather a maximum… In obstetrics the By the 1870s, rivalry between the Toronto administer licensing examinations.47 examination is practical. For the oral medical schools was good-natured. Most [examination] in surgery one may be of Trinity’s faculty had worked at the other Despite these efforts to improve asked to amputate a finger or tie a vessel. schools in the interim and maintained educational standards in Ontario, the [Trinity] and [Victoria] are fighting for their OBSTETRICS & GYNAECOLOGY OBSTETRICS cordial relationships.44 At both Trinity quality still lagged behind Europe. As late schools, and unless the schools do more and the Toronto School, there was a as 1883, homeopathic textbooks were part they should have nothing to say in the 50 new emphasis on clinical instruction.45 of the curriculum at the Toronto School matter. The standard should be raised. This was still principally carried out at of Medicine.48 Dr. James Ross (who would Toronto General Hospital, but by the eventually succeed Ogden as professor of Indeed, in 1881, the University of Toronto late 1860s, the 14-bed Burnside Lying- Gynaecology at the University of Toronto), did raise their standards for the MB In Hospital was established, providing studied at the Toronto School of Medicine degree. This led to a stark drop in the dedicated obstetrical instruction led by from 1874 to 1878 before undertaking annual number of students attempting and Dean Hodder. In the late 1850s, most further study in England, Germany, and passing this examination. Many students 23 chose otherwise, taking a path of least have one of the largest and most modern The increase of births at “the Burnside” resistance, which was through Victoria or hospitals in North America, namely reflected the gradual societal acceptance of Trinity.51 However, these smaller colleges Toronto General Hospital. In 1877, the hospital births in general. Province-wide, struggled to offer adequate scientific Hospital grew in size when it amalgamated the number of hospital births quadrupled training and to provide the expensive with the Burnside Lying-In Department; in the last quarter of the nineteenth- laboratories that were required to keep up subsequently “the Burnside” moved into century. However, it would not be until with the rapid advances in medical science a new building on the Toronto General 1939 that hospital births would outnumber coming out of European (particularly Hospital grounds on Gerrard Street East. homebirths in Ontario.56 Unfortunately German) institutions.52 As Ross noted in The facility housed 22 public beds and four during this time, maternal mortality also

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: a subsequent letter, any ambitious young private ones, and over the next 10 years the increased at the Burnside’s new facility, Canadian doctor had to study outside of annual number of births steadily increased perhaps in part due to the high number Canada in order to reach the top of his from 159 in 1879 to 195 in 1889.54 Echoes of patients needing care, which taxed field. “Such an education is necessary of the hospital’s reformatory philosophy the inadequate systems of equipment now-a-days when our medical schools were still evident, as the trustees of the sterilization and infection control. In the are manufacturing men by the scores.”53 Toronto General Hospital conceded to the years before amalgamation, between 1867 ladies’ committee to continue providing and 1877, eight deaths were reported for “moral and religious instruction” to 1108 cases at the Burnside (7.22 per 1000 Burnside Lying-In Department unwed mothers.55 Indeed, just as in the births), four of which were caused by two Amalgamates maternity hospitals of the 1850s, patients outbreaks of puerperal fever.57 While data Although the Toronto schools were behind at the Burnside were overwhelmingly for the first decade at Toronto General academically, the city could still claim to poor, young, unmarried women. Hospital did not survive, between 1888 and 1891 (before stricter new hygiene rules were instituted), five deaths were reported for 519 cases (9.63 per 1000 births), three of which were from septicaemia.58

The need for antiseptic and aseptic

| MAVERICKS, COLLABORATORS VISIONARIES, AND precautions was increasingly being recognized at this time. The stimulus came from doctors with training in microbiology and especially from those who received training abroad. A further contribution came from rethinking the “interventionist” approach to normal childbirth.59 Rather than treating birth as a major operation, many obstetricians began to adopt a hands-off attitude of “watchful waiting” letting nature take its course. Writing in 1884, A.H. Wright, who later became the first professor of Obstetrics at 24 the University’s re-established Faculty of Medicine, argued against injections and suppositories during and after labour, as well as any proactive extraction of the baby (though he did concede to a more proactive extraction of the placenta).60 He had particularly strong opinions on attempts to accelerate delivery with forceps:

Examine your patient only when necessary, and look upon the forceps as an evil – not to be used unless actually necessary. The employment of forceps Dr. Jennie Kidd Trout to save time for the obstetrician should be considered a criminal offence.61 The Growth of Gynaecology Medical Education for Women The use of forceps varied dramatically amongst obstetricians, and started to Prior to the 1880s, Gynaecology The following year, Toronto also saw decline significantly at the Burnside was not a separate speciality in the the establishment of another institution in the century’s final decades.62 In Toronto medical realm but significant dedicated to women. On October 1st, fact, between 1893 and 1897, forceps changes were ahead, especially after the 1883, led by Dr. Emily Stowe, the were used in approximately five per establishment of a dedicated Women’s Woman’s Medical College formally opened cent of the 500 deliveries.63 A further Pavilion at Toronto General Hospital in in a house at 227 Sumach Street, with development in Obstetrics was the 1882. In the medical schools’ curricula, an inaugural class of five.68 However, in increased use of anaesthesia, despite the Gynaecology was included in the choosing that date, Stowe stole the thunder fact that many devout physicians and Obstetrics (or Midwifery) course, and from her professional rival, Dr. Jennie patients believed the administration of shared the crowded field of Diseases Kidd Trout, who, the very next day, had of Women and Children.65 Specific the grand opening of Kidd Trout’s own anaesthesia was morally wrong (some TORONTO OF UNIVERSITY biblical interpretations promoted the opportunities for clinical instruction in Women’s Medical College in Kingston, notion that God deliberately punished Gynaecology were lacking at Toronto with an inaugural class of 10.69 The women with labour pains). The birth of General Hospital. Indeed, one editorial Toronto college was affiliated with Trinity Queen Victoria’s eighth child in 1853 from 1881 acknowledged that many College, while its Kingston counterpart was influential in changing this archaic new doctors lacked knowledge of “the was affiliated with Queen’s University. The mindset. She agreed to take chloroform simplest operations and examinations latter would eventually close in 1895 and be & GYNAECOLOGY OBSTETRICS during the birth and subsequently, of Gynaecology, as during the whole absorbed by the Toronto College to form anaesthetic became acceptable, and sought four years of their study, many of them the Ontario Medical College for Women.70 after by wealthier patients. By 1890, it have never seen a speculum, or a sound was in widespread use during births, even vessel, or a pessary introduced”.66 Prior to the establishment of these schools, on the public ward at the Burnside.64 However, just one year after this Canadian women aspiring to become complaint, a special two-storey, 40- doctors had to study in the U.S., where bed facility opened adjacent to the opportunities for medical education existed 71 Burnside, and was staffed by several since the late 1840s. The Toronto School 25 of the Burnside’s physicians.67 of Medicine had permitted a modest 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

number of women to take classes there Europe were particularly expensive to set over the years; most notably Stowe and up and run.73 Thirdly, there were ongoing Kidd Trout. However, only one woman concerns about the quality of medical had graduated in medicine in Canada up education in the province. Between 1853 to that point. Emily Stowe’s daughter, and 1887, only 370 students graduated in Ann Augusta Stowe-Gullen, studied at medicine from the University of Toronto, the Toronto School and graduated from whereas over 1000 graduated from Victoria in 1883, just months before Trinity and Victoria.74 Since these smaller joining the Toronto Women’s Medical institutions had a monetary incentive to College as its anatomy demonstrator.72 keep standards lower and revenues high, the University asserted that Toronto medical education would only be improved The Faculty of Medicine Returns if it assumed a greater degree of control.75 It By the mid-1880s, there were several approached the Trinity and Toronto schools | MAVERICKS, COLLABORATORS VISIONARIES, AND compelling arguments for the re- with the idea of amalgamating. Trinity establishment of the University of steadfastly refused and held out until 1903.76 Toronto’s School of Medicine. Firstly, Toronto was an anomaly among Canadian Thus, the University Federation Act Universities because it did not have its own was passed in 1887 by the provincial faculty of medicine, but rather farmed out parliament, re-establishing the University medical education to private schools and of Toronto’s Faculty of Medicine, which small denominational colleges. Secondly, promptly incorporated the faculty of the the existing medical schools (as well as Toronto School of Medicine. On October the smaller universities with which they 1st, 1887, the University once again opened were affiliated) were struggling to provide its doors for medical teaching.77 However, adequate instruction in the sciences. The those doors would remain closed to 26 laboratories required to keep pace with women for almost another two decades. the rapid scientific advances coming out of Wright: The First Professor of Obstetrics

After receiving his MB from the Toronto School of Medicine as one of the three silver medallists, Adam Henry Wright (1846–1930) moved to Colborne, Ontario, to set up a general practice. Three years later he undertook postgraduate training and travelled to Europe, ultimately spending 15 months in London, Paris, and Dublin. After passing the examination for membership of the Royal College of Surgeons (England), he returned to Toronto and reopened his practice at 312 78 Jarvis Street on October 1st, 1877. TORONTO OF UNIVERSITY

Dr. Adam Henry Wright (1846–1930) Wright also became an attending physician at the Toronto Dispensary and at the Hospital for Sick Children.79 He began giving clinical instruction, and was appointed adjunct lecturer of Physiology at & GYNAECOLOGY OBSTETRICS the Toronto School of Medicine in 1880.80 The following year, he was appointed demonstrator of Normal and Pathological Histology. Wright then joined the surgical staff at the Toronto General Hospital, attending the Burnside Lying-In Hospital and the new Women’s Pavilion.81 However, it was only in 1883 that he was given the 27 opportunity to lecture on Obstetrics, when he joined the faculty of the newly textbook, dedicated to William Osler, in the Faculty – factions were apparent established Women’s Medical College. “A Good Physician and a Kind Friend”. at the Faculty meets where one group From 1884, he also taught operative supported the Dean [W.T. Aikins], but the Obstetrics during the summer sessions Wright was heavily involved in other leaned to Ogden and Cameron.84 at the Toronto School of Medicine.82 University affairs. He became a member of the University Senate, was While this criticism may have been His 1905 textbook devoted 24 pages to the elected secretary of the Faculty of harsh (and perhaps motivated by the the art of using forceps, containing many Medicine, and with the re-establishment personal antipathy of its author, the practical tips that remain very relevant of the Faculty of Medicine, he was University’s chancellor, Edward Blake) Wright was removed as secretary the

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: today. Two examples are as follows: appointed as the University’s very first professor of Obstetrics.83 At the following year when the Faculty was First: “One should try to ascertain the exact Faculty’s first convocation, he was reorganized, although he remained chair position of the child’s head, and endeavour awarded an MD. Although Wright was of Obstetrics until retiring in 1912. to apply the blades to the sides of the head widely esteemed as an educator and without regard to the sides of the pelvis” as a practitioner, a senate report from Outside of academic politics, Wright 1892 offers a rather different view: was highly influential. He was elected Second: “Pull gently on the handle, as president of the American Association far as possible during pains, and desist He is not [a] good speaker, his want of of Obstetricians and Gynecologists in during the intervals between them. preparation sometimes barely shows 1890, the Ontario Medical Association Endeavor to extract with the smallest itself – it may be that his duties as in 1900, and the Canadian Medical amount of force. Use one hand at first; secretary [of the Faculty of Medicine], Association in 1909. His colleagues which he performs almost equally badly, this will generally be sufficient”. affectionately described him as being interfere with his ‘duties’ as lecturer. His the “doyen” of Canadian medical conduct in the position of secretary has Frontpiece and Simpson’s forceps journalism in his role as editor of The resulted in the formation of two factions illustrations, from Adam Wright’s 1905 Canadian Practitioner (later The Canadian Practitioner and Review).85 As a journalist, he advocated for aseptic precautions

| MAVERICKS, COLLABORATORS VISIONARIES, AND and a conservative approach to surgical intervention. He also supported public health reform and in January 1911, he was appointed chairman of the Provincial Board of Health, a position he held until 1924 when the board was replaced by Ontario’s Department of Health.86

Although Wright retired as the chair of Obstetrics in 1912, he remained active for another dozen years with his government work and his private practice, finally retiring in 1924, almost 28 50 years after first qualifying as a doctor. Adam Henry Wright’s text book from 1905 Wright’s illustrations of Simpon’s forceps Ogden: The First Professor of Gynaecology

After initially apprenticing under a physician in Cooksville (now in Mississauga), Ogden (1828–1910), became one of the first students at John Rolph’s original Toronto School of Medicine (back in its stable days).87 Having obtained his provincial licence in 1849, Ogden practiced in Aylmer for several years before returning to Toronto to begin what would ultimately be a 50-year teaching career.88

In 1853, Ogden joined the staff at Rolph’s

school, taking over from Joseph Workman TORONTO OF UNIVERSITY in teaching Midwifery and Diseases of Dr. Uzziel Ogden (1828–1910) Women, as well as Materia Medica and Therapeutics. While lecturing at Rolph’s school, Ogden took advanced science courses at the University of Toronto and received his MD from Victoria College. & GYNAECOLOGY OBSTETRICS Just one year later, indignant at his teacher’s behaviour, Ogden resigned with the rest of the faculty and joined Dr. W.T. Aikins in starting the new Toronto School of Medicine. Following the recruitment of Hodder in 1856, Ogden taught Materia Medica and Therapeutics. When Hodder left in 1870, Ogden once more assumed 29 the role of professor of Midwifery and 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

Diseases of Women and Children. By joined the staff at the Toronto General Having celebrated his 50-year jubilee as 1887, Ogden had been teaching Midwifery Hospital in 1878 as an obstetric specialist, a medical educator, Ogden tendered his and Diseases of Women and Children at as well as attending it’s Gynaecology resignation in 1902 and was succeeded by the Toronto School of Medicine for over Pavilion (which opened in 1882).91 his colleague, James Ross, at the beginning 15 years.89 With the re-establishment of of the next session. Over the course of his the University’s Faculty of Medicine, he No doubt aided by the Chancellor’s esteem, career, he had studiously kept up with the became its first professor of Gynaecology. Ogden was elected Dean of the Faculty of latest developments in his field. A retirement Medicine following its reorganisation in tribute contrasted these advances to the state As an educator, Ogden was highly 1893, in a surprise victory over the very of medicine when he first began practicing: regarded. Even after 40 years, first Dean, W.T. Aikins.92 From 1880 to he was praised by Chancellor 1892, Ogden had served in the essentially From the apprenticeship and saddle-bags of Blake in his 1892 report as: honorary role of Dean of the Victoria the old-time doctor to the modern physician, medical faculty. In his new leadership role, with his automobile; from a loft in the stable to one of the most careful and painstaking however, the “naturally shy and diffident” the palatial dissecting room of the Biological | MAVERICKS, COLLABORATORS VISIONARIES, AND Department, seems a far cry, yet such are teachers on staff. He conscientiously Ogden seemed to have served out his the extremes in the professional life of Dr. and carefully prepares his lectures and term as unobtrusively as possible. He was Uzziel Ogden… To have taught and to have the students appreciate them for the succeeded by R.A. Reeve in 1896.93 attendance is good. According to [Dr. I.H. practiced medicine for the fifty years during Cameron, professor of clinical surgery], which the healing art has made its greatest Besides a lifetime of teaching and modest Ogden is the best surgeon in this line advances; to have seen the introduction of forays into university politics, Ogden was in the city. Ogden does not stint in his chloroform, ether and cocaine, to have realized reading or his efforts to keep abreast.90 a pioneer of Canadian medical journalism. the marvels of antisepsis and asepsis, to He was involved in the early days of The have witnessed the growth of abdominal surgery, and the wonders of the Roentgen He was physician to the Protestant Canada Lancet (established in 1868), and in rays, is a lot one may well envy him.95 Orphans’ Home from 1853 and to 1876 he founded The Canadian Journal of the House of Industry from 1861, and Medical Science, continuing on as an editor 94 Ogden had indeed witnessed remarkable became consulting surgeon to the with several successor publications. medical advances over the course of his life.96 30 Hospital for Sick Children. He also Ontario Medical College for Women on Sumach Street, Toronto

1903.100 The expansion of teaching and and Ogden were exclusively for upper- Medical School laboratory facilities was another major year students.105 According to the Medical Integration in Toronto factor in the school’s rapid growth. By School’s calendar for the 1889–1890 1892, the new Biological Building had session, Ogden’s lectures on Gynaecology Having successfully assimilated the been built on the site of the old Medical would cover “descriptions of all the Toronto School of Medicine, the new Building, and in October 1903 the new diseases peculiar to women, methods of Faculty of Medicine began the 1887 Medical Building officially opened.101 diagnosis and treatment. Instruments will session with 250 eager undergraduates.97 be presented, and the modes of using them Enrolment remained consistent for the Equipped with new laboratories and will be demonstrated.” Wright’s course first decade, after which the program access to laboratory space at Toronto would “consist of lectures and recitations expanded significantly, from 277 students General Hospital, the curriculum placed on the Science and Art of Obstetrics. to 622 just five years later in 1904–05, an increased emphasis on scientific It will be illustrated by diagrams and operations on the phantom [i.e. manikin]. with a further 30 occasional students training. For the first time, students TORONTO OF UNIVERSITY taking medical courses but not formally were systematically trained in the use Special attention will be paid to the enrolled for the four-year MB degree.98 of microscopes and required to conduct emergencies of obstetric practice.”106 experiments in chemistry and physiology.102 The University’s medical school was now The amount of clinical instruction was Wright and Ogden were also attending the sole option for aspiring physicians in doubled in the Faculty’s first few years.103 physicians at Toronto General in both Toronto, which explained the marked With the expanded curriculum, the the Burnside Lying-In Hospital and the & GYNAECOLOGY OBSTETRICS increase in enrolment. It amalgamated undergraduate medical program was Gynaecology Pavilion where they led ward with Trinity Medical School in 1903, consequently lengthened to five years in rounds in addition to providing clinical and the Ontario Medical College for 1899, and eventually to six years in 1919.104 lectures in the surgical theatre, which Women closed in 1906 when the Faculty seated up to 600 students. At the Burnside, of Medicine agreed to accept female Teaching Obstetrics and only final-year students could attend students.99 The first Jewish students and assist with births, although students also began to enrol around 1900, with Gynaecology could make their own arrangements Solomon Singer having the honour of The courses in Obstetrics and Gynaecology with outpatients to attend their home 31 being the first Jewish MB graduate in taught respectively by Professors Wright births.107 As part of the stricter and more enlightened hygiene rules instituted at the The increase in hospital births was in part Developments in Gynaecology Burnside from 1891 onwards, students linked to safer ward environments. By the were not allowed to visit the maternity 1890s, antiseptic and aseptic precautions From the 1890s, the advances in hygiene ward if they had “recently engaged in were widely accepted by Toronto and anaesthesia produced safer and more pathological operations… in dissecting,” obstetricians, if not always followed. In sophisticated gynaecological surgeries. or had recently dressed “putrid sores.”108 1891, Adam Wright noted that the newly The Women’s Pavilion became a centre implemented hygiene rules “were not for increasingly invasive abdominal While clinical instruction was held popular at first. The resident assistants procedures as the mortality rate for these primarily at Toronto General Hospital, sometimes ignored them or obeyed the surgeries fell. By 1891, gynaecological surgeries were already accounting for over

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: two other hospitals were open to medical directions in a half-hearted way.” However, students by 1900 (the Hospital for Sick once the rules were adhered to, maternal 15 per cent of all surgeries at Toronto 118 Children, established in 1875, and St. mortality declined dramatically. Of the General Hospital. However, as Dr. Michael’s Hospital, established in 1892). 500 deliveries between mid-1893 and James Russell, a Hamilton psychiatrist, Ogden and his eventual successor, 1897, there were no maternal deaths, observed at the end of the century: Ross, were consultants at SickKids compared with the eight deaths (five because the specialties of Gynaecology from sepsis) that occurred in the 769 Since the introduction of asepsis the abdominal cavity has become the happy and Paediatrics were still closely allied deliveries from 1888 to mid-1893.114 hunting ground of the surgeon, and at this time. Ross was also on staff at the very impunity with which it may be Toronto General Hospital and at St. Improved hygienic conditions meant eviscerated or mutilated is a strong Michael’s Hospital, which was handling that obstetricians could intervene more incentive to the specialist in search of 109 about 80 births annually by 1900. successfully when complications arose. Not surgical glorification to ply his art.119 surprisingly, caesarean sections increased, particularly for wealthier women now Consequently, as one historian noted, Turn of the Century Obstetrics 115 using maternity hospitals. Nevertheless, “Gynaecology as a discipline was plagued By 1900, most women still gave birth Toronto obstetricians, particularly those in the late nineteenth century with at home, although in the last quarter of at the Burnside where Wright held dangerous and meddlesome operations the 19th century, the number of hospital sway, were conservative in this regard, on women for uterine malposition 110 | MAVERICKS, COLLABORATORS VISIONARIES, AND births quadrupled in Ontario. Maternity compared to American, and British, and ‘ovarian hysteria’.”120 In particular, 116 hospitals were no longer caring for physicians. Having seen maternity wards the number of oophorectomies being poor women exclusively, as evidenced decimated by puerperal fever, Wright performed increased alarmingly around by the growing number of private beds argued for a relatively hands-off approach this time.121 In Toronto, this procedure in obstetric wards. For instance, at the to childbirth, specifically condemning was pioneered by Adam Wright and was Burnside in 1896, four of the 25 beds the overuse of forceps. Under Wright, gaining popularity.122 Writing in 1890, 111 were private. At St. Michael’s, after the forceps were used in approximately five James Ross complained that, “the axiom opening of its new maternity wing in 1907, per cent of cases, and only with the direct seems to have become: ‘If a woman has there were 12 private rooms and 18 semi- supervision of an attending obstetrician. indefinite pains or pelvic symptoms that private rooms (with either two or three Wright was similarly conservative about you cannot account for, take out her 112 beds). In addition, maternity care was the use of anaesthesia, however, by the ovaries.’”123 Sadly, most of these surgeries now offered at Toronto Western Hospital turn of the 20th century, it was fairly were both unnecessary and harmful. 113 117 and at Grace Homeopathic Hospital. routine even on the public wards. The function of the ovaries was poorly 32 UNIVERSITY OF TORONTO TORONTO OF UNIVERSITY OBSTETRICS & GYNAECOLOGY OBSTETRICS

Interns and babies, Toronto General Hospital, c. 1899

33 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

understood and their removal was often Thankfully, most Canadian gynaecologists recommended as a cure for mental illness.124 held a conservative view regarding the barbaric strategies James Russell James Russell was far ahead of his lamented, which meant that Canadian time when he criticised the practice women were largely spared from the of treating women’s mental health egregious surgical “cures” for female issues with drastic surgeries: hysteria being practised elsewhere.

The specialist in surgical gynaecology believes that insanity in women is largely if not altogether due to pelvic disorders, and he proceeds to restore to reason the unhappy victim by unsheathing his scalpel and removing the offending organ. He never fails

| MAVERICKS, COLLABORATORS VISIONARIES, AND in his diagnosis, for he always finds exactly what he searches for, and if he finds no gross [lesions] there are at least microscopic lesions to justify the operation. He wages his most relentless surgical fury on the ovaries, for in them he believes reside the chief demoniacal spirits that torture the unhappy lunatic. Other spirits dwell in the uterus and he proceeds to the operation of hysterectomy, ventral fixation and trachelorrhaphy, etc.125

34 Illustration of the removal of the ovary (oophorectomy) in 1908. From Gynecology and Abdominal Surgery, Eds Howard A. Kelly & Charles P. Noble. Note the healthy fallopian tube and uterus. Ross: Free from Circumlocution and Ambiguity

The most distinguished of the non- Ross joined his father’s general practice interventionist Toronto gynaecologists for several years and specialised in was James Frederick William Ross Gynaecology and abdominal surgery. (1857–1911), who succeeded Ogden as He was described as “the driving force” chair of Gynaecology in the Faculty of behind the establishment of the Women’s Medicine. As one colleague described Pavilion in 1882 and was clearly dedicated him, Ross “was ever wont to deprecate to those specialties.128 He launched his the performance of unnecessary and teaching career in 1886, with lectures on unjustifiable operations,” such as “the too Medical Jurisprudence and Toxicology at

frequent removal of tubes and ovaries that the Toronto Women’s Medical College.129 TORONTO OF UNIVERSITY were not the seat of gross pathological In the late 1880s, he travelled once again changes or of the patients’ ills.”126 to Europe to undertake specialised training in gynaecological surgery, spending a Dr. James Frederick William Ross (1857–1911) Ross received his MB degree from the year in Birmingham, UK and Zurich, University of Toronto in 1878. He then Switzerland. While in Birmingham, he OBSTETRICS & GYNAECOLOGY OBSTETRICS studied in London, Berlin, Leipzig, and trained with Lawson Tait, then the most Vienna, before returning to London and renowned abdominal and gynaecological qualifying for the license of the Royal surgeon in the world. (Unfortunately, College of Physicians in the summer of it was Tait’s popularisation of a safer 1880. Following a brief stint as a ship’s oophorectomy procedure that led to surgeon on a Calcutta-bound steamer, so many unnecessary surgeries.) Ross returned to Toronto in early 1881, and served a year’s residence as a When he returned to Toronto, Ross house surgeon at Toronto General.127 joined the staff of the Surgical and 35 Gynaecological Departments at Toronto Ross earned an international reputation Consolidation of the two specialties General Hospital. At some point, he through his research and leadership. Over reflected a broader trend across Canada. was noted to be on staff at almost every the course of his career, he published McGill University consolidated in 1910, Toronto hospital. Though generally approximately 70 papers, including while at Queen’s University the two “brusquely honest and straight-forward” notable early work on ectopic pregnancy, specialties had evolved together from with his patients, he worked tirelessly uterine cancer, and refinements to the traditional subject of Midwifery and was renowned as a “neat, brilliant, the hysterectomy procedure.135 He and Diseases of Women.139 Even at quick and very thorough operator”.130 His also served terms as president of the the University of Toronto, Dr. James dedication to clinical practice enabled him American Association of Obstetricians Algernon Temple’s official title in the

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: to compile detailed records of the almost and Gynecologists in 1897 and of the Department of Gynaecology had been 2000 abdominal surgeries that he had Ontario Medical Association in 1904. “Professor of Operative Obstetrics and performed over the course of his career.131 In addition, Ross led the establishment Gynaecology” since 1903.140 And while of the Toronto Academy of Medicine Obstetrics and Gynaecology remained With his staff appointment secured, in 1907, which consolidated the local separate at Toronto General Hospital, and Ross began giving clinical instruction medical societies. He was subsequently housed in separate, dedicated facilities at to medical students. From 1889, he elected its first president.136 Tragically, St. Michael’s Hospital, the two services switched to teaching surgical Gynaecology Ross’ career was cut short due to a had been combined since 1909.141 and clinical Surgery at the Women’s motor vehicle accident in 1911. Medical College, subsequently becoming At the end of the 1911–12 session, Wright professor of Gynaecology there.132 The Union of Obstetrics resigned as chair of Obstetrics in the “As a teacher,” his colleague, the Faculty of Medicine.142 With over 25 pathologist Harry Anderson, recalled: and Gynaecology years as chair, his cautious, fundamentally 19th century approach meant that the Ross was eminently practical, clear-cut, After Ross’s untimely death in 1911, the Department had been slow to embrace and forceful. Free from circumlocution and Faculty of Medicine decided to consolidate new international developments in ambiguity, he went straight to the core of the Departments of Obstetrics and obstetrical science. Additionally, in his subject, and impressed the essentials Gynaecology.137 Outlining the reason for January 1911, Wright had taken up the on his students with rare discrimination.133 | MAVERICKS, COLLABORATORS VISIONARIES, AND this decision, the University President’s chairmanship of the provincial Board 1912 report noted that while “Gynaecology of Health, the precursor to the Ontario In 1897, Ross was appointed associate exists as a distinct department in a large Health Department. His retirement professor of Gynaecology in the number of hospitals in Britain, Canada, from the University cleared the way for University’s Faculty of Medicine and when and the United States... [in] Great Britain Obstetrics to be combined under a new Ogden retired in 1903, Ross became chair it is much more frequently associated appointee. Seeking a candidate who of the Department of Gynaecology, as with obstetrics than in America.” The could bring the unified department into well as chief of the Gynaecology service at Faculty’s recommendation was therefore the 20th century, the faculty once again Toronto General Hospital. In these roles, “in line with the practice of the best looked to “the best medical schools of the he established an outpatient Gynaecology medical schools of the Old Country.138” Old Country.” In November 1912, they Clinic in 1908, and led the planning of the appointed Dr. Benjamin Philip Watson.143 gynaecological facilities destined for the hospital’s new location on College Street.134 36 Smillie Robertson: Keeping the “Mischievous” Boys in Order

(1878–1981), one of the six first-year internship at the Women’s Medical women could practise. In 1898, the students to enrol at the women’s College hospital in Philadelphia. In 1910, Women’s Medical College had opened a college the following year, recalled a she returned to Toronto and began in dispensary (effectively an out-patient less negative impact of co-education: general practice, but soon decided to clinic), and this continued to operate seek specialist training in Surgery.149 As after the college was absorbed by The professors had been she explained almost 70 years later: the University. However, in 1911, the having difficulty keeping the dispensary was re-established by a mischievous and obstreperous Though there weren’t many group of women physicians including boys in order, and noted women practising in Toronto, Smillie Robertson as Women’s College that the gentlemen behaved we got a fair share of work Hospital and Dispensary at a new better when the ladies were to do, but none in Surgery. location on Seaton Street.152 Leading present in the classes, so I thought we women would the Gynaecology Service were Smillie they decided to take the never amount to anything in 146 Robertson and Jennie Gray Wildman, girls into all the classes. Medicine as long as we had an associate professor of Gynaecology Dr. Jennie Smillie Robertson to hand over our Surgery to The Faculty of Medicine had been feeling the men… I decided if no at the college before amalgamation. government pressure to officially admit one else would [specialise in Rowena Hume, an 1899 graduate who women for some time. In April 1906, Surgery], I would have to do had taught Pathology and Bacteriology at The early years of the the University acquiesced and on July it myself. I had some difficulty the Ontario Medical College for Women, 153 20th century marked the 1st, the Ontario Medical College for finding a place. No one in headed the Obstetrics Department. Toronto would accept a girl. admission of the first small Women closed, officially transferring its But I knew the chief surgeon group of women to the students to the Faculty of Medicine.147 In at the Women’s College in Faculty of Medicine at the its 22-year history, the college graduated University of Toronto. Philadelphia was very good… I approximately 120 women, and although got on very well with the chief women could now attend the University surgeon, and she taught me a While women were permitted to enrol Medical Program, the overall number of lot and let me do everything… in the Faculty of Arts in 1884 (with the women studying medicine in the province Towards the end of the six first five women graduating in 1885), subsequently declined and teaching months there, she left me in the Faculty of Medicine did not officially opportunities for women evaporated.148 charge for a week while she TORONTO OF UNIVERSITY enrol women until 1906. Since the 1890s, was out of town and I did women seeking medical education Among the several women practising some operations on my own while she was away. That in the province attended the Ontario Obstetrics and Gynaecology in Toronto helped my self-confidence Medical College for Women. However, in the first decades of the 20th century, in the 1904–05 session, students at a lot when I first started to Jennie Smillie Robertson was notable do surgery in Toronto.150 the women’s college attended classes for being the first woman to perform Dr. Jenny Gray Wildman OBSTETRICS & GYNAECOLOGY OBSTETRICS alongside the male students for the major gynaecological surgery in Canada. very first time; anatomy was still Upon returning to Toronto, Smillie At 18 years of age, she qualified as a Robertson had nowhere to apply her Smillie Robertson remained at Women’s taught separately to uphold a level teacher, and taught for several years College Hospital as associate chief of propriety.144 The reception these training, experience, and confidence, as while saving money for medical school. not one hospital would grant her surgical of Gynaecology until 1942, when she women received in the faculty was In 1905, she had sufficient funds to retired after a 40-year career. After her likely hostile and would have deterred privileges. Her first operation in Canada, enrol at the Ontario Medical College an oophorectomy, was performed on retirement, she married Alex Robertson, all but the most determined female for Women in what would be its last whom she had first met while working as applicants. One of the first women to her patient’s kitchen table (at midday intake year. After graduating from the 151 a young teacher. She recalled that she graduate, Elizabeth Stewart, observed so there would be enough light). The University with an MB in 1909, she successful operation emphasized the had been “planning for medicine, not that the female students were “cordially was unable to find a single placement marriage, and didn’t think [she] could 145 need for a dedicated hospital in which 37 hated”. Jennie Smillie Robertson in Toronto hospitals, and accepted an have both.”154 She lived to the age of 103. and had repeatedly clashed with school Anxiety over the future of the nation MacMurchy: The Influence of Eugenics authorities over her independence brought attention to maternal and infant and power to implement reforms. mortality, and it was a crucial factor given a hospital staff appointment in in the development and expansion of Canada. (By contrast, in 1901, there Her career continued as assistant perinatal care after the First World were 302 female physicians on staff at Inspector of Hospitals, Prisons, and War. MacMurchy’s 1928 report revealed American hospitals and 149 at British Public Charities for Ontario from 1913, that most maternal deaths in Canada ones.) After her initial year at Toronto and in 1920, she was appointed chief in 1925–26 were prefaced by a lack General Hospital, she became the first of the new Child Welfare division of of prenatal care. She observed, “We woman to undertake postgraduate the federal Department of Health. are only now discovering that Empires studies at Johns Hopkins Medical School, She served in this last post for 14 and States are built up of babies…

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: where she was mentored by the famous years, which at that time was the Armies are recruited only if and William Osler. She then completed most senior position in the Canadian when we have cared for our babies.” further training at the Women’s Medical civil service ever held by a woman. Canada’s national birth rate continued College of Pennsylvania in Philadelphia. During her career, she wrote numerous on a decline, and would not increase Helen MacMurchy (1862–1953) government reports, pamphlets and significantly until the baby boom was a woman of ‘firsts’. Returning to practice in Toronto in books on childcare, maternal welfare, occurring after the Second World War.157 She was the first woman to 1902, MacMurchy worked with the poor, and public health. These brought her intern at Toronto General focussing on issues of public health, national and international renown; The decline in the birth rate between Hospital in addition to being school conditions, the welfare of children, in particular, The Almosts: A Study of wars was a result of the increasingly one of the founders of and the “feeble minded”. In 1911, she the Feeble-Minded, and The Canadian widespread use of contraception. While Women’s College Hospital. was also one of the founding physicians Mother’s Book, a childcare manual. birth control remained a taboo subject of Women’s College Hospital and, in in polite conversation (and officially During her long career of government the same year, she was appointed as Regrettably, MacMurchy’s public health illegal to either distribute or advertise), service, she achieved the highest rank Assistant Demonstrator in Obstetrics and advocacy and government work was by the 1920s and ‘30s it was a common of any woman in the civil service at Gynaecology at Toronto General Hospital, consistently eugenicist; encompassing a practice. In fact, in the 1930s, the that time and in 1911 she became the with a cross-appointment in the Faculty strong endorsement of the sterilization University of Toronto became the first first woman to be appointed to the of Medicine at the University of Toronto, of “the unfit.” Her 1934 book, Canadian medical school to offer University of Toronto’s Department of thus making her the first woman to hold Sterilization? Birth Control? A Book for instruction on the use of contraception Obstetrics and Gynaecology. Despite a post in the University’s Department Family Welfare reflects these views: to medical students. However, public her remarkable, ground-breaking of Obstetrics and Gynaecology. and medical attitudes toward abortion roles, there was a darker side to her There is a dead weight of remained far more conservative. Doctors | MAVERICKS, COLLABORATORS VISIONARIES, AND legacy. Throughout the early decades As a result of her public advocacy, unfitness for community and in particular were reluctant to even see of the 20th century, she was a MacMurchy was appointed to the newly family life, which costs us patients who had miscarried, let alone much in money and more well-known proponent of eugenics formed provincial position of Inspector to perform therapeutic abortions, for in national prosperity and of the Feeble Minded in 1906. She was fear of being tarnished professionally. happiness. Can we expect also commissioned to investigate infant Born into a well-to-do Toronto family, the defective among us, who MacMurchy attended the Toronto Normal mortality, producing a provincial report have the least capacity for In 1934, MacMurchy was made a School, and subsequently taught at in 1910. At that time, infant mortality in self-control, to rule one of Commander of the Order of the British Jarvis Collegiate in the 1880s, where Toronto was considerably higher than in the strongest urges of life??155 Empire (CBE). A decade later she was her father was the principal. But she other North American cities: her 1907 listed as one of the 10 leading women soon left teaching to enter the Ontario report cited statistics that put infant Her book was endorsed “without physicians in the western world. Despite Medical College for Women, earning mortality for Toronto at just under 20 hesitation” in the journal of the her preoccupation with eugenics, her MB in 1900 and an MD in 1901. per cent. Her career in public service Canadian Medical Association, which she was considered a pioneer for her Remarkably, her thesis for the latter continued despite being forced to resign four years previously had run an editorial ground-breaking focus on the connection degree was published in the British as Medical Inspector of Schools for the advocating “Sterilization for Human between medicine and social needs, 38 Lancet medical journal. MacMurchy then Toronto Board of Education in 1911, just Betterment.”156 However, an increased and for highlighting the importance interned at Toronto General Hospital. Up one year after being appointed. She had understanding of the horrors of the Nazi of maternal and child hygiene.158 to that point, no women had ever been called the education system a “farce,” regime in World War II would significantly change existing views on eugenics. Watson: Inaugural Chair of a Combined Department

At 17 years of age, Benjamin Philip Watson publish one of the first textbooks in (1880–1976) entered the University of gynaecological pathology in 1913.159 Edinburgh as a medical student and graduated in the top of his class in 1902, As 1912 came to an end, Watson having earned an award for proficiency was recruited by the University of in Obstetrics and Gynaecology. Watson Toronto to become the first chair of the then joined the Gynaecology Department combined Department of Obstetrics at the Royal Infirmary in Edinburgh and Gynaecology and he was perhaps and at the Royal Maternity Hospital. In attracted by “the enormous salary of one

1905, he was awarded a gold medal and thousand dollars a year”.160 His mandate TORONTO OF UNIVERSITY the MD degree from the University of included creating a strong and cohesive Edinburgh for his thesis on amniotic fluid Obstetrics and Gynaecology department and changes in the placenta following fetal and his expertise in pathology would have 161 Dr. Benjamin Philip Watson (1880–1976) death. He also became a Fellow of the helped him establish some authority. Royal College of Surgeons of Edinburgh He also introduced “the Scottish method OBSTETRICS & GYNAECOLOGY OBSTETRICS (having been examined by Dr. Joseph of teaching,” whereby “the staff of the Bell, the man who inspired the Arthur hospital and the staff of the University Conan-Doyle character, Sherlock Holmes). looked on teaching as their second most Watson was subsequently appointed as important assignment, of first importance tutor in Gynaecology at the University being, of course, the care of the patients.”162 of Edinburgh, while continuing with his private practice and pathology research. As head of the University Department, In 1910, he was promoted to lecturer, Watson was also chief of the (still separate) and worked with Freeland Barbour to Gynaecology and Obstetrics services 39 at Toronto General Hospital. In June 1913, Toronto General Hospital moved from Gerrard Street East to College and University.163 The new hospital became one of the largest and most modern in North America. Gynaecology was housed in a ward on the third floor of the main building, while the Burnside was transferred to an adjacent building

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: on Elizabeth Street (although Obstetrics actually remained at Gerrard Street until Dr. John Gordon Gallie Dr. William Edward Gallie the following year when this new building Gallie was a native of Barrie, Ontario, and later research. He also instituted the city’s was ready).164 In 1912, Toronto Western the younger brother of the more renowned first dedicated postgraduate program in Hospital also became affiliated with the William Edward Gallie, who served as Obstetrics and Gynaecology, and helped to University’s Faculty of Medicine, which Dean of the Faculty of Medicine between modernise the residency system at Toronto eased the crowding of medical students 1936 and 1946 (and organized Canada’s General Hospital. While Watson failed at the public wards of Toronto General first postgraduate program in Surgery, the to appoint any women to either clinical Hospital.165 However, clinical instruction “Gallie course”).169 The younger Gallie or academic positions, he launched the in Obstetrics and Gynaecology was not graduated from the Faculty of Medicine careers of several men who would figure offered at Toronto Western Hospital in 1910 and trained in New York State. prominently in the Toronto medical until 1914, when the chief of its service, In 1913, he was hired by Toronto General world. With J.G. Gallie, he had overseen Albert Angus MacDonald, was appointed Hospital to set up the first antenatal clinic the start of prenatal care in Toronto, and an associate professor of Obstetrics.166 in the city, modelled on those he had in 1914, Watson collaborated with Alan attended during his New York training. Brown, a clinical assistant at the Burnside Watson quickly created a pathology The clinic dramatically reduced maternal Hospital at the time, to set up one of the laboratory at the Burnside and invited mortality on the public ward at the new earliest nurseries for premature babies.172 the technician he had worked with in 167 Burnside. (Gallie was also responsible for | MAVERICKS, COLLABORATORS VISIONARIES, AND Edinburgh to join him. However, the city’s first postnatal clinic in 1923.)170 In 1922, Watson was offered the chair in his first major hire as chief at Toronto In 1914, he appointed Alan Brown as a Obstetrics and Gynaecology at his alma General Hospital was Dr. William Albert clinical assistant at the Burnside Hospital. mater, the University of Edinburgh, Scott. Scott was the gold medallist Brown, Canada’s first professionally and was succeeded by his colleague and of the University of Toronto medical trained paediatrician, would go on to former commander during the war, Dr. class of 1913 and would eventually serve as chief physician at the Hospital William Belfry Hendry.173 Yet Watson’s become chief at Toronto General for Sick Children from 1919 to 1952.171 stay in Edinburgh proved to be relatively Hospital and chair of the Department short-lived. In 1926, frustrated by his of Obstetrics and Gynaecology.168 Despite the interruption of the war, the new colleagues’ resistance to his efforts Department of Obstetrics and Gynaecology to reorganize the department and its Two early hires at Toronto General advanced greatly during Watson’s hospital set-up, he accepted an offer as Hospital would prove significant for chairmanship. He ensured that staff and chair of Obstetrics and Gynaecology at the development of Paediatrics and students were well-trained in Pathology, Columbia University in New York.174 He 40 Perinatology in Toronto. John Gordon which laid the groundwork for much taught there until his retirement in 1946. WWI and No. 4 Canadian General Hospital

established Department of Obstetrics them very badly, hardly gave them and Gynaecology. His brother, Allan enough to eat, and made them sleep in Roy Dafoe, was also an obstetrician the same quarters as the servants, and and was legendary for having delivered made very nasty remarks about them the Dionne quintuplets in 1934.178 wearing a uniform with lieutenant’s stars and receiving lieutenant’s pay. You would The No. 4 shipped out on May 1915, think that women would be pleased arriving in England with a total of 38 to find that at least some parts of the officers, 73 nurses, and 206 “other Empire treated their nurses properly ranks”, one of whom was Private Lester instead of being jealous of them.”180 Bowles Pearson. The future prime minister served with the No. 4 until In November 1915, the unit was assigned 1917, when he transferred to the Royal to the Macedonian Front and arrived Flying Corps.179 Most of the nurses at Salonika (now Thessaloniki, Greece) Ambulance of No. 4 Canadian General Hospital were recent graduates of the main where they would remain until August hospitals in Toronto. For several months 1917.181 They were initially inundated with after arrival, they were loaned out to casualties from the offensive at Gallipoli, On August 4th, 1914, Great he succeeded Watson as department hospitals in England and France while after which they primarily saw cases Britain joined the war chair. Watson joined up as a captain, the No. 4 awaited orders. Unlike nurses of malaria, dysentery, and jaundice. against the Central Powers, along with J.G. Gallie.175 W.A. Scott, in the British medical corps, Canadian Conditions the first winter were difficult automatically drawing later Hendry’s successor as chair, nurses had officer status and officer due to the prevalence of mosquitoes, lice, Canada into the conflict. also joined the No. 4 in early 1918. pay (roughly $4 per day). Unfortunately and rats. Mary Darling, a nurse trained at they were often treated with undisguised the Hospital for Sick Children, recalled: Within months, many medical students Several future department members contempt. As the pathologist Captain J.J. “You made rounds and would hear the and faculty of the University of Toronto served with the No. 4 as well. H.B. Mackenzie reported to his wife, “In one boys throwing their boots around … you had enlisted. By March 1915, the No. 4 Van Wyck was commissioned in April of the hospitals the authorities treated knew it was the rats they were after.”182 Canadian General Hospital was organized 1915, while still a medical student, and in Toronto as a unit of the Canadian graduated with the class of 1915 while TORONTO OF UNIVERSITY Army Medical Corps. Commanded by serving overseas. He joined the medical Colonel James Alexander Roberts, a faculty in 1920 and became the chair of demonstrator in the Department of Obstetrics and Gynaecology right after Surgery and junior assistant surgeon the Second World War.176 William Allan at Toronto General Hospital, the unit Dafoe was also a medical student at the drew its officers from the University’s University of Toronto when he enlisted OBSTETRICS & GYNAECOLOGY OBSTETRICS Faculty of Medicine and many other in March 1915. He joined the No. 4 as a staff from Toronto’s main hospitals. private and rose to the rank of sergeant before taking up a commission in the Several members of the Department Royal Navy in May 1917. However, after of Obstetrics and Gynaecology were his destroyer sank in the North Sea, commissioned with the No. 4 Canadian he returned to his medical studies and General Hospital. In fact, the unit’s graduated with the class of 1920.177 second-in-command and eventual After training with B.P. Watson, Dafoe commander was Hendry. Colonel Hendry spent the following decades at Toronto was an associate in Gynaecology at General Hospital until 1949, when he Group of officers at No. 4 Canadian General Hospital, Salonika. 41 headed up the Wellesley Hospital’s newly the war’s outset but after the war, May 1916 The hospital grew to 2000 beds, intervention in the Russian Civil War.190 Francis Joseph O’Leary (1890–1952) but typically had 1000 patients at a Samuel John Newton Magwood, an enlisted in the CAMC in 1915 while time.183 Hendry assumed command in assistant demonstrator in Obstetrics, still in his first year of medicine at the late 1916 when Colonel Roberts was served with the No. 2 Casualty Clearing University of Toronto. He became a promoted to other duties in England. Station in northern France from October stretcher bearer with the No. 5 Field After two long years, the understaffed 1915 to July 1917.191 His colleague, Ambulance, which was attached to the University appealed to its overseas Herbert Ernest Clutterbuck, also served 2nd Canadian Division. In late 1917, faculty members to return to Toronto. in northern France with the British he was injured at the second Battle of Some, such as Watson, returned for Army’s No. 13 Base Hospital and No. Passchendaele, which resulted in the the start of the 1916-17 session.184 J.G. 8 Casualty Clearing Station.192 amputation of his left leg at mid- Gallie also left Salonika in late 1916 to thigh and his receipt of the Military

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: seek treatment for chronic dysentery, Two department members saw service in Medal. He then dedicated his time to and returned to Canada in June 1917.185 Canada only. Frederick William Marlow, medical studies and graduated in 1922. When the No. 4 was reassigned to associate professor of Gynaecology O’Leary was appointed to the Faculty England in September, several more and senior gynaecologist at Toronto of Medicine in 1929, and became faculty members returned, though many General Hospital, served as a district head of Obstetrics and Gynaecology were replaced by other colleagues, officer for the CAMC in Ontario, as at St. Michael’s Hospital in 1947.196 one of whom was W.A. Scott. The Dr. Malcolm Maclachlan well as an inspector for medical No. 4 spent the remainder of the war Crawford units throughout Canada.193 Arthur staffing the Canadian Military Hospital Clinton Hendrick, a demonstrator in Medical Women Step Up at Basingstoke in Hampshire, treating Gynaecology and Marlow’s colleague While female physicians were officially Canadian casualties from the Western at Toronto General Hospital, served barred from the CAMC, 331 Canadian en route to Salonika, and later developed Front. When the war ended on November from 1917 to 1918 with the CAMC at women were commissioned in the British blackwater fever, a severe malarial 194 11, 1918, the hospital’s 1500 patients the Mobilisation Centre in Toronto. Royal Army Medical Corps, and several infection that ultimately proved fatal.188 were gradually returned to Canada, more joined French and American units. and in July 1919, the No. 4 followed. Two future department members served One notable example from Toronto was Proud Contributors with particular distinction during the war. Edna Mary Guest (1883–1958), a 1910 Although many of the hospital’s Waring Gerald Cosbie joined Obstetrics graduate of the Faculty of Medicine who personnel became ill during the war, Many members of the Department of and Gynaecology and Toronto General initially specialised in gynaecological records indicate only two deaths. The Obstetrics and Gynaecology saw service Hospital in 1921. After graduating in surgery. (Guest was the first woman first was Captain Norman Yellowlees, with other units during the war. Malcolm Medicine from the University of Toronto elected to the Council of the Toronto a 1909 graduate and a physician at Maclachlan Crawford, a demonstrator in in 1915, he enlisted in the CAMC and

| MAVERICKS, COLLABORATORS VISIONARIES, AND Academy of Medicine.) After working and the Nurses’ Training School at Toronto Obstetrics and assistant at St. Michael’s was assigned as a medical officer to teaching in India, she joined the British General Hospital. In May of 1916, he Hospital, enlisted in February 1916 to the 58th Battalion of the Canadian drowned while crossing a river in an serve with the No. 16 Canadian General Expeditionary Force. In May 1916, he attempt to reach the wreckage of a Hospital at Orpington, Kent, and later at was wounded by shrapnel at Ypres. downed zeppelin.186 Helen Sibbald, St. Andrew’s Military Hospital in Toronto. After his recovery, he was assigned to a nurse from St. Michael’s Hospital, He eventually left Obstetrics and became the No. 8 Canadian Field Ambulance, witnessed his death, “Dr. Yellowlees chief coroner for Toronto and the province and saw action at Vimy Ridge in April went down in the quicksand right of Ontario.189 Another demonstrator, 1917. He was awarded the Military beside Dr. Wilson and was never seen Frederick Adam Cleland, enlisted in Cross for having “led his [stretcher] again… I could see Dr. Wilson still on the Canadian Medical Army Corps bearers into the open under heavy fire the horse. He was just like a death’s (CAMC) in September 1918 after having and rescued many wounded men. He head. He was just lucky he didn’t get established the first gynaecological worked continuously for 48 hours under into the quicksand.”187 The second loss service at Grace Hospital in Toronto very heavy fire.” He finished the war as was Lena Aloa Davis in February of the previous year. He served several a medical officer with the 5th Battalion 195 42 1918, while the No. 4 was stationed at months with the No. 11 Stationary of the Canadian Mounted Rifles. Basingstoke. Davis caught malaria while Hospital in Siberia, as part of the Allies’ Dr. Edna Mary Guest (1883–1958) medical course grew from just 11 Western Hospital since the hospital’s baby – the poorly kept Jewish in 1910 to 51 in 1917.199 A small foundation in 1896.202 This appointment home where the baby is number of women also managed to was in large part due to her marriage to nearly always welcome – the secure internships and junior staff the hospital’s founder, John B. Gullen. English or the Scotch home where the mother is perhaps appointments at major Toronto hospitals. struggling on alone…205 Jennie Smillie Robertson (whose The return of several department name the hospital initially misspelled members from service overseas in 1916 This prejudice against immigrants, the as “Smellie”) and Geraldine Oakley, and 1917 eased some of the pressure on poor, and single mothers fed into the were assistants on staff at Toronto teaching and clinical practice. Watson broader eugenic mission of the Social General Hospital in Anaesthesia from arrived back in Toronto in the fall of Service Department, which was to 1915, joining Pearl Jane Sproule (later 1916 and resumed his duties as chair identify the “defective” and prevent Manson) who had been in Otolaryngology and chief at Toronto General Hospital.203 them from recklessly multiplying and since 1912.200 Olive Gair Patterson In 1917, he married a Belgian woman Dr. Geraldine Oakley causing “a stream of disease and also served as a resident at Toronto named Angel Hamendt who had fled to degeneracy to spring up where there General Hospital in 1916–17 after Toronto when the Germans occupied should be strength and power.”206 C.K. graduating the previous year.201 her home at the start of the war. Army and was head of the Scottish Clarke, chief psychiatrist at Toronto Women’s Hospital unit in Corsica from General Hospital and Dean of the Faculty Despite their important contributions, 1917 to mid-1918. She finished the war of Medicine, determined that 54 per cent these women were never appointed Social Work Plays a Role as commander of a base hospital on of the “defectives” examined at his clinic to the Department of Obstetrics and the Western Front and subsequently The war years saw the beginning of were immigrants.207 Maternity patients Gynaecology, and did not secure clinical joined the staff of Women’s College the coordination of social workers on the public ward were also subjected appointments at any other Toronto Hospital.197 Guest had the distinction with Obstetrics and Gynaecology. to psychiatric evaluation, particularly hospitals affiliated with the University. of being named to the Order of the The Social Service Department was unmarried women, whose numbers had No women would join the clinical staff British Empire by King George V. established at Toronto General Hospital increased substantially during the war.208 at the Hospital for Sick Children until in 1911 under Helen MacMurchy, and Of the 129 unmarried women admitted 1921 or at St. Michael’s Hospital until The absence of so many members of the a special clinic was created in 1914 to the Burnside in 1915, only 34 were 1922. The exception was Ann Augusta Faculty of Medicine who were serving for the psychiatric evaluation of young fortunate enough to be classified as Stowe-Gullen (the first woman to in the armed forces put pressure on women, often referred there by the “hopeful cases” mentally, while over graduate from a Canadian medical those who remained behind. Additionally, courts.204 When J.G. Gallie launched half were discharged to institutions.209 the University sought to accelerate school), who had been on staff at Toronto the prenatal clinic that same year, the the education of upper year medical Social Service Department was integral The Social Service Department also felt TORONTO OF UNIVERSITY students so that they could join the in conducting patient evaluations, home compelled to tackle the rise in sexually CAMC. The major Toronto hospitals inspections, and follow-ups. While transmitted infections. The increase also suffered from understaffing; a there was value in ensuring proper was caused by the soldier-driven boom problem compounded by the lack of newborn care, the service was deeply in the city’s sex trade and the return of new medical graduates taking up prejudiced in its approach, aiming to: soldiers infected overseas.210 At Toronto

their junior staff positions. In fact, for General Hospital, the annual number of & GYNAECOLOGY OBSTETRICS several months in 1917, J.F. Uren was … go to these homes and syphilis cases jumped by over 40 per apparently the sole doctor attending study the racial characteristics cent after the outbreak of the war. In the Surgical, Gynaecological, and and home environment of 1915, the “Special Treatment Clinic” these people in the months Emergency departments at St. Michael’s was established there to specifically before the baby is born. The Hospital. When several of his colleagues handle syphilis cases, as was an Italian with little conception finally returned from military service, of home comforts, used in outpatient clinic in 1917 for women and 198 211 Uren collapsed from exhaustion. Italy to out-door life, settling girls with gonorrhea. Other hospitals in our poorer districts, has would follow suit to address these Women began to take up some of the to be told everything that challenges as the war continued.212 positions left empty, and the number is needed for a Canadian 43 of women enrolled in the University’s Dr. Ann Augusta Stowe-Gullen Postwar Presents When the pandemic finally receded in In 1915, Women’s College Hospital moved December, roughly 150,000 of Toronto’s to a new location at 125 Rusholme Road, Challenges and half a million residents had caught the and in 1919 (after a brief appropriation Advancements flu, and 1750 of them had died.218 by the City for influenza patients), a new wing opened, doubling the number On November 11th, 1918, Germany When normalcy returned, the Faculty of of infant cots in the hospital.224 The signed an armistice and the First Medicine welcomed veterans who were following year, Edna Guest, having World War at last came to an end. starting or resuming their studies. The served with distinction during the war, Seventy students and alumni of the medical course was now lengthened established a Venereal Disease Clinic at Faculty of Medicine had been killed in to six years and for the first time ever, the hospital, sponsored by the municipal action or had died of their wounds.213 more than 1000 medical students and provincial governments. Radiology

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: Among them was Norman Yellowlees were enrolled at the University of and Pathology Departments were also of the No. 4, as well as John McCrae, Toronto. In 1921, with funds from established, while Gynaecology was the 1898 Toronto medical graduate the Rockefeller Foundation, Watson reorganized as its own department famous for his war poem, In Flanders established a fellowship in Obstetrics distinct from Medicine and Surgery.225 It . In January 1918, McCrae died Fields and Gynaecology at Toronto General was led by Jennie Gray Wildman (1862– of pneumonia and meningitis at Hospital, as well as the specialty’s 1953), one of the hospital’s founders Boulogne while serving as commander first residency there along with similar in 1911, as well as one of the first of the No. 3 Canadian General Hospital, programs in Medicine and Surgery.219 graduates of the former Woman’s Medical which was mostly drawn from McGill Given the growing cohort, competition College in 1889.226 Obstetrics continued University’s medical school.214 for placements at Toronto hospitals under the leadership of Rowena Hume was fierce. At St. Michael’s Hospital, (1877–1966), another founder and a But with the war’s last gasp came a for instance, there were 37 applicants pioneer of family planning in Ontario.227 devastating visitor. During the summer for its nine intern positions in 1923.220 of 1918, a deadly strain of influenza developed in the crowded, miserable Despite the influx of returning conditions of the Western Front and servicemen, women managed to in the fall of that year, Toronto was hit continue making gains in the Toronto by the pandemic sweeping Europe. By medical world. The number of female mid-October, Toronto Western Hospital medical students climbed steadily, was teeming with patients, while at and by 1921, there were 85 women Toronto General Hospital almost half of out of 1,127 students enrolled in the | MAVERICKS, COLLABORATORS VISIONARIES, AND the patients had the flu, as well as 80 Faculty of Medicine.221 Women also nurses, three of whom died. Half the began to gain positions on staff at nurses at the Grace Hospital had also Toronto’s hospitals. In 1921, Gladys taken ill, while at St. Michael’s Hospital, Boyd (1893–1970), a 1918 Toronto still chronically understaffed because graduate, joined the clinical staff at of the war, the Sisters of St. Joseph the Hospital for Sick Children and was drafted teaching staff, student nurses, chief endocrinologist there until 1950.222 and other local nuns to keep the hospital At St. Michael’s Hospital, Esther Doane functioning.215 Large sections of Toronto Harrison (1896–1969) became the first General Hospital were reorganized as woman to join the staff. In August 1922, isolation accommodation, including having graduated the previous year, she half of the gynaecology ward and a was appointed assistant gynaecologist section of the Burnside Hospital.216 in the outpatient department. She The new wing of Women’s College subsequently worked for over 30 Hospital was also commandeered by years in Obstetrics and Gynaecology 44 the city before it could even open.217 at Women’s College Hospital.223 Hendry: A Great Mentor Takes the Helm

With the departure of Watson to Scotland in 1922, the Faculty of Medicine turned to a local candidate: William Belfry Hendry (1874–1939). The Faculty considered him an obvious replacement as chair of Obstetrics and Gynaecology at the University (and chief of Obstetrics and Gynaecology at Toronto General Hospital), given his history with the medical contingent during the war, and recent posting as associate professor and assistant at the hospital.228 UNIVERSITY OF TORONTO TORONTO OF UNIVERSITY After training as a teacher, Hendry taught Dr. William Belfry Hendry (1874–1939) mathematics for four years at Ridley College in St. Catharines, Ontario, while saving funds to study medicine.229 In 1900, he returned to Toronto and enrolled in Medicine.230 During his second year & GYNAECOLOGY OBSTETRICS he joined the Canadian Medical Army Corps (CAMC), as a private eventually becoming an officer. He interned at Toronto General Hospital after graduating in 1904 and subsequently joined the staff there as a house surgeon.231 He received his first faculty appointment in 1907 in Anatomy, then in Gynaecology in 1910, 45 becoming an associate in 1915.232 At Toronto General Hospital, Hendry oversaw the earliest development Post WWI: Hospitals of Perinatology and early work in Radiotherapy for cervical cancer. However, Between the First and Second his principal focus was teaching and Toronto General World War, Toronto became mentorship. Forty years after his death, a dynamic and growing city, Hospital D.E. Cannell recalled him as a “superb with a population that almost James Clifford Goodwin (1902–1953) lecturer” and “one of the most likeable and doubled to one million before was a 1926 University of Toronto clear-cut sort of teachers.”233 The Faculty the outset of the Second medical graduate who went on to serve World War.237 This population as a resident in the Obstetrics and

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: of Medicine noted in its tribute that “he growth, coupled with a new counted it his greatest achievement that Gynaecology Department at Toronto acceptance of hospital births, General Hospital, subsequently joining he had been able to foster the careers of a created increased demand the teaching staff. His casebooks provide 234 large number of his younger colleagues.” for hospital services. a glimpse of Obstetrics at the hospital. One of those young colleagues was Marion Hilliard. At the start of her career, Despite a declining national birth The casebooks document a shift in pain he advised her against seeking a junior rate, by the late 1930s Toronto was management; most public obstetric averaging over 10,000 births annually position in Obstetrics and Gynaecology at patients now received some form of and 75 per cent of these occurred in pain relief. This was generally a mixture Toronto General Hospital: “Even if you 238 medical centres. Although part of of ether and chloroform, but for a could get it, don’t. You’d be the last flick of a larger international shift toward small number of cases, 5mg of heroin the dog’s tail there. Go to Women’s College hospitalisation, other factors influenced was administered subcutaneously.240 Hospital and help build the department. this shift to hospital births, including However, as Goodwin’s colleague You can achieve something there.”235 This the changing attitudes among Leslie Watt admitted, “The quality wealthier private patients, hospitals’ seemingly pragmatic advice was a tacit of anaesthesia during the ‘30s was increasing reputations due to decreased indifferent to say the least.”241 endorsement of the hospital’s entrenched mortality rates, the development discrimination against women and ethnic of prenatal programs, and better Caesarean section rates posed a risk minorities (particularly Jews). Hendry, access to pain relief in labour.239 of infection until the introduction of as the top dog flicking that tail, never

| MAVERICKS, COLLABORATORS VISIONARIES, AND once appointed either a female or Jewish doctor to his department. At retirement age, Hendry stepped down as chair and chief at Toronto General Hospital.236

46 Toronto General Hospital Repeat Caesarean sections were also considered risky at this time. As a result, over 40 per cent of these procedures were combined with tubal ligation (at Toronto General between 1925 and 1939).247 At a time when “there was a veil of silence over contraception,” as Watt put it, satisfying patients’ desires for effective birth control may have played a role.248 Though various methods of birth control were widely used (and this was the chief factor in the declining national birth rate), both contraception and therapeutic abortion remained technically illegal Dr. James Clifford Goodwin until 1969, and many women had to Toronto Western Hospital (1902–1953) resort to self-induced abortion or poorly trained abortionists.249 According to Goodwin’s casebooks, complications sulfa drugs in the late 1930s (and then from abortion or incomplete abortions The University of Toronto Department Street. Stowe-Gullen was a consultant penicillin after the Second World War). were the most common cases on the of Obstetrics and Gynaecology faculty and delivered the hospital’s very first In fact, the last outbreak of puerperal public gynaecology ward at Toronto members were primarily composed of baby.253 Toronto Western Hospital became sepsis at Toronto General Hospital’s General Hospital.250 W.G. Cosbie, a staff Toronto General Hospital Staff between affiliated with the University of Toronto Burnside unit was in 1924, resulting obstetrician, noted in 1940 that over the wars. Besides the chief (Hendry), in 1912, offering clinical teaching in in the deaths of seven patients from a 10-year period, “1,710 women were both of the subsequent chairs, Scott Medicine, Surgery, and Gynaecology.254 streptococcal septicemia.242 Despite admitted with abortion,” of whom 40 and Van Wyck, were on staff there. The Obstetrics and Gynaecology such risks, by the late 1920s, the died. He further noted that across the Frederick Marlow and K.C. McIlwraith Department was overseen by A.A. Caesarean delivery rate at Toronto country, “undoubtedly the number of were longstanding members, while other MacDonald, but R.W. Wesley became General Hospital was relatively high: reported deaths from abortion is only a staff members included W.G. Cosbie, chief there in 1919.255 In 1924, clinical 5.78 per cent in 1930, compared to fair percentage of the actual number.”251 W.A. Dafoe, and J.C. Goodwin. The 1930s teaching in Obstetrics was offered and

the national rate of roughly 2 per cent also included Nelson Henderson, Leslie the following year a new obstetrical TORONTO OF UNIVERSITY of hospital births.243 Contrary to wider Watt, John Mann, and J.R. McArthur. wing was added.256 In 1926, Toronto trends, which saw the rate for Canada The staffing (hiring) bias against Western Hospital also amalgamated rise to 5 per cent by the late 1940s, women, Catholics, and Jews was still with Grace Hospital, which had been conservative efforts at Toronto General deeply entrenched at the General.252 operating as a homeopathic hospital at Hospital led by W.A. Scott (who also Huron and College since 1893.257 (This pioneered the introduction of the lower hospital should not be confused with the segment method of Caesarean delivery Toronto Western Salvation Army’s Toronto Grace Hospital & GYNAECOLOGY OBSTETRICS in Toronto) significantly reduced their Hospital at Bloor and Church.) These expansions operation rate.244 By 1938, it had fallen made Toronto Western Hospital-Grace to 1.7 per cent although for private Toronto Western Hospital had a similarly the busiest obstetrical service in the patients at Toronto General Hospital, the homogenous staff profile. Initially the city by the late 1920s, overtaking St. rate was 7.4 per cent245 (Doctors earned hospital was organized in 1896 by a Michael’s Hospital and Toronto General more from performing a Caesarean group of local west end doctors, which Hospital. The annual number of deliveries section than a vaginal delivery, included Ann Augusta Stowe-Gullen, the jumped from 419 in 1924 to 1688 just which was a motivating factor.)246 first woman to graduate from a Canadian five years later.258 In 1936, another large medical school. In 1899, the hospital extension opened at Bathurst Street, 47 moved to its present location on Bathurst 259 Dr. Frederick W. Marlow and the Grace division was closed. Robert Watson Wesley (1885-1962) St. Michael’s Hospital As his obituary in The Globe and oversaw the department at Toronto Mail noted, Francis Joseph O’Leary Western Hospital throughout this time. Certain figures dominated Obstetrics and (1891–1952) “was almost synonymous After graduating from the University of Gynaecology at St. Michael’s Hospital with that of St. Michael’s Hospital.”267 Toronto in 1909 and setting up practice between the wars. Just like Wesley at Like Frawley, he was from Orillia and on Palmerston Avenue, he became Toronto Western Hospital, Nicholas D’Arcy initially qualified as a pharmacist associated with Toronto Western Hospital Frawley (1884–1969) had a remarkably before returning to the University of and was appointed to the University long reign as chief. He graduated Toronto to study medicine. After his of Toronto faculty as an assistant in from the University of Toronto in 1906, serious injury at Passchendaele in 1917, Gynaecology in 1914. After 27 years then interned at several hospitals in he returned to his medical studies, as chief, he stepped down in 1946, New York State. Back in Toronto, his graduating in 1922 and completed two Sister Vincentia (1888–1958)

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: remaining a consultant for several practice became increasingly centred on years of specialty training at the New years.260 (In the 1950s and ‘60s, his son Obstetrics and Gynaecology, and in 1916, York Women’s Hospital, after which he Nicknamed both Vinnie and “Beads” by R.H. Wesley was also an obstetrician he became chief gynaecologist at St. was taken on the teaching staff at St. nurses and interns due to the rattle of at Toronto Western Hospital and later, Michael’s Hospital. Obstetrics remained Michael’s Hospital.268 As O’Leary’s friend her rosary as she strode down the halls, the chief at Sunnybrook Hospital from in the charge of M.M. Crawford until Robert Meiklejohn described him, he she was feared and respected for her 1971 to 1983.)261 Wesley Senior’s 1920, when both services were combined was “short, stocky, rumpled, with bushy exacting thoroughness.273 “She was a long-time colleagues included Kent under Frawley.264 He became an assistant eyebrows and the map of Ireland written tyrant,” one of her last trainees recalled. Manning and S.J.N. Magwood. Magwood professor in 1926 and only retired in over his face… the complete antithesis “Even the doctors were at her mercy. But (1884–1975) was a 1906 MB graduate 1947 because of university age limits.265 of the elegant, urbane obstetrician.”269 she still had a great sense of humour who had subsequently trained at the Between 1928 and 1934, Frawley saw the He was estimated to have delivered at and cared about all [our] patients, Rotunda Hospital in Dublin and at St. annual number of births at St. Michael’s least 3000 babies but served as chief staff and anyone who walked through Michael’s Hospital. After serving with Hospital double to 1324 – second only for only five years, retiring in 1951 our doors.”274 One doctor described the CAMC in France during the First to Toronto Western Hospital-Grace.266 and being succeeded by Noonan.270 her as “a giant cannon that fired World War, he joined the staff at Toronto Though his main achievement seems marshmallows, not shells” – for which Western Hospital, retiring around the to have been a tenacious tenure, his O’Leary must have been thankful!275 same time as Wesley.262 In the 1930s, legacy includes leaving a strong staff Sister Vincentia: Still She continued working up until two L.T. Armstrong, A.D.T. Purdy, and D. contingency, most notably William Striding Down the Halls years before her death in 1958.276 Cannell joined the staff as well.263 T. Noonan and Frank O’Leary. Perhaps the most well-known staff member at St. Michael’s Hospital Sister Vincentia’s legacy at St. Michael’s was not a doctor, but rather a nurse: Hospital continues to this day, at least

| MAVERICKS, COLLABORATORS VISIONARIES, AND Sister Vincentia (1888–1958), the for the staff who claim to have seen nursing supervisor of the Obstetrics her ghost in the halls of the Cardinal and Gynaecology Department. Between Carter wing’s 7th floor. Chuckie Shevlen 1928 and her retirement in 1956 she trained as a nurse at the hospital oversaw 60,000 births, and trained in the early 1960s, then became the 18,000 student nurses.271 She trained nursing coordinator for Obstetrics and at St. Michael’s Hospital in 1922 before Gynaecology and later the hospital’s completing postgraduate study at director of mission and values. Reports of University of Toronto in public health the ghost begun about the time Shevlen nursing. Sister Vincentia worked in started working on the gynaecology ward northern Ontario with the Victoria Order in the mid-60s: “She will appear in the of Nurses (VON) and the provincial night, faceless and dressed in all white. Health Department before taking her She will briefly touch a person’s arm and vows with the Sisters of St. Joseph in then offer that person a blanket.”277 1925. In 1928, she was assigned to the 48 obstetrical ward at the hospital.272 St. Michael’s Hospital Mount Sinai Hospital 1953, Louis J. Harris (1922–2012), was chief of Obstetrics and Gynaecology.290 In September 1922, the 30-bed Toronto He entered the University of Toronto at Jewish Maternity and Convalescent the age of 16, studying Biological and Hospital opened at 100 Yorkville Medical Sciences before proceeding to Avenue. It was the result of an study Medicine, where he graduated at intensive fundraising campaign led the top of the class of 1929.291 As chief by the Ezras Noshem, a “Ladies’ Aid” following Benjamin Cohen’s death in society of prominent Jewish women.278 1951, Harris played a key role in Mount The hospital was managed by Dorothy Sinai’s first research efforts, and he Dworkin, a trained midwife who had spearheaded the hospital’s work on been instrumental in earlier efforts infertility, as well as Ely Ravinsky’s to establish health services catering first forays into fetal monitoring in the to Toronto’s Jewish community.279 late 1950s.292 As Frederick Papsin, his In the preceding decades, this Dorothy Dworkin (bottom row, centre). Photo credit: eventual successor as Chief, recalled, community grew enormously from Ontario Jewish Archives “Lou Harris was a brilliant individual the influx of largely Yiddish-speaking and an excellent gynaecologist, as was immigrants from Eastern Europe, his partner, Dr. Bernard Ludwig, and recalled a scheme whereby, during public example, in the mid-30s, it granted numbering almost 35,000 by 1921 they and others in the department had tours of the hospital, the staff would get admitting privileges to a black doctor in a city of half a million.280 a huge following in the community… into the empty beds and pretend to be named Morrison, who practiced on No one could touch them in terms satisfied patients on a bustling ward.281 Bathurst Street.285 Around the same of numbers and the quality of their The need for a specifically Jewish time, two female physicians joined work.”293 Indeed, Ludwig was probably hospital had long been recognised. In theory Jewish students’ access to the associate staff of Mount Sinai’s Toronto’s most prolific obstetrician At existing Toronto hospitals, Jewish medical education was guaranteed Hospital department of Obstetrics ever. When he retired in 2008 after 58 patients faced discrimination from staff, under law (University of Toronto had and Gynaecology.286 Bertha Wilensky years at Mount Sinai Hospital, he had often compounded by a language barrier, to accept all qualified applicants who graduated from the University of delivered more than 20,000 babies.294 and access to kosher meals was difficult. resided in Ontario), but on rotations Toronto Faculty of Medicine in 1929, As a result, few Jews were willing to seek they faced intense anti-Semitism, and subsequently training in New York hospital treatment, and even when the were tacitly barred from internships at and New Jersey. Although she initially Throughout Harris’ tenure, the new Jewish hospital opened, it struggled any of Toronto’s hospitals. Practicing worked in Obstetrics and Gynaecology department and hospital remained to attract patients. Dorothy Dworkin Jewish doctors were also denied at Mount Sinai Hospital, she eventually pointedly neglected by the University. In TORONTO OF UNIVERSITY attending privileges, and often had specialised in Internal Medicine, and 1953, to prepare for affiliation, the new to hand over the care of their most joined the staff of both Women’s College hospital organized residency programs serious cases.282 From the outset, the Hospital and Toronto Western Hospital.287 in Surgery, Medicine, and Obstetrics new hospital struggled financially and Rose Abramowitz Lahman, also known and Gynaecology, while expanding and 295 in 1923, control was largely transferred as Rose Abron, received her MD from retraining its staff. Yet negotiations with the University were stymied

from the ladies of the Ezras Noshem to the University in 1932. After working & GYNAECOLOGY OBSTETRICS Toronto’s Jewish medical community. at Mount Sinai Hospital, she moved to until the new dean of Medicine, John The fledgling institution was reorganized Atlanta with her husband, where she Hamilton, took office in 1962. That year, under the new name of “Mount Sinai continued to practice as a specialist the hospital’s Medicine Department, Hospital.”283 As the range of services in Obstetrics and Gynaecology and under Mitchell Kohan, became the first 296 expanded, Benjamin Cohen, one of only Endocrinology well into her 80s.288 fully affiliated teaching department. two specialists on staff initially, was However, it would not be until 1967 made the hospital’s very first chief After the war, the hospital developed on a that the Department of Obstetrics and of Obstetrics and Gynaecology.284 new site on University Avenue, following Gynaecology succeeded in achieving 297 a gift from the steel magnate, Samuel the same status. At the end of the Mount Sinai Hospital located Mount Sinai Hospital was relatively Lunenfeld.289 By the time the “New 1960s, Harris retired, and in early 1971, 49 at 100 Yorkville Avenue progressive in its staffing. As an Mount Sinai Hospital” opened in August Papsin came from Toronto Western Rowena Hume led the Obstetrics service from the hospital’s beginning in 1911. Jenny Gray Wildman, an 1892 graduate of the same school, led Gynaecology when it was reorganized as its own service in 1920.306 From 1926, Marion Grant Kerr led both services, and was joined two years later by her protégé and eventual successor as chief, Marion Hilliard.307 In 1936, the hospital moved from its site on Rusholme Road to a

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: new building on Grenville Street.308

Another hospital in the city provided St. Joseph’s Hospital c. 1920 Dr. Les Watt, Chief at North York dedicated Obstetrics and Gynaecology General Hospital from 1965–1972 care to the growing city: the Salvation Army’s Grace Hospital. Known as the by a group of nuns after their return Hospital to lead the Department as it Toronto Women’s Hospital until 1936, from nursing British and Canadian gynaecological surgery but remained revolutionised over the next decade.298 when it took the name “Grace” from soldiers wounded during the North- a dedicated maternity hospital.310 By the recently closed division of Toronto West Rebellion led by Louis Riel.300 It 1925, 6000 babies had been born there Western Hospital, the hospital first began moved to its Major Street location in and that same year a new wing was Other Toronto as a rescue home for unmarried women 1889, and with 30 beds (10 for public added, increasing the number of beds in 1889. In 1905, it became a maternity Hospitals patients), it was the city’s first hospital from 35 to 55 (only 20 of which were on hospital, and in 1909, moved from Esther Although the University Department’s dedicated to treating female patients, the public ward).311 In 1938, 745 babies Street to Bloor and Church streets to clinical teaching remained centred on the and focussed on surgery.301 One of the were born at the hospital and by the late offer maternity care to married women above three hospitals until the 1950s, staff surgeons in the 1920s and ‘30s 1940s, annual births were over 2500.312 as well.309 From 1924, it also provided Obstetrics and Gynaecology care was was R.V.B. Shier, a 1909 University of available at several other unaffiliated Toronto MB graduate (who was also the North York General Hospital celebrated hospitals throughout the growing city. father and grandfather of two prominent its 50th year of service to women For instance, in 1921, the Sisters of future members of the Department).302In in 2018, with the founding Chief of St. Joseph founded another Catholic 1937, the Sisters opened a convalescent Obstetrics and Gynaecology, Dr. Les

| MAVERICKS, COLLABORATORS VISIONARIES, AND hospital in west Toronto. St. Joseph’s hospital on Cummer Avenue in North Watt starting the department in 1968 Hospital was initially set up in a wing York. (This institution eventually by recruiting a handful of talented of an orphanage in Sunnyside, formerly amalgamated with Sunnybrook in physicians from the downtown hospitals. run by the Sisters. In 1925, renovations 2012 as St. John’s Rehab.)303 Their At that time, North York General Hospital on the site expanded it from 25 beds convent remained at Major Street, but serviced the outer suburbs of the city to 112, and another major expansion the surgical hospital did not.304 In the of Toronto before the construction of in 1931 increased the bed capacity early 1950s, the Sisters moved to North the 401 highway, in an era when the to 300, adding dedicated obstetrical York and the Major Street site was Yonge subway line ended at Eglinton facilities as well. As the city grew and re-established as Doctor’s Hospital.305 station. Currently, there are 18 the population of the west end expanded, Obstetrics and Gynaecology staff with another addition in 1949 would double While Women’s College Hospital was an average of 5,800 births annually. the number of beds to 600.299 not the first hospital in Toronto devoted to women’s health, it remained the Community-affiliated hospital teaching The Anglican Sisters of St. John the only hospital in the city where female centres developed in parallel at Divine also ran St. John’s Hospital on physicians and surgeons could practice both Toronto East General Hospital 50 Major Street just north of College. The independently. An 1899 graduate of Women’s College, 76 Grenville (now Michael Garron Hospital) and small hospital was established in 1885 the old Trinity College medical school, St, demolished in 2016 at St. Joseph’s Health Centre. Scott: More than a Wartime Caretaker

associate in Obstetrics and Gynaecology. Scott, like many other senior physicians In 1929, he was promoted to assistant at Toronto hospitals, stayed in his post professor, and then chair and chief when until the end of the war to free up as many Hendry stepped down in 1935.314 doctors as possible for military service.320 Indeed, he seems to have deferred making He soon appointed Leslie Watt to his significant changes in training during department, with whom he helped the war in order to avoid creating a establish the travel club that eventually disadvantage to the students and junior became the Canadian Gynaecological doctors in uniform.321 During his 11- Society. 315 He was also influential in the year tenure, Scott established joint clinics formation of the Society of Obstetricians at the Institute of Radiotherapy, which and Gynaecologists of Canada (SOGC) and focussed on the radiologic treatments of 316 served as president in 1945. As Cannell pelvic lesions, tumors, and abnormalities TORONTO OF UNIVERSITY Dr. William Albert Scott (1885–1960) recalled, Scott was a “very capable” of female physiology, and shared this chair. “He was a very competent, active knowledge with countless undergraduates. William Albert Scott (1885–1960) entered gynaecological surgeon as well as [a] the University of Toronto medical school slightly impatient obstetrician… He was Scott retired in 1946, and was succeeded by in 1909 and was the gold medallist of the interested in getting on with the labour his long-time colleague at Toronto General 1913 class, after which he was appointed and delivery and he would sometimes Hospital, H.B. Van Wyck. Together, & GYNAECOLOGY OBSTETRICS to a clinical post at Toronto General stimulate both of these.”317 In fact, Scott they authored the foundational textbook, Hospital. By 1915, he had an appointment had done some early research after the The Essentials of Obstetrics and Gynecology, at the Faculty of Medicine and was in First World War on the use of “pituitary published in 1947. During his tenure, charge of the outpatient Obstetrics and extract” for the induction of labour.318 Scott oversaw the continued growth of the Gynaecology Department at Toronto Department, the discovery of the Ferguson General Hospital.313 After serving in While Cannell noted that Scott was not reflex, the pioneering radiological work England with the No. 4 Canadian General simply a wartime caretaker, his tenure of Cosbie and McArthur, and guided Hospital during the First World War, Scott as chair was dominated by the Second the Department through the prolonged 51 worked closely with Chair Hendry, as an World War. 319 As part of a wider policy, disruptions of the Second World War.322 The Impact of WWII outbreak of war, he initially commanded of Toronto General Hospital’s nurses the No. 7 Cavalry Field Ambulance, where and nursing graduates served during one of his subordinates, John Mann, the war, as did 107 from St. Michael’s was a former colleague. The unit was Hospital and roughly 70 from Toronto attached to the 5th Armoured Division, Western Hospital.337 However, the labour and soon shipped out to Europe.330 shortage was particularly acute with By 1944, Watson was a colonel and support staff. As the war economy assistant director of medical services ramped up, high-wage industrial jobs for the 3rd Canadian Division. He lured away many of the poorly paid 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: was reputedly one of the first medical orderlies, laundry workers, and janitors. officers on Juno Beach on D-Day during In 1942 alone, Toronto General Hospital the Normandy Invasion.331 Several experienced a 100 per cent turnover obstetricians also enlisted with the Navy, among its non-professional staff.338 including J.R. McArthur, who served as a reserve officer, and George Hendry, who However, the disruptions of the war perished when the HMCS Ottawa sank started to erode some of the anti- in 1942.332 One Toronto General Hospital Semitism of the Toronto medical resident, A.L. Payne, also interrupted establishment. Thirty Jewish physicians Victory in Europe Day (VE Day) celebrations on Bay Street, his training to join the British Royal associated with Mount Sinai Hospital, Toronto, May 7, 1945 Navy. He served on a destroyer in the as well as roughly 100 Jewish medical Mediterranean, notably seeing action at graduates from Toronto, all served in the Second Battle of Sirte in 1942, where the armed forces during the war.339 When war broke out in General Hospital. Several members a British squadron escorting a convoy to Their service, and the horrific anti- September 1939, Toronto of the Department of Obstetrics and Malta warded off a larger Italian fleet.333 Semitism of the regime against which doctors, nurses, and medical Gynaecology, such as Cannell, joined the country had fought, made it difficult students rushed to join up. up immediately.326 This time, faculty Meanwhile in Toronto, almost every for the discriminatory pre-war policies In the first week alone, 42 of members who wished to serve overseas hospital experienced significant labour to continue. Until shortly after the war, the medical and nursing staff were rotated to avoid putting a strain shortages. Despite the shortened only three Jewish medical graduates at Toronto General Hospital on the remaining faculty back home.327 internships, the hospitals struggled to would be accepted each year for junior 323 | MAVERICKS, COLLABORATORS VISIONARIES, AND enlisted in the armed forces. Cannell was sent back to Toronto fill junior positions. As R.W. Wesley, chief internships at the teaching hospitals, Western Hospital in 1944, taking over the at Toronto Western Hospital, reported in and none for specialty training or staff The MD program at the University of reorganized Venereal Disease clinic.328 1944, “Graduate training came almost positions. Yet the end of the war marked Toronto was quickly replaced with an to a standstill during the early years of a generational shift as so many of the accelerated version to provide medical Elsewhere in the Royal Canadian Army the war.”334 Obstetrics and Gynaecology older and more overtly discriminatory personnel to the military. Internships at Medical Corp (RCAMC), several Toronto seems to have particularly struggled. At senior faculty retired, including the hospitals were similarly shortened physicians took on important roles Toronto General Hospital, Scott had to department heads such as W.E. Gallie, from one year to eight months.324 By in other units. Bill Noonan, who later accept graduates from other provinces Duncan Graham, and W.A. Scott.340 June 1945, 1512 faculty members became chief at St. Michael’s Hospital, and even Americans (as opposed to and graduates of the Faculty of served with the No. 24 Canadian General any of the many female graduates of While no woman would be appointed Medicine had been commissioned in Hospital before being assigned to the the University’s own medical school).335 to the Obstetrics and Gynaecology the armed forces – almost a third of Canadian Military Headquarters in Nurses were also hard to secure. By Department until Geraldine Maloney all Canadian medical officers.325 London.329 Melville Clarence Watson, a 1942, Toronto General Hospital was in 1947 (right after Scott had retired), 1922 University of Toronto graduate and operating with “a constant shortage the war did provide more opportunities Just as in the First World War, the a staff obstetrician at Toronto General of 45 to 50 nurses” and several floors for female physicians. With so many 52 Faculty of Medicine mobilized a Hospital, also served with particular of the private patient’s pavilion had male graduates serving in the military, hospital unit: the No. 15 Canadian distinction. A reserve officer at the to be closed for a time.336 In all, 227 and the hospitals struggling to fill During the Second World War, Ferguson joined the Royal Canadian Air Force junior positions, several departments (RCAF), and conducted research on in the teaching hospitals appointed respiratory physiology and the effects of women. Marjorie Davis, for example, high altitude. He also directed the design was accepted as a resident in surgery of emergency equipment for aircrews, at Toronto General Hospital in 1942. She recalled that “all the younger [male] and was awarded a Most Excellent Order surgeons had gone to war and [Gallie, of the British Empire (MBE) in 1945 for the Dean and chief surgeon at TGH] was his role in developing a new oxygen mask short of any person to be the resident that did not freeze up at low temperatures 341 who had any degree of training.” (Davis and pressures.350 His research pertaining would go on to be chief of surgery at to Obstetrics and Gynaecology had a Women’s College Hospital.)342 From 1942, Dr. James Kenneth Wallace Ferguson (1907–1999) with a crisis in manpower, the RCAMC significant impact on the field. Working also began accepting women as medical with rabbits, he identified what came officers for the first time, and many (such to be known as the “Ferguson’s reflex,” as Maloney), served with distinction.343 The Ferguson Reflex where cervical dilation stimulates the secretion of oxytocin. This discovery was While postgraduate positions began One of the most significant discoveries in crucial to understanding the dynamics to open for Jewish and female medical the history of Obstetrics and Gynaecology of the second stage of labour and the graduates, it became more difficult at the University of Toronto was published for students wishing to enter the MD effects of epidural anaesthesia, which in September 1941 – not by a member program at the University of Toronto at can block these reflex pathways.351 the end of the war. The proportion of of the Department but by an MD- women entering the MD program at the trained researcher in pharmacology. At the end of the war in September University had increased significantly 1945, Ferguson was appointed chair of during the war. In 1939, only seven out After studying Biological and Medical the Pharmacology Department, where of 148 first-year students had been Sciences at University of Toronto, women.344 Yet in 1944, the admissions he focussed on addiction research and

followed by an MA in Physiology in TORONTO OF UNIVERSITY committee reported that “this year developing drugs to treat alcoholism. we have had to admit 37 women” as 1929, James Kenneth Wallace Ferguson He would reportedly test these well as 31 Jewish students (three of (1907–1999) enrolled in the MD program compounds on himself and his friends whom were women). “That means and became good friends with Charles at home after drinking martinis.352 that women plus Jews constitute Best of insulin fame.347 He graduated in almost 45% of the class.”345 After the 1932 and interned at Toronto General In 1955, he stepped down as chair to war, with the increased demand for & GYNAECOLOGY OBSTETRICS Hospital.348 As a National Research places from returning servicemen, become director of the Connaught Medical the current practice of accepting all Council Fellow the following year, he Research Laboratories at the University qualified residents of Ontario gave undertook further physiology research of Toronto, and played a key role in the way to a more selective process. This at the University of Cambridge with development and introduction of polio new system instituted quotas limiting Sir Joseph Barcroft. He continued his the percentage of women and Jews vaccines, as well as vaccines for rubella and research at the University of Western 353 to 10 per cent, which unfortunately whooping cough. He retired in 1972 but Ontario and Ohio State University, before persisted as a policy until the 1960s.346 he remained active in the Pharmacology returning to the University in 1938 as Department for many years afterwards. assistant professor in the Department 53 of Pharmacy and Pharmacology.349 Hospital, which in 1920 also became the McArthur continued refining a combined The Use of Radiotherapy University’s Department of Radiology.360 approach of radiotherapy and limited While popular, radiotherapy also met surgery, particularly for cervical cancer.365 Two prominent members of the with deep resistance and skepticism Cosbie was so well known in this field Department spearheaded the use of from many surgeons. Indeed, before in the early 1950s that he was asked to radiotherapy in treating gynaecological effective methods of early diagnosis, attend to the First Lady of Argentina, Eva cancers in the 1930s. In collaboration most cases of genito-urinary cancer Perón. He apparently did so in secret at with the pioneering radiologist presented at an already advanced stage, the Mayo Clinic in Rochester, Minnesota, Gordon Richards, the work of Waring and survival rates for both surgery and though he was ultimately unsuccessful and Gerald Cosbie (1894–1987) and John 361 366

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: radiotherapy remained relatively low. Perón later died from cervical cancer. Robertson McArthur (1907–1964) Yet Cosbie was an early enthusiast of was decisive in moving from the the latter’s potential, even declaring Throughout the Cannell era, McArthur reliance on radical surgery.354 in 1931 that radium had consigned and Cosbie remained central figures in surgery “to the realm of history.”362 the Department and at Toronto General Cosbie studied medicine at the University Hospital. McArthur bequeathed $114,000 of Toronto, graduating in 1915.355 The following year, Cosbie and Richards to the University to fund research in He served with great distinction as a were joined by J.R. McArthur, who Obstetrics and Gynaecology in 1964.367 medical officer on the Western Front had graduated in medicine from the Cosbie retired his professorship in 1954, and was awarded the Military Cross University in 1932. After interning at though he remained active on the teaching for his bravery at Vimy Ridge.356 After Vancouver General Hospital, he returned staff at Toronto General Hospital and as the war, he joined the Department and to Toronto for specialty training at medical director of the Ontario Cancer the staff at Toronto General Hospital. Toronto General Hospital. He also Treatment and Research Foundation. He While his earliest research focussed on undertook further study abroad, visiting was succeeded in the latter role by Cannell stillbirth and infant mortality, from 1928 major cancer centres in New York, when he retired as chair in 1965.368 After Cosbie collaborated with Richards, Paris, Stockholm, and Berlin, as well as retiring, Cosbie became a dedicated studying the use of radiotherapy in gaining membership in the Royal College medical historian, publishing a history Gynaecological Oncology.357 From 1932, of Obstetricians and Gynaecologists of Toronto General Hospital in 1975.369 he also collaborated with the Department | MAVERICKS, COLLABORATORS VISIONARIES, AND (England). On his return to Toronto in of Radiology in studying the use of 1937, he was appointed to the teaching thorotrast (ironically, a highly carcinogenic staff at Toronto General Hospital, with a compound) for obstetrics diagnosis.358 focus on Gynaecological Oncology.363

After the Curies’ discovery of radium By the late 1940s, detection techniques in 1898, and Henri Becquerel noted its had improved markedly. Although the potential medical applications, radiation Papanicolaou test (Pap smear test) was therapy quickly come into vogue. In developed in 1928, vaginal smears were Toronto, it was first offered in 1907 at a not routinely used in Toronto at that private clinic on Bloor Street, run by the time. (In 1947 a simplified procedure nephew of the University’s first dean of was developed by Marion Hilliard and a medicine.359 In 1917, Richards returned screening clinic was set up at Women’s from war service in Greece to establish a 54 College Hospital the following year.)364 Dr. John Robertson McArthur (1907–1964) radiology department at Toronto General With better early detection, Cosbie and Van Wyck: Bringing Breadth and Depth

Hermon Brookfield Van Wyck (1890–1952) was a brilliant classics scholar who was offered a teaching position by Victoria College when he graduated in 1911, but he turned his attention to studying medicine instead.370 At the end of his final medical school year he enlisted with the No. 4 Canadian General Hospital and was shipped off to England.371 He served for the duration of the war at Salonika and subsequently at Basingstoke, where he offered patients lessons in French 372 grammar. Following his discharge Van TORONTO OF UNIVERSITY Hermon Brookfield Van Wyck (1890–1952) Wyck undertook postgraduate training at Toronto General Hospital in Obstetrics and Gynaecology, and was subsequently appointed the Department’s first research fellow in 1921. He led the hospital’s new Metabolic Unit and for the next & GYNAECOLOGY OBSTETRICS decade, he oversaw the research of this unit on toxaemia and the management of pre-eclampsia, collaborating with the Department of Pathological Chemistry.373

Van Wyck worked closely with Scott, co- authoring a textbook on Obstetrics and Gynaecology (spelt “Gynecology” for the 55 American market).374 When Scott stepped 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

down as chair in 1946, the University of linked to hemolytic disease of the fetus and Toronto appointed Van Wyck to succeed newborn, and in 1946, in collaboration him. The University also elevated the with the department of Bacteriology, the Department’s status within the Faculty of Department (particularly Donald Low) Medicine to be on a par with Medicine began conducting prenatal blood tests for and Surgery. By all accounts a brilliant public ward patients at the three university educator, Van Wyck focussed chiefly on hospitals. Within a year, the study had university work during his four-year tenure expanded to six other Toronto hospitals, as chair, and quickly reorganized the covering all private patients as well. By undergraduate curriculum.375 His successor, 1950, roughly 30,000 tests had been Douglas Cannell remembered him as “a completed, and the findings proved crucial very excellent lecturer,” particularly helped in refining treatments and prenatal care in by his background in classics.376 Van Wyck cases of blood group incompatibility.379 also set the precedent for the chair of the | MAVERICKS, COLLABORATORS VISIONARIES, AND Department to be “geographic full-time” In July 1950, Van Wyck retired while (that is, having clinical work and private continuing to give lectures on the role of practice curtailed and capped).377 Moreover, the humanities in medicine.380 In 1952, he made the first moves to integrate the Dean of Medicine’s report noted: “not Obstetrics teaching across the various often does the medical profession produce university-affiliated hospitals, laying the men of such stature, such brilliance, groundwork for the organisation of the and such versatility. Doctor, teacher, “Cannell course” after his retirement.378 writer, artist, musician, and philosopher – of no one can it be more truly said As chair and chief at Toronto General that he ‘adorned’ his profession.”381 Hospital, he oversaw key research in the postwar years, particularly an in- 56 depth study of the Rhesus (Rh) factor in Toronto. In 1940, the Rh factor had been Cannell: The “Cannell Course”

Douglas Edward Cannell (1902–1979) once remarked that the untimely death of his teen brother motivated his decision to study medicine.382He graduated in 1927 – the last year that the degree of Bachelor of Medicine was awarded by the University. He was in the same class as Marion Hilliard, and they remained good friends.383

Cannell figures prominently in the history of the University of Toronto’s Department of Obstetrics and Gynaecology. As

chair of the Department from 1950 to TORONTO OF UNIVERSITY Dr. Douglas Edward Cannell (1902–1979) 1965, his extended tenure was second only to Adam Wright’s 25 years as head of Obstetrics at the turn of the century. The key achievement during Cannell’s 15 years was the development of Canada’s first university-based & GYNAECOLOGY OBSTETRICS postgraduate program in Obstetrics and Gynaecology, which trained a generation of national leaders in the field and laid the foundation for the Department’s international excellence today.384

In many ways, Cannell’s own postgraduate training mirrored the program he 57 eventually established as chair. At the time, even those wishing to specialise in July 1940, and Cannell remained with six months of pathology, then six months Obstetrics and Gynaecology after their them as a surgeon until July 1942, when he of low-level Obstetrics and Gynaecology. internship, generally only did six months’ was given command of the No. 2 Casualty The second year was comprised of six- training in each area, and usually all at Clearing Station. This unit was soon tasked month rotations in Medicine and Surgery, the same hospital. Cannell had decided to with treating casualties evacuated after and the last two years included six-month specialise in Obstetrics and Gynaecology the abortive raid on Dieppe in August.388 rotations in Obstetrics and Gynaecology.394 after taking a summer course in Obstetrics at Case Western University in Cleveland In 1944, the University recalled Cannell Crucially, the rotations included all of just before his final year.385 However, he to Toronto Western Hospital to take up the university-affiliated hospitals. Van

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: first completed a one-year fellowship in his teaching duties again. This was part of Wyck had organized the program before Pathology at the University of Toronto, the Army’s policy of rotating doctors who retiring, but his plan was centred on earning a BSc. for his work on cardiac served overseas.389 Such patriotic service Toronto General Hospital.395 Cannell tissue degeneration in cases of yellow fever. was quite valuable for one’s career, as it wanted to standardize the training at all After a rotating internship at Toronto would prove to be for Cannell. When Van of the university hospitals, as well as the General Hospital, he then returned to Wyck stepped down as chair in 1950, his training future appointees received.396 Cleveland and trained under Arthur heir apparent at Toronto General Hospital James Goodwin, who was mentored Bill and William Weir, two prominent was Nelson Henderson. Staff at the other by Cannell and his successor Bill Paul, American obstetricians of the time. A teaching hospitals had never before been recalled: “One thing that Cannell used year later he returned to Toronto General considered for the top position. However, to do, he’d go around – and this was Hospital for a year in Surgery, then spent Henderson had not served during either something the Professor had never done another year as a resident in Cleveland.386 war, and the new Dean of medicine, before – he’d attend rounds at places like After five years of specialty training plus Joseph MacFarlane, had served in both.390 the East General Hospital, and he’d go his general internship and pathology In fact, before going on to oversee to the St. Michael’s, and he’d go to St. fellowship, Cannell returned to Toronto Canadian military hospitals throughout Joseph’s, and he’d go to the Western … around 1934, at the height of the Europe, the Dean had been Cannell’s He brought the fold in, which was a great Depression and without a job. He began immediate superior in the No. 15.391 thing to do.”397 (While there was still a doing general surgery at various hospitals, mindset of drawing in the other hospitals

| MAVERICKS, COLLABORATORS VISIONARIES, AND and became associated with the Grace To some degree, because of this personal to Toronto General Hospital, Dr. Walter Hospital, where he set up a perinatal clinic. connection, Cannell was appointed chair Hannah would later break with the In July 1939, he joined the staff at Toronto in 1950, also transferring from Toronto tradition of the chair of the Department Western Hospital, and was appointed to the Western Hospital to become chief at also being chief at that Hospital.) Faculty of Medicine as a demonstrator.387 Toronto General Hospital. Cannell attributed his appointment to the extensive Hannah completed the Cannell Course With the outbreak of the Second World training he had received, and his first in 1961 and recalled being interviewed War just a few months away, Cannell move as chair was to establish a similarly by Cannell for a spot in the program. immediately joined up with the No. 15 extensive postgraduate program for When Hannah explained that he wanted Canadian General Hospital. He went ahead Toronto. 392 In the 1930s, and again after the to take the course because he loved of this unit to England, and was attached to war, a formal postgraduate program was Obstetrics but was anxious about his the 1st Signals Division, where he mainly established in Surgery by W.E. Gallie.”393 relative ignorance, “the whole tenor dealt with motorcycle and car accidents. In what soon became known as the of the interview changed… Until that 58 The No. 15 finally set up in England in “Cannell Course,” residents would take time, he’d been very gruff and brusque in his manner, very formal. But he just Dr. William “Bill” George Whittaker, warmed up immediately, and it was clear our most senior Alumnus in 2018 that I’d given a very adequate answer to at 91 years old, addressing the be admitted to the program.”398 Douglas resident graduating class of 2017 Gare, a resident during Cannell’s last at Hart House, University of Toronto. years as chair, found him to be a quiet, Bill graduated with an MD at the intensely modest person, though his University of Toronto in 1950, and silence and restraint often inspired subsequently was a “Cannell Club” nervousness: “He was intimidating, resident at Toronto Western and though also shy deep-down.”399 General Hospitals, 1954-1959. Bill subsequently opened his Cannell also held some deeply ingrained practice in Brampton in 1961, and prejudices. During his tenure, there was the first staff Obstetrician- was no admissions committee, only Gynaecologist at Peel Memorial the kind of one-on-one ordeal that Hospital, Brampton. He retired as Hannah underwent. Getting admitted Department Chief in 1991 to spend into the residency program was entirely his summers travelling and at his Cannell’s personal decision, and it is cottage on southern Georgian Bay. telling that in 15 years, he accepted just one woman (Carol Cowell).400

Cannell was widely respected, especially by those physicians he had mentored. He was an excellent teacher, and very skilled in handling breech deliveries and in the use of forceps. He also fostered a great deal of research, particularly in the area TORONTO OF UNIVERSITY 401 of fetal physiology. Upon retiring as Award. He served as president of the honour. The group’s membership reflected chair in 1965, he succeeded W.G. Cosbie Society of Obstetricians and Gynaecologists the affection they felt for their mentor as medical director of the Ontario Cancer of Canada (SOGC) in 1960, was made and the tremendous impact he had on Treatment and Research Foundation, an Honorary Fellow of the Royal Obstetrics and Gynaecology in Canada coordinating fundraising and clinical Society of Medicine (London) and of from mentoring so many prominent & GYNAECOLOGY OBSTETRICS 402 oncology research until retiring in 1975. the Royal College of Obstetricians and obstetricians. Following his death the Club Gynaecologist (England). In 1973, he was endowed an annual lectureship, which For this work and his leadership of the also awarded an Honorary LLD by his began in 1982 and continues to this day Department, he was internationally alma mater, the University of Toronto.403 under the joint auspices of SOGC, the admired, receiving many honours Association of Academic Professionals in including the Canada Medal, the When he retired in 1965, the almost 100 Obstetrics and Gynaecology of Canada University’s Sesquicentennial Medal, alumni of the Cannell course formed “the (APOG), and the University’s Department and the Royal College of Physicians and Cannell Club,” which met at the SOGC of Obstetrics and Gynaecology.404 59 Surgeons of Canada’s Duncan Graham annual conference, with a dinner in his to gain the qualifications of LRCP and stepped down the following (London) and MRCS (England).407 year when her department finally affiliated with the University.413 This Hilliard returned to Toronto in 1928 process was similarly followed by and was appointed assistant to Marion Surgery in 1957, Medicine in 1959, Grant Kerr, the chief of Obstetrics and culminating in full teaching hospital of Gynaecology at Women’s College status in 1961, the 50th anniversary Hospital. Before this appointment, of Women’s College Hospital.414 Kerr was the only obstetrician on the hospital’s staff, and the two departments Following the Second World War, the were not combined until 1935.408 Hilliard volume of obstetrics at Women’s College

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: would spend the rest of her career there, Hospital increased with the “baby boom”. apart from further training in Hungary Hilliard averaged almost 50 deliveries in 1934 focussed on female fertility a month, and in 1953, her department treatments.409 She succeeded Kerr as handled 2800 births without a single chief at the hospital in 1947, and was maternal death.415 Over the course of instrumental in the establishment of the her career, she witnessed the hospital’s Cancer Detection Clinic the following move from a pair of cramped houses year. This clinic was the first of its kind on Rusholme Road to a new facility at in Canada, focussing on early screenings its present location on Grenville Street, and check-ups and specialising in a and she oversaw the growth of her simplified version of the Pap test that department into one of the busiest and Hilliard had helped to develop with most well-regarded in the country.416 pathologists at the Banting Institute.410 Besides her clinical work, Hilliard Hilliard headed the hospital’s Obstetrics was an internationally popular author and Gynaecology Department from 1947 and columnist, though much of this to 1956 and spearheaded their affiliation writing was done in collaboration with the University of Toronto. Hilliard with a ghostwriter (June Callwood). In had long cherished the goal of Women’s magazines and several best-selling Dr. Anna Marion Hilliard (1902–1958) pictured College Hospital becoming fully affiliated books, Hilliard discussed relationships, with Dr. Jessie Gray with the University as a teaching women’s health, and her own | MAVERICKS, COLLABORATORS VISIONARIES, AND hospital. Plans to seek affiliation were experiences.417 Although the moral tone rejected by hospital staff in 1935 and of her advice was generally conservative, 1947 over fears of jeopardizing the it was ground-breaking due to her frank, hospital’s independence.411 However, public discourse on sexual matters. She Hilliard: A Wide Spectrum of Care Hilliard persisted throughout the was deeply religious, even entertaining 1950s, encouraged by Cannell and an early ambition to go overseas as a the University’s Dean of Medicine, missionary. Yet her singular devotion No figure looms larger in the She then enrolled in Medicine, Joseph MacFarlane. In fact, she was was to Women’s College Hospital, modern history of Women’s graduating in 1927 alongside Cannell.406 so convinced that affiliation was vital demonstrated by her active fundraising College Hospital than Anna Deciding to specialise in Obstetrics that she was willing to step down as and donations from the sale of her Marion Hilliard (1902–1958). and Gynaecology after interning at chief. (The University required heads books.418 A fellowship at Women’s College She first studied science Women’s College Hospital in her final of teaching departments to be Fellows Hospital was established in her honour at Victoria College, where year, Hilliard undertook postgraduate of RCPS, Canada, and Hilliard did not in 1958, and years later, a school she became lifelong friends training in the UK at Queen Charlotte have this distinction.)412 Consequently, was named after her in Scarborough, with Maryon Moody, the Lying-In Hospital in London and at the she recruited Geraldine Maloney from close to where she once lived.419 60 future wife of Prime Minister Rotunda Maternity Hospital in Dublin. Toronto General Hospital in 1955, Lester B. Pearson.405 She was the third Canadian woman Maloney: Paving the Way Forward

Over a pioneering medical (Nurses in the RCAMC also held officers’ career of more than 30 commissions, though generally of lower years, Geraldine Maloney rank.) Initially tasked with examining (1906–1985) was a remarkable recruits for the Canadian Women’s groundbreaker for Canadian Army Corps (CWAC), she was later women in medicine. promoted to major and charged with directing all medical services for women She was the first woman to advance in the Army. In April 1944, she went to a senior internship and residency at to England to study the British Army’s St. Michael’s Hospital, the first female demobilisation plans.424 While there, physician commissioned in the Royal she was “bombed out” by one of the Canadian Army Medical Corps (RCAMC), very first V-1 bombs, or “doodlebugs”, the first woman to become a Fellow of launched by the Germans targeting the Royal College of Surgeons of Canada British cities.425 She returned to Canada in Obstetrics and Gynaecology, the and helped organize army hospitals for first woman appointed to a permanent female service members and veterans. staff position at a university-affiliated teaching hospital, and the first woman After leaving the army in 1945, Maloney Dr. Geraldine Maloney (1906–1985) to receive a senior faculty appointment undertook a further two years of in the University of Toronto’s Department specialty training at Toronto General of Obstetrics and Gynaecology.420 Hospital.426 In 1947, she passed her fellowship exams, the first woman to do at Women’s College Hospital formally He described a particularly heroic case of affiliated with the University of Toronto hers where an improperly referred patient Maloney graduated with an MD in 1937, so in the newly instituted specialty of as a clinical teaching centre and turned out to have a placenta accreta. followed by a two-year internship at Obstetrics and Gynaecology.427 In 1947, Hilliard stepped down at the end of “As Dr. Maloney began to dilate the St. Michael’s Hospital.421 The hospital in another pioneering achievement, she the year to conform to the University’s cervix, she was greeted by a torrent of had been accepting one or two women joined the full-time teaching staff at requirement that teaching staff hold blood as if someone had turned on a tap annually as junior interns from the early Toronto General Hospital, becoming the Royal College fellowships in their at the top end of the vagina.” While the

1930s but in 1938, Maloney became the first woman appointed to the permanent TORONTO OF UNIVERSITY specialty. Maloney succeeded her.430 patient was prepped for surgery, Maloney first to proceed to a senior internship. clinical staff of a Toronto teaching and several nurses personally donated She then undertook specialty training hospital, and the first full-time female While the department at Women’s College blood and the operation, 14 blood bags in Obstetrics and Gynaecology at St. member of the University’s Department Hospital was strong under Hilliard, as later, was ultimately a success.433 Michael’s Hospital (another first), and at of Obstetrics and Gynaecology.428 (Helen the historian Edward Shorter notes, it the Royal Postgraduate Medical School MacMurchy had been appointed a junior “evolved into a powerhouse” during In 1961, Maloney broke with Women in London, before joining the hospital demonstrator in 1911, but this was

Maloney’s tenure from 1957 to 1966, College Hospital’s longstanding & GYNAECOLOGY OBSTETRICS staff and entering private practice.422 not a permanent faculty position.) particularly as the clinical teaching tradition of “female physicians only”, by program matured.431 With university appointing Drs. Hannah and Moore.434 In In July 1942, the RCAMC opened its At Toronto General Hospital in the affiliation, men had also begun training 1966, she stepped down as chief, with ranks to female physicians due to a late 1940s and early 1950s, Maloney as residents at the hospital for the first Hannah succeeding her and breaking shortfall of 600 doctors, far more than undertook research into cytological time – including the future Department with another tradition of the hospital. Canadian medical schools could fill smears, assisted by Crawford Shier.429 chair, Walter Hannah, in 1960. As Hannah Maloney continued on as a consultant with new graduates. Maloney signed In 1955, she was recruited to Women’s recalled, “Dr. Maloney was an excellent at the hospital and focussed on her up immediately, becoming the first College Hospital by Marion Hilliard surgeon and someone who spared gynaecology practice.435 She left an woman to receive a commission as a as associate chief in charge of the nothing to ensure that her residents incredible legacy, and an unsurpassed physician in the RCAMC, with the same new teaching program. In 1956, the received excellent surgical training.”432 model, for subsequent physician leaders. 61 rank and pay as her male comrades.423 Obstetrics and Gynaecology Department Paul: Lecturer Extraordinaire 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

The brief tenure of Bill Paul (1924–2006) In 1962, Paul took up the chair of as chair of the Department was in some Obstetrics and Gynaecology at the ways an extension of the Cannell era. The University of Alberta as well as heading the residency program continued to flourish Obstetrics and Gynaecology Department and the Department’s commitment at the University Hospital in Edmonton. to research intensified, aided by the In Alberta, he sought to cultivate a similar generous bequest of J.R. McArthur.436 focus on research, hiring Jim Goodwin and even attempting to lure Hannah Born in Toronto, Paul was considered a away from Toronto.439 Frustrated with the brilliant student, graduating in medicine stubbornness of his colleagues’ refusal to from the University of Toronto in 1947. He contribute to research, Paul readily accepted completed a one-year fellowship in anatomy the offer of the chair at the University of at the University with J.C.B. Grant, Toronto upon Cannell’s retirement in 1965. renowned for Grant’s Atlas of Anatomy.437 Goodwin followed two years later, joining | MAVERICKS, COLLABORATORS VISIONARIES, AND Dr. William Paul (1924–2006) In 1950, Paul began the residency program the staff at Women’s College Hospital.440 in Obstetrics and Gynaecology in the first year of its establishment by Cannell. As chair of the Department, Paul continued After completing this training, he then to support and promote research. He hired took up a McLaughlin fellowship to Goodwin back from Edmonton and also study fetal physiology at the Carnegie hired Goran Enhorning, who subsequently Institute in Baltimore, followed by another pioneered the use of surfactant treatment fellowship in anatomy at the University of for neonatal respiratory distress syndrome.441 Illinois. In 1956, he returned to Toronto Paul was widely adored by his students and as a full-time faculty member on staff colleagues. Douglas Gare was chief resident at Toronto Western Hospital, where he at Toronto General Hospital when Paul continued his physiology research with returned from Alberta. He was struck by 62 sheep, fostering collaborations with the Paul’s brilliance as a lecturer: “He would departments of Anaesthesia and Medicine.438 even throw away his notes so as not to Cowell: Pioneer of Paediatric Gynaecology

in the departments of Obstetrics & Gynaecology, Paediatrics, and Paediatric Surgery. Cowell founded the Division of Paediatric and Adolescent Gynaecology, a novel concept at that time, with the only comparable unit being led by Sir John Dewhurst at Queen Charlotte’s Hospital in London, UK. Cowell’s units was one of the first in North America to recognize the unique clinical needs of adolescent girls. Under her leadership, a generation of national leaders were trained in a subspecialty that addressed become repetitive, to make it fresh the next After completing her residency adolescent contraception, pregnancy, year,” and students would actually make at the University of Toronto, abortion, and a number of gynaecologic medical and surgical disorders.446 an effort to attend the same lecture twice. Carol Cowell (1938–2011) became the first and only female member of the Lisa Allen, the current head of the When Paul stepped down as chair in 1970, “Cannell Club,” as well as the SickKids Hospital division, commenced the publication list for the Department had very first chief resident in her own staff career at SickKids in grown considerably. Paul returned as chief Obstetrics and Gynaecology 1998, in Dr. Cowell’s Cowell pre- to Toronto Western Hospital, where he felt at Toronto General Hospital.444 retirement years. She noted that Cowell’s achievements were “a big at home and proved to be very effective.442 deal because Paediatric Gynaecology Derek Nicholson was hired on staff at Dr. Cowell then undertook postgraduate training, initially in pathological was considered to mostly be a surgical Toronto Western Hospital by Paul after chemistry and endocrinology. In 1970, specialty and she was a woman and completing his Obstetrics and Gynaecology she traveled to study childhood health that wasn’t an easy thing to do at that 447 residency training and fellowship exams and development with the renowned time.” Indeed, as a colleague Dr. TORONTO OF UNIVERSITY in 1975. As he recalled, “when you’re chief British Paediatric Endocrinologist J.M. Jerry Shime recalled, Cowell “had to fight against a very male atmosphere of the department, often you’re a good Tanner at the Institute of Child Health there… To get operating room time administrator, or a really nice guy, or a and Great Ormond Street Hospital in London.445 (Previously, while studying was like battling a giant. The chief of brilliant clinician, or a fabulous researcher. 448 medicine at the University of Alberta, surgery just made her life difficult.” Paul was all of those things. He was Cowell had crossed paths with Dr. Bill soft-spoken, an incredible administrator, Paul, whom she would later marry when As a founding member of the North & GYNAECOLOGY OBSTETRICS clinically superb, and he had been doing he subsequently moved to the chair of American Society for Pediatric and Adolescent Gynecology, Cowell was research…He was very unique as a chief.”443 Obstetrics and Gynaecology in 1965.) instrumental in developing the scope Paul went on to serve as associate dean In 1970, Cowell became the first of the subspecialty, particularly for Institutional Affairs Sciences in the woman in Canada to receive a five-year through her pioneering research. Some Faculty of Medicine at the University. $50,000 Canada Life Medical Research of her research is still commonly Fellowship, funding her research on cited, according to Allen. “She did adolescent development. She returned work on abnormal bleeding and the tendency to be admitted to hospital in 1971 to SickKids Hospital and Toronto 63 General Hospital, with appointments in adolescence – her work is still considered one of those foundational papers.” Additionally, Cowell is remembered as a world authority on Turner syndrome. By connecting two former adolescent patients with this condition, Marg and Meli, she sparked their collective efforts to establish the “Turner Syndrome Society of Canada”.449

By 1979, Cowell had become an associate professor of Obstetrics and

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: Gynaecology, yet despite her extensive advocacy, subspecialty clinical work and research, she was reluctant to pursue promotion to full professorship. When Shime encouraged her, she replied that she had been told repeatedly over the years not to bother since at that time no female member of the Department had ever been promoted to full professor. (In the much larger Department of Medicine, just two women had been promoted to full professor in the prior decade). When Cowell finally became the first female full professor of Obstetrics and Gynaecology at the University of Toronto, it was celebrated, and well overdue!450

Cowell retired in the late 1990s, honored with a party held by the Toronto chapter of the Turner Syndrome Society of Canada. She subsequently received the | MAVERICKS, COLLABORATORS VISIONARIES, AND lifetime achievement award from the Ontario Medical Association in 2008.451

Besides her internationally recognized work in Paediatric and Adolescent Gynaecology and her commitment to girls’ and women’s health, Cowell was fondly remembered as a deeply caring physician, especially by her many patients with Turner syndrome.452 She died tragically following a car accident in 2011.

64 Harkins: Introducing Transparency

In the late 1950s and ‘60s, Harkins co- Shime as the first program director in authored publications with Nelson 1971, as well as setting up an admissions Henderson and Terry Doran.455 However, his committee.459 Previously, admission had focus was on pedagogy, and this may account been at the sole discretion of the chair. for the lack of emphasis research was given This key change into a transparent process during his chairmanship.456 Jerry Shime, ensured that more women and visible Harkins’ future colleague at Toronto General minorities would be admitted, where Hospital, first encountered him as a lecturer. previously they had been almost entirely He recalled Harkins being “a real gentleman. excluded from advanced training.460 He would always give an excellent, well- prepared lecture to the undergrads.”457 During Harkins’ reign tensions developed between Women’s College and Toronto

Harkins was appointed chair when Paul General Hospital, which increased when TORONTO OF UNIVERSITY stepped down as chair of the University Women’s College Hospital secured Canada’s John Leonard Hugh Harkins (1922–1994) Department and chief of Obstetrics and first Regional High-Risk Perinatal Unit Gynaecology at Toronto General Hospital in 1981, beating out proposals from both John Leonard Hugh Harkins (1922–1994) in 1970. Harkins’ appointment was a Mount Sinai Hospital and Toronto General had been a student in the University’s recapitulation of the Department’s previous Hospital. However, this setback led to first prewar medical class, graduating in alignment with Toronto General Hospital. advances in other areas of research and & GYNAECOLOGY OBSTETRICS 1950.453 After interning at St. Michael’s The appointments of Cannell and Paul had practice. Shime, for example, subsequently Hospital, Harkins was one of the select been a deviation from tradition as both led the development of Obstetric Medicine few to be accepted into the newly were associated with Toronto Western as a subspecialty in Toronto with Gerald established Cannell course. He completed Hospital prior to becoming chair. While Burrow and Carl Laskin.461 In 1981, Harkins his residency training in 1955, and took chair, Harkins contributed to the redesign was succeeded as department chair by the further training at the University of of the curriculum and the redevelopment chief of Women’s College Hospital, Walter Buffalo. In 1957, he joined the teaching of the undergraduate admissions process.458 Hannah. Harkins remained on staff at staff at Toronto General Hospital, where he He also instituted a significant reform Toronto General Hospital for several years. 65 would remain for the rest of his career.454 to the residency program, appointing Hannah: Rejuvenating Research 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

Walter Hannah (1927–) graduated from the there was little assistance if something University of Western Ontario Medical went wrong, which often happened School in 1953 and subsequently did his in the middle of the night. Hannah internship at Toronto Western Hospital. He contributes the “many anxious middle- then joined a general practice in Milton, of-the-night experiences”, where he was Ontario, where he would be exposed “unsure what to do” as the driving force to everything from appendectomies to behind a decision to pursue the four-year Caesarean sections. The doctors and postgraduate studies under Cannell.463 nurses worked out of a residential home that had been transformed into a modest Hannah spent his second year of the hospital of 12 beds. Being at that time program at the Boston-lying-in Hospital an agricultural region, the farmers and before returning to Toronto for the last their families offered a wide variety of two years. He incorporated some of the clinical cases. Hannah recalls that he found knowledge acquired there upon returning | MAVERICKS, COLLABORATORS VISIONARIES, AND Walter Hannah (1927–) obstetrics in particular, very rewarding, to Toronto, including the treatment of but the set-up in the house was not ideal, preeclampsia with magnesium sulfate, the as patients had to be carried up and down application of intravenous oxytocin, and a the stairs, from the operating room back new skill set in forceps use. Boston Lying- and Gynaecology (succeeding Geraldine to their beds. During that time, nurses in Hospital also had a major shortcoming Maloney). Hannah chose Women’s administered anaesthesia, and it was typically in Hannah’s view. “They did everything College Hospital (he had been offered comprised of chloroform and ether, which by the book; there was no room for positions at other Toronto hospitals as was problematic, as chloroform functioned individual initiative” and no demonstrated well) because he felt the Obstetrics and to relax the uterus. This could, and often acknowledgement or practice concerning Gynaecology Department would be did, lead to excess blood loss. Hannah the uniqueness of each presenting case.464 given a high priority and would likely recalled that this was an unfortunate, grow in distinction. Hannah (and Donald but not uncommon occurrence.462 One of Hannah’s rotations was at Women’s Moore, the other male physician), felt 66 College Hospital, and he joined the staff quite welcome despite the unorthodoxy Another challenge was the clinical in 1961, where he would become chief of being the first male clinicians at the isolation of the practice, which meant that resident, and in 1966, chief of Obstetrics hospital. As Hannah pointed out: There was remarkably little hostility...but I famous line: “There’s no place for the could imagine what it was like for women, state in the bedrooms of the nation”.467 going into an all male hospital. This was sexism in reverse in a way. We were doing As chair of the University of Toronto’s something that women had been doing for Obstetrics and Gynaecology Department, decades: women had to work in an all-male Hannah’s goal was to strengthen research and environment, and having a lot of trouble his efforts helped to significantly reinvigorate with it....we were more fortunate and were the weak record of departmental research well-received by the women staff.465 at that time. This was no easy feat. Eight of the 11 years in which he was chair, the In 1967, construction started on a new departmental budget was reduced rather labour and delivery wing of the hospital than increased. In 1993, he called upon and this was soon accompanied by a plan to his fellow clinicians to divert some of their incorporate a new perinatal intensive care earnings to create the new Genesis Research unit, which opened in 1970. (This created Foundation. They raised an impressive a strong clinical advantage as newborns $400,000 to support and grow clinical and no longer had to be transported routinely basic research. By 1992, the foundation to the Hospital for Sick Children.) had supported 12 projects with 19 more Frederick R. Papsin (1931–2003) approved.468 His efforts started a legacy of Physicians were also on shaky legal ground continued emphasis on active and sound in 1967 when progressive legislative changes Following his completion of postgraduate research in Obstetrics and Gynaecology, were initiated regarding the performance of training in Vienna and in London, Papsin supported by clinician’s earnings. Hannah therapeutic abortions. Hannah recalled it as held the vision of developing an excellent went on to serve as president of the Society of being “one of his most controversial moments undergraduate teaching and residency Obstetricians and Gynaecologists of Canada as chief of department”.466 Women’s College training program. To achieve this he (SOGC) from 1988–89. He retired in 1992 Hospital had performed 12 therapeutic utilized renowned teachers such as Bernard and in 2006 he was awarded the Lifetime abortions in the prior year, as reported at a Ludwig, Abe Eisen, Abe Bernstein, and Jack Achievement Award by the Ontario Society TORONTO OF UNIVERSITY staff meeting. This information was in no Shuber together with new recruits, Paul of Obstetricians and Gynaecologists (OSOG). way considered scandalous as these abortions Bernstein, Fred Engle, and Fred Mandel. were performed in most neighbouring hospitals too, but was leaked to the press. Papsin: Residency Training With a growing number of patients the The resulting media attention led to changes Begins at Mount Sinai Hospital teaching experience became outstanding. He in the legislation which put physicians on chanelled a proportion of staff earnings into & GYNAECOLOGY OBSTETRICS firmer legal ground and no longer in fear of Very few departments of obstetrics and a fund to support research which was the breaching the criminal code. While it was an gynaecology have achieved national and forerunner of an early practice plan. Thus unnerving, albeit short episode in Hannah’s international stature in such a short space the academic foundations were laid over career prior to becoming the Obstetrics of time as Mount Sinai Hospital and a decade before the high-risk pregnancy and Gynaecology chair at the University in much of the groundwork was laid in the unit was established in conjunction with 1981, it seemed to echo his own enlightened early years. Only coming on stream as a large neonatal intensive care unit in the approach to serving women’s health and a teaching hospital in 1971, Fred Papsin mid-1980s and the opening of the Samuel was appointed as chief with a remit to promoting choice. When thinking back on Lunenfeld Research Institute in 1984. 67 that time, Hannah cited Pierre Trudeau’s establish an academic department. Ritchie: Recruitment and Integration 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

J.W. Knox Ritchie (1944–) graduated from Ritchie set about delivering the full the Medical School at Queen’s University, potential of these resources. He began Belfast in 1968 and was subsequently initially as Head of Maternal-Fetal appointed senior house officer at the Royal Medicine (MFM) developing the first high- Maternity Hospital in Belfast, the hospital risk perinatology clinic at Mount Sinai in which he was born. Ritchie then went Hospital, where previously the hospital to Rhodesia, Zimbabwe, to complete his had been handling overflow cases from Obstetrics and Gynaecology residency Women’s College Hospital. He recruited in 1970 (followed by a MRC research two highly-successful perinatal researchers, fellowship in fetal physiology under Drs’ S. Lee Adamson and Stephen Lye, to Geoffrey Dawes at the Nuffield Institute at work at the Samuel Lunenfeld Research Oxford). After receiving his MD thesis he Institute, as full members of the hospital returned to Belfast, eventually becoming a department of Obstetrics and Gynaecology. consultant at the Royal Maternity Hospital. In 1988, he progressed to become chief | MAVERICKS, COLLABORATORS VISIONARIES, AND J. W. Knox Ritchie (1944–) of Obstetrics and Gynaecology following In 1984, Ritchie was recruited to the Fred Papsin. Under Knox’s leadership, University of Toronto by Walter Hannah Mount Sinai Hospital became one of the and felt compelled by the possibilities: first hospitals to institute an in-house, on- call system for consultants. “At that time, Part of the reason for coming was that private practice was quite competitive. I realised that Toronto was a medical You could directly bill the patient. So I powerhouse. I mean, you had these three think the catalyst [for the introduction major teaching hospitals all sitting looking of the on-call system] was when the at each other on University Avenue… and Federal Government said no, you can’t they all had research institutes and were do that anymore.” There was also an growing rapidly… SickKids was probably unwritten rule that if you were on-call the outstanding one then. But what I 68 realised was that they were very young and saw someone else’s patient, you would in their academic pursuits, in particular not accept them as your own patient, 470 in Obstetrics and Gynaecology.469 if they asked for you in the future. Ritchie was appointed chair of the Ritchie also led the politically challenging University of Toronto Obstetrics and move to finance academic growth by Gynaecology Department in 1992, while instigating a city-wide practice plan continuing as both head of the division policy whereby obligatory taxation of of MFM (until 2000) and as chief of faculty earnings was used as a steady Obstetrics and Gynaecology at Mount income stream to support the broad Sinai Hospital (until 2003). Ritchie academic mission. Ritchie recalled that skillfully navigated the University of implementing this policy was one of his Toronto Department through a period of most difficult decisions as chief at Sinai, and economic downsizing and organizational certainly was not popular. His approach shifts in the provincial health care sector was supported by the chief’s at Women’s and in the University environment. Despite College and at St. Michael’s, which aligned shrinking provincial funds, and motivated Obstetrics and Gynaecology with larger by necessity, Ritchie led the restructuring departments at the University, especially of the Obstetrics and Gynaecology service Medicine and Surgery. As a consequence, down to three teaching hospitals (from the specialty gained significant respect at six) in the mid-1990s, and initiated the the Decanal level472 and at the hospital. amalgamation (in 2000) of the Obstetrics Dr. Mary Hannah: and Gynaecology programs (together with After 11 years of service as department Maternal, Infant and services in neonatal paediatrics, perinatal chair, Ritchie left the combined roles genetics, and obstetric medicine) at of chair and Sinai Chief in 2003, and Reproductive Health Toronto General Hospital and Mount Sinai continued to practice perinatology at Research Unit (MIRU) Hospital on the “Sinai side” of University Mount Sinai Hospital, together with a Avenue. At this juncture he appointed newly-developed role as Departmental In 1988, Dr. Mary Hannah, a Maternal- Mathew Sermer as the inaugural head of Ombudsman until 2012. Throughout his Fetal Medicine specialist and perinatal a newly-merged Maternal-Fetal Medicine post-leadership period, he often commented epidemiologist at Women’s College Division. Starting as the largest such on how impressed he was by the incredible Hospital, began a journey to form one of TORONTO OF UNIVERSITY clinical group in Canada, from its outset it expertise of the emerging faculty across all the most highly-regarded clinical trials provided 24/7 in-house staff coverage for sites in Toronto that he had the privilege units worldwide. Following initial pilot high-risk pregnancy services. Dr. Ritchie of training, recruiting, and ultimately funding, and an external search, by July also decided to set a higher academic working alongside.473 In 2012, Ritchie 1990 Dr. Hannah assumed directorship bar at Sinai for new appointees; Ritchie was recruited to Penang Medical College of the Perinatal Clinical Epidemiology OBSTETRICS & GYNAECOLOGY OBSTETRICS recalls, “We wouldn’t take anybody on staff in Malaysia as professor of Obstetrics and Unit. Two of the unit’s early successes unless they undertook a relevant graduate Gynaecology to lead their undergraduate were the post-term trial (NEJM 1992) degree, had completed fellowship training, teaching program. For the next four years, and the term PROM trial (NEJM 1996). or been away for further experience.”471 he combined this role with extensive The intent of the new recruitment policy travel in South East Asia. In 2015, he was By 1995, the unit moved to 790 Bay was to promote growth and diversity in admitted as an honorary fellow of the Royal Street, renamed at the Maternal, Infant academic medicine, a strategy that would College of Physicians in Ireland for services and Reproductive Health research unit subsequently have a long-standing positive in medical education. In 2016, he retired (MIRU) at the new centre for Research impact on the trajectory of the department. to combine living between Tiny Beaches, in Women’s Health. With further CIHR 69 Ontario and his native Northern Ireland. funding, the term breech trial was launched in 1996, and ultimately published (Lancet 2000). This success was followed by the Nursing SCIL trial evaluating the effect of continuous supportive care in labour on the risk of Caesarean section, funded by the National Institutes of Health, USA (JAMA 2002). Dr. Hannah retired as Emeritus Professor in 2005, handing the leadership of clinical epidemiology to her Paediatric

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: colleague, Dr. Elizabeth Asztalos.

In 2010, the unit moved along with Obstetrics and Neonatal Paediatrics to Sunnybrook Health Sciences Centre and was renamed as the Centre for Maternal Infant and Child Research ( CMCIR) A major focus and legacy of MIRU has been the mentorship of junior department faculty in the design and implementation of large clinical trials, with notable examples being Dr. Kellie Murphy (MACS trial of antenatal corticosteroids, Lancet 2009) and Dr. Jon Barrett (twin birth study, NEJM 2013). Currently, Kellie Murphy (left side, front row, third person in) and the MACS International Collaborators Dr. Jon Barrett is the Medical Director Group. Participating centres in MACS were from Argentina, Bolivia, Brazil, Canada, Chile, of Clinical Trial Services (CTS), which China, Colombia, Denmark, Germany, Hungary, Israel, Jordan, Netherlands, Peru, Poland, contains the Perinatal Epidemiology Russia, Spain, Switzerland, United Kingdom, and United States of America.

| MAVERICKS, COLLABORATORS VISIONARIES, AND trials unit at Sunnybrook Health Sciences Centre, continuing the legacy created by his mentor, Dr. Mary Hannah.

In the 2002 External Review of MIRU, Dr. Hannah was described as follows: “She is one of the most influential obstetrical researchers in the world today, and she brings international distinction to your University”.

70 Bocking: Facilitating Progress and Growth

Alan Dixon Bocking (1953–) completed continue with these combined roles, his medical degree in 1977 at Western to foster harmonized growth.475 University in London, Ontario. After doing a rotating internship in Obstetrics In the month that Bocking started, he was and Gynaecology at St. Paul’s Hospital, confronted with the serious threat posed Vancouver, British Columbia, he by the outbreak of severe acute respiratory returned to Western University to syndrome (SARS) in Toronto hospitals, complete his four-year residency in a disease that posed a substantial threat Obstetrics and Gynaecology.474 to pregnant women. Bocking recalled that several staff were quarantined for the He subsequently trained in Maternal- requisite 10 days (one resident did develop Fetal Medicine, with a strong emphasis SARS), which put a lot of logistical

on fetal physiology, developed during a pressure on the remaining staff across TORONTO OF UNIVERSITY Alan Dixon Bocking (1953–) research fellowship in the Department several sites. Faculty were also instructed of Physiology, Monash University, to reduce or eliminate socializing (or Melbourne, Australia. Bocking developed having face-to-face meetings) with staff his academic career back in London, from other hospitals, resulting in the Ontario, combining a clinician-scientist cancellation of the annual Research Day career in fetal development at the and many continuing education courses. & GYNAECOLOGY OBSTETRICS Lawson Research Institute with senior administration, as chief of Obstetrics Heather Shapiro (the Residency Program and Gynaecology, 1999 to 2003. In Director at the time), recalls Bocking as 2003, he succeeded Dr. Ritchie in the being a calm, professional presence for staff. combined roles of chair and as chief Bocking was regarded as a very methodical, at Mount Sinai Hospital (including thorough, and analytical leader, with Gynaecologic Oncology at University exemplary administrative skill, who Health Network). At that time, Bocking kept his finger on the pulse of the wider 71 felt that it would be optimal for him to Department despite his many obligations: Those of us in the department felt, not the Ontario Birth Study (OBS), a robust only did we have his support emotionally, ongoing platform for translational research External Review but that he always kept up on issues in Obstetrics, which promoted integrative In the fall of 2012, the Department that may not have been that important thinking, and formally combined underwent a five-year external review to him, but where important to us. I was resources with St. Michael’s Hospital that strongly affirmed Bocking’s impressed by his quiet diligence – he and SickKids. New faculty hires were was a great model and mentor. .476 accomplishments, describing the encouraged to pursue research activities. Department of Obstetrics and Gynaecology In 2009, three sub-specialties (Maternal- Ted Brown also recalls that Bocking as “having matured into a world-class Fetal Medicine [MFM], Gynaecologic offered a strong, supportive, and steady department by many metrics”. At that

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: Oncology [GO], and Reproductive leadership presence to the Department, time, Toronto had emerged as the largest Endocrinology and Infertility [REI]) and was particularly impacted by his academic department of Obstetrics and each gained RCPSC accreditation, emphasis on fostering research across Gynaecology in Canada, with 250 primary resulting in board-certification by the full spectrum from clinical trials to appointees and 56 cross-appointees. national examination. Importantly, the fundamental science. Until this point in Ontario Ministry of Health then provided time, research in Toronto tended to exist in In the summer of 2013, Bocking handed salary funding for Canadian trainees, parallel, but separated domains, as viewed the role of the department chair to John relieving practice plan resources for other externally by impactful large randomized Kingdom, while continuing to focus his components of the academic mission. All control trials, and scientific discovery efforts on research (vaginal microbiome of these positive developments fostered in early placental development and fetal and preterm birth), advocacy in research, substantial annual growth in research physiology, all funded by prestigious integrated education and as director of submissions and attendance at the annual large CIHR grants to a small group of the Ontario Birth Study.478 He remains an Research Day. Status-only (non-clinical) investigators. Bocking saw the importance active member of the Board of Directors faculty were actively incorporated into of integrative translational medicine, and of the Maternal Infant, Child and departmental leadership. This philosophy so built on the previous endeavours of Youth Research Network (MICYRN) was aptly demonstrated when Ted Ritchie to create a more cohesive, inclusive and continues to serve as the Vice- Brown, a reproductive scientist at the department. A first step was the merger of President of the Molly Towell Perinatal Lunenfeld was appointed as Division accumulated practice plan resources (mostly Research Foundation, which funds basic | MAVERICKS, COLLABORATORS VISIONARIES, AND Head for Reproductive Endocrinology provided by higher taxation of income and translational research in Perinatal and Infertility (REI). APOG resident generated by Maternal-Fetal Medicine Medicine. During his chair tenure, training guidelines encompassed a faculty) to form a unified investment Bocking was president of the Canadian research rotation, though this was not fund, the annual proceeds of which were Association of Academic Professionals in obligatory. Bocking felt that research used to support the initial stages of trainee Obstetrics and Gynaecology (APOG). experience should be strongly encouraged. and junior faculty research. Secondly, he He continues to support the AMPATH As a champion of resident research, he facilitated new and frequent dialogue and Reproductive Health partnership at Moi directed resources as Chair towards this engagement between clinical and science University. In his honor, the Department goal and initiated a formal mentorship faculty appointees. Thirdly, as Chair he was established the Alan Bocking Travel Award program for clinical trainees.477 an ardent supporter of the Maternal Infant program, supporting trainees on exchange Research unit (MIRU) based at Women’s between UofT and Moi University. College Hospital. Finally, he worked with 72 Stephen Lye at the Lunenfeld to create health care facilities in Western Kenya, generous donations from the Purpleville AMPATH the department has been engaged in and Kimel Family foundations, efforts designing and scaling-up a number of within AMPATH extended to the launch Bocking’s legacy also includes his guidance community initiatives including mother- of sub-specialty training fellowships in of the Department in developing a major child peer support groups, called Chamas. Gynaecologic Oncology in 2012, followed focus in global women’s health. In 2007, Collaboration between departments has by Maternal-Fetal Medicine in 2018. the department joined AMPATH, the also given rise to a robust NIH-funded Academic Model Providing Access clinical research program in cervical cancer to Healthcare. AMPATH is a unique and a Maternal, Newborn & Child Health collaboration committed to developing Connections and (MNCH) Research and Innovations Team. leadership capacity in care, education Collaborations and research in sub-Saharan Africa. Over 100 learners and faculty have “Leading with Care”, AMPATH is a participated in the bi-directional The Department has maintained a long consortium of universities and academic exchange program between Canada tradition of supporting and connecting health centres that have supported the and Kenya over the past decade. Recent clinicians and researchers across the wide establishment of the Moi University School examples include Heather Millar and field of Obstetrics and Gynaecology. of Medicine in 1989 and an ambitious Julie Thorne, recent UofT Alumni HIV and Primary Care program serving of the OBGYN Residency program, As such, University of Toronto faculty are a population of 3.5 million. In 2007, who subsequently joined AMPATH as cross-appointed from the departments of the University of Toronto became the on-site team leaders. Through further Paediatrics, Medical Imaging, Medical lead institution for building capacity in the Reproductive Health Program at Moi Teaching and referral Hospital.

Bocking recalls that this initially was a trying and difficult endeavor to establish,

one that required patience and resolve. TORONTO OF UNIVERSITY Bocking hired Dr. Astrid Christoffersen- Deb as the Department’s on-site field director in 2010 and promoted Rachel Spitzer in 2010 to a unique (at that time) role as director of Global Health and

Advocacy.479 The combined efforts of these & GYNAECOLOGY OBSTETRICS three individuals embedded deeper and stronger connections between Toronto and Western Kenya. As examples, the collaboration has fostered the introduction of protocol-based care in obstetrics, a cervical cancer screening and treatment program and family planning integration Preparing for a Gynecologic Oncology case at Moi University, Eldoret, Kenya. Drs. Peter Itsura (left) and within chronic medical care. Since most Elkanah Omenge Orango (right) with Dr. Al Covens (centre), Head, Division of Gynecologic Oncology, 73 maternal deaths still take place outside University of Toronto. Education Food Security Income Security Happiness Family Hope Health Care Sustainability Housing

Minist ry of H ealth

Academic Partners PopulationP MTRH Health Nourishment GOK Moi University AMPATH HIV/NCD Screening CHW CHWC Communities RFP GISHE Groups

Community Insurance CHW Groups 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: ZURI

CHW ms Progra County Health FacilityAMRS MOH/AMPATH CDSS FLTR Methodology

MNCH CHW Trust Efficiency Gathering Data Equity CHW Research Integrity Collaboration Embracing Change

This Strategic Learning Map® visual is a product of Root Inc., Sylvania, OH 43560 www.rootinc.com DOWA01-005_030816 ©2016

AMPATH’s population health strategy in which attention to Reproductive, Maternal, Newborn, Child and Adolescent Health is central. | MAVERICKS, COLLABORATORS VISIONARIES, AND

From left to right: Dr. Julia Songok, Moi University Lecturer, Dr. Rachel Spitzer, Vice Chair, Global 74 Women’s Health and Advocacy, Dr. Astrid Christoffersen-Deb, AMPATH Field Director, Dr. Caitlin Bernard, Team Leader 2015-16, and Dr. Julie Thorne, Team Leader 2018-19, in Eldoret, Kenya. Biophysics, Physiology, Laboratory Medicine and Pathobiology, and beyond, Welcoming Midwifery to the Dalla Lana Faculty of Public into the Community Health including the Institute of Health of Practice Policy, Management and Evaluation (IHPME). Internationally, the Department Ontario families often had the support of enjoys many connections in addition neighbours, relatives, or community lay to it’s comprehensive global maternal midwives during a homebirth until the and newborn health efforts in Kenya. slow decline of this birth choice through to Researchers and Educators have active the 1950s, a time when midwifery barely collaborations across the world, including: survived the growing trend of hospital North America, Asia, Europe and the births (which aligned with new social UK, Israel and the Middle East, Australia norms in that regard).480 Contributing and New Zealand. As an example of to the disappearance of homebirths was worldwide connections, over 150 Alumni Dr. Mathias Gysler (1949–2018) the decline in community networks have graduated from our MFM Fellowship (especially in newly-constructed urban since it’s inception nearly 30 years ago. settings) and the concerted opposition of the medical profession that was primarily in 1987. As an accomplished infertility focussed on maternal safety, intent on Mississauga Academy specialist and renowned pelvic surgeon, consolidating the substantial success of Gylser was appointed Chief of Obstetrics reducing the risk of maternal mortality. of Medicine & Trillium & Gynaecology at Credit Valley Hospital Health partners: from 2000–2005, and subsequently named Slowly midwifery resurfaced in the late Dr. Mathias (Matt) Gysler as Chief of Medical Staff from 2005–2011. 1960s fueled by the women’s movement He played an instrumental role in the and a growing intolerance for a long list creation of Trillium Health Partners in of hospital practices that in some cases During Bocking’s tenure, a fourth teaching TORONTO OF UNIVERSITY 2011, and then served as the founding academy was established as the Mississauga unnecessarily “medicalized” the birthing co-Chief of Staff of THP (2011–2013). 481 Academy of Medicine, which combined experience. As a result of newfound He subsequently served as President of the clinical staff of the Mississauga General awareness and energy, in 1983 Ontario the Canadian Fertility and Andrology Hospital and Credit Valley Hospital as midwives and their supporters began Society, receiving its Excellence Award in Trillium Health Partners (THP). The meeting to advocate for Midwifery as 2017 for his contributions to Reproductive Obstetrician-Gynaecologists based at THP a recognized profession in Ontario. & GYNAECOLOGY OBSTETRICS Medicine and Science. The following is have since substantially contributed to the This movement led to the creation of taken from his Globe and Mail obituary: growth of the GTA-wide Department, the Midwifery Task Force of Ontario (MFT-O) to promote midwifery providing much-needed student teaching “Matt was a man of many trades. He raced legislation. The Ontario Association of and training of senior residents preparing cars, flew planes, and sailed boats. He Midwives and Ontario Nurse-Midwives for independent practice. Substantial credit studied, he taught, he practiced and most Association joined forces as the Association for these achievements belongs to Dr. certainly, he inspired. He was a leader and a Matias (Matt) Gysler (1949–2018) a long- role model. He believed in people’s dreams, of Ontario Midwives (AOM) with a standing member of the Department who and in helping them become realized.” strong mandate to formally incorporate 75 482 joined the staff of Credit Valley Hospital midwifery into the health care system . Even before the creation of the MFT-O, that there were many physicians who contribute to, while many of his colleagues Ontario doctors were keenly aware that dismissed the value of midwifery due to disagreed. Nevertheless Gare was able a subset of women saw the value of a this lack of quality scientific evidence.483 and willing to work with midwives in midwife-assisted birth, some of whom were the hospital environment of the 1980s to electing for homebirths. In fact, in 1980 The tragic outcome of a homebirth on support midwifery clients in hospital care. Douglas Gare at Toronto General Hospital Toronto Island (and the subsequent inquest (professor emeritus) published a piece in where Knox Ritchie testified), eventually At this time, Kathy Chu and Ray Osborne JAMA which illuminated the conflicting resulted in midwifery legislation. Both also recognized that homebirths were a and sometimes nebulous research at the obstetricians and nurses were generally reality in Toronto, and so provided on-call

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: time concerning the outcomes and safety uncomfortable with midwives, and Gare consultation to many of the pre-regulation comparing home versus hospital births. He felt that this was, in part, because of midwives when a homebirth to hospital- asserted that the lack of good data was a their ill-defined scope of practice. (He transfer was necessary. Ray Osborne major impediment to rational discussions also recalled that younger obstetricians decided to attend two homebirths as an and decision-making among health- were far more likely to be open-minded observer, in addition to attending Lamaze care providers, and he offered a fair and about the value of midwifery.) Gare was classes to gain a fuller understanding of balanced view of homebirth advocates’ an early adopter, recognizing the “best women’s needs during the natural birthing perspectives. He also acknowledged of both worlds” that midwifery could process. Similar to Gare, he was an outlier | MAVERICKS, COLLABORATORS VISIONARIES, AND

From the first midwifery graduation ceremony at Ryerson University in Toronto in 1996. Includes midwifery faculty members Mary Sharpe and Vicki Van Wagner (bottom from left), Rena Porteous (bottom right) and Judy Rogers (top left), Dr. Murray Enkin (centre) and midwifery students Donna Wood and Martha Aitkin (top centre and right). Dr Enkin, an obstetrician from 76 McMaster University was awarded an honourary doctorate for his contributions to the development of the regulated profession of midwifery in Ontario as well as his international contributions to evidence-based care in pregnancy and childbirth. who not only recognized the value of the physicians participating in homebirths.487 at hospital births. Midwives were then midwife’s role, but felt no reluctance in Consequently at this point all physicians recognized as autonomous practitioners working with them. When looking back he stopped attending homebirths with within the health care system, and Ontario recalled: “I was appalled by my colleagues midwives, and as Vicki Van Wagner recalls: hospitals could grant them practice who wouldn’t even let a woman’s husband privileges. Doug Gare was “increasingly into the delivery room, nevermind a This sanction corresponded with the doctors impressed” with their professionalism and midwife!”484 This was the rule, rather than realizing that the midwives they were working engagement at this time: “They came to the exception, as Paul Bernstein recalled: with were fully capable of managing home academic rounds, presented occasionally births independently. So although I think at rounds – and their presence lowered the physicians liked attending homebirths, it was No one was allowed in the delivery room. current C-section rate at our hospital.”489 We even had an elaborate system in the OR, not very easy to fit this commitment into their schedules. In addition, their contributions so that we could phone the husband in the Today, interprofessionalism is widely to care were not well-compensated ...but waiting room and let him know the baby was understood to be a concept that enhances born. I remember once letting a father come this same small group continued to provide patient care, quality and safety, and the in the OR….his wife was having a C-Section. access to some of the lab tests, and to full range of maternity service choices The anesthesiologist nearly killed me! We drugs that midwives needed at home births, are available at our University-affiliated are way more patient-centred now!485 such as uterotonics, which they could not otherwise access until we were legalized and hospitals. Since 2002, the Department has working officially in the hospital setting.488 held a joint annual continuing education Vicki Van Wagner, an associate conference (Refresher in Maternity professor with the Ryerson In 1991, the persistent advocacy efforts Care), led jointly with the Department Midwifery Program recalls: of the MTF-O and the AOM resulted in of Community and Family Medicine Ray Osborne and Kathy Chu were both the Midwifery Act, which was passed on and the Midwifery program at Ryerson. respectful and collaborative at a time December 31st, 1993, making Ontario the Interestingly, this conference was the sole when midwifery practice was outside of first province in Canada to regulate and survivor of the 2003 SARS epidemic, and the system and considered controversial fund midwifery as part of the health care was spawned at a 3 a.m. consult by a newly- – their professionalism made homebirth system. The Regulated Health Professions minted family physician (Milena Forte) safer. They role-modelled collaboration Act, 1991 (RHPA), thereafter included requesting assistance (from John Kingdom) TORONTO OF UNIVERSITY before collaboration between professionals midwifery as one of 23 regulated health with a difficult perineal repair at Sinai. became a buzzword. These types of professions. In 1994, almost 60 individuals professional relationships allowed midwives became the first regulated midwives in to work ‘as if’ we were part of the system Ontario, having completed the provisional and is a big part of why midwifery is so educational program. (In 1998, the College well-integrated in Ontario today.486 & GYNAECOLOGY OBSTETRICS of Midwives reported a total of 136 registered midwives and that has grown Around this time, in 1983, the College substantially since, to over 900 in 2017.) of Physicians and Surgeons of Ontario released a statement sanctioning physicians The Interim Regulatory Council on against attending homebirths and/or Midwifery (IRCM), an interdisciplinary cooperating with unofficial practitioners. In body, developed the standards, determined tandem, the Ontario Medical Association the qualifications for entry to practice, threatened disciplinary action toward and facilitated the presence of midwives 77 The Trials and Triumphs of Managing Fertility

Prior to the 19th century, barely veiled concerns that the white met a need that had not disappeared abortions in suboptimal, unsanitary fertility was in the hands of protestant population was dropping with the diminishment of women’s conditions, typically performed by Canadian women and keenly rapidly while other cultural groups legal rights. He formulated pills in his dubious individuals. The infection practiced in the form of continued to grow. In an excerpt from basement, and arranged for nurses to rate, and consequently the mortality prolonged breastfeeding, Canadian Bulletin of Medical History, distribute condoms and contraceptive rate, from unwanted pregnancy was employing the withdrawal jellies during home visits. Despite concerningly high. Dr. Morton Shulman, method, using pessaries, Physicians’ journals made unrelenting criticism from her colleagues Chief Coroner in the 1960s in Toronto vaginal douches, and reference to the decline of and religious groups, Dr. Bagshaw was recalled, “By the time I became Chief the birth rate among “the 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: numerous widely marketed instrumental in providing birth control Coroner I had had the unpleasant pills and herbal potions.490 better class of inhabitants” and and family planning options to women experience of seeing the bodies of some “Protestant families” while who were desperate for them during dozens of young women who had died as the “extraordinary fecundity” the Great Depression. At one point, the a result of these amateur abortions.”499 With names like Cook’s Cotton Root of the French-Canadians, the Compound and Sir James Clarke’s Irish, and other non-English organization was serving 25,000 clients 496 Female Pills, these offerings and immigrants moved the writers annually. Dr. Bagshaw was made a Desperate women with the financial others like them, sometimes contained to fearful speculation. In Member of the Order of Canada in 1972. means would later travel from Toronto herbs and roots that induced sum, when women from the to Montreal seeking abortions at Dr. vomiting and muscular contractions “respectable classes” sought Acceptance of birth control grew after Henry Morgentaler’s clinic, which with the desired side effect of to regulate their reproductive World War II and the resultant baby at that time operated illegally.500 expulsion of the pregnancy.491 abilities, it generated a concern boom. In the 1930s, the University of of great magnitude.494 Toronto became the first Canadian The general public and the media did not During this period, abortion was legal medical school to offer instruction on routinely concern itself with the internal during the first four months of pregnancy The 1879 court case of Dr. Emily Stowe in the use of contraception to medical hospital practices regarding therapeutic and professional abortionists were Toronto, prior to legislation, was perhaps students. However, public and medical abortions but that changed after a staff available in some regions; typically a bellweather of this new focus, and attitudes towards abortion remained member decided to share the hospital employed by married women of the while a large part of the trial challenged far more conservative. Doctors in minutes from a Women’s College Hospital wealthier classes. Because women her abilities as a female physician particular were reluctant to even see meeting in Toronto on April 10th, 1967. had some agency to limit their family and her perceived lack of skill in this patients who had miscarried, let alone Walter Hannah, chief of obstetrics at the size both pre and post-conception, the regard, the trial also cast public light to perform therapeutic abortions, for hospital, gave his routine report on the fertility rate declined. In Ontario, the rate on the covert reproductive “activities” fear of being tarnished professionally. number of annual therapeutic abortions, | MAVERICKS, COLLABORATORS VISIONARIES, AND dropped by 44 per cent between 1871 of women. This event would mark 1956 marked the first clinical testing and this was leaked to the press. In the and 1901.492 In response to this sharp the beginning of several legal twists of the birth control pill and in 1960 it autumn of that same year, Cannell and drop, jurisdictions began to criminalize and turns before eventually returning became legal in Canada. It was available four other physicians went to Parliament abortion in any trimester, and by 1892 legal jurisprudence to the realm of by prescription for strictly therapeutic to bring further attention to the nebulous all forms of perceived contraception reason, which recognized independent purposes, rather than as a birth control position obstetrician-gynaecologists became illegal across the country, reproductive rights for women. method.497 It was typically limited to were facing, asserting that they when Parliament passed Canada’s first married women with children.498 should not be treated as criminals Criminal Code. In fact, until the 1960s, Despite the restrictive changes to the for performing hospital therapeutic preventing reproduction in any form was Criminal Code in 1892, women continued Abortions also remained a part of abortions and providing contraception. deemed illegal in Canada.493 Certainly, to seek out reproductive control.495 In women’s lives, and women with “My colleagues and I have been breaking other factors contributed to this the early 1900s the Birth Control Society sufficient funds sought out the small the law long enough.” he asserted.501 restrictive legal stance on reproductive of Hamilton, also called the Parent’s number of physicians willing to rights. Physicians were unhappy with Information Bureau, operated illegally, perform the procedure for a fee. But In 1969, the decriminalization of the role (and income) that professional led by A.R. Kaufman and Dr. Elizabeth the environment for such services contraception granted Canadians the abortionists enjoyed, religious groups Bagshaw. Kaufman was primarily operated under the radar and women right to prevent pregnancy, but the new 78 began to hold sway, and there were motivated by eugenics, but his services without financial means often had legislation concerning abortion still left compassion than the scope of the law research and popularity continued in intended. Because hospital clinicians European countries. Further development worked more independently at that time, of IUDs, especially the incorporation and generally had good support from the of local progesterone delivery, and hospital administration, many physicians better epidemiologic studies, has did not care as much how they were resulted in increasing popularity perceived outside the hospital; they also of IUDs in Canada including the maintained professional collegiality management of heavy menstruation.507 with colleagues who would not perform abortions.505 Nevertheless, it could still In recognition of the fact that Canadian be a difficult position to be in, with the women spend a significant part of threat of the legal system overshadowing their lives at risk of an unintended their clinical work. Not all Hospital pregnancy, the Society of Obstetricians Therapeutic Abortion Committees were and Gynaecologists of Canada (SOGC) so compassionate and patient-centred, created clinical guidelines in 2004 which but rather, used the wording of the law formulate a Canadian contraception to apply their own conservative bias. consensus to provide health-care After years of advocacy and protest by providers with evidence-based guidelines Canadians concerned with women’s lack on a wide spectrum of options, from of access to abortion, and the limitations hormonal contraceptives to copper of the Hospital Therapeutic Abortion IUDs and emergency contraception Committee process, the time was ripe such as Plan B. Since that time more for a legal review of abortion legislation. options have appeared, for example the RU-486 pill combined with vaginal In 1988, the Supreme Court of Canada misoprostol (approved by Health Canada Dr. Emily Stowe struck down the abortion law as in 2015) has evolved to become the unconstitutional. The decision was gold standard for medical abortion in based on the violation of the Charter of Ontario, as a fully-funded choice.508 Rights and Freedoms and Chief Justice the decision to obtain a safe and legal abortions.503 With the exception of Brian Dickson declared: “Forcing a Canadian women have many more

abortion out of the hands of individual Roman Catholic hospitals, physicians woman, by threat of criminal sanction, choices for managing their fertility TORONTO OF UNIVERSITY women and within the narrow scope of on staff were trying to serve women to carry a fetus to term unless she now, and routinely arrive at the restricted conditions. Women requiring well, as Paul Bernstein recalled: meets certain criteria unrelated to physician’s office having researched abortions had to go before a hospital her own priorities and aspirations, their options to discuss with their panel of (primarily male) doctors, called We were pretty liberal at is a profound interference with a doctor. The SOGC is commended the Therapeutic Abortion Committee, Mount Sinai, and were kind woman’s body and thus a violation for its educational leadership in of like a benevolent society, which determined whether they were of her security of the person.”506 this domain (www.sexandu.ca). eligible for a legal abortion.502 The same a Jewish hospital but non- & GYNAECOLOGY OBSTETRICS denominational, and serving year, Dr. Henry Morgentaler opened his those who didn’t have care. Contraception had also undergone Paul Bernstein comments: clinic in Montreal and would later open Most terminations were enormous change, with more choices an additional clinic in Toronto in 1983. early trimester, with a few developed for women. Both the pill and They know more than I mid-trimester cases. It was the intrauterine device (IUD) underwent do. They have the time to Toronto Hospitals were now permitted pretty rare for an abortion numerous iterations. The IUD steadily really dig and dig and do to conduct abortions while trying to request in early pregnancy dropped out of favour due to concerning online research. I don’t take 504 it personally – why would I? meet demand within the permitted not to be approved. side effects of pelvic infection. A direct Of course they are interested restrictive scope of the law, and in 1975, consequence of this was that some in their own health and for example, the five Toronto downtown Clinicians often found themselves Canadian companies stopped producing it’s a positive thing.509 79 hospitals performed 7230 therapeutic applying the law with more leniency and IUDs for fear of litigation, but IUD 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS:

Moving Day Walk in the rain from Women’s College Hospital Women’s College Hospital to Sunnybrook Health Sciences Centre, 2010

for perinatal medicine. In addition, From Women’s to the absence of inpatient medical or 92 College Street Sunnybrook surgical support at Women’s College 92 College Street had a long history before Hospital raised safety concerns for becoming the home of the Department The Bocking decade was marked women with high-risk pregancies. of Obstetrics and Gynaecology. It was by uncertainties over the future of built between 1883 and 1884 as part of Women’s College Hospital. The Obstetrics & Gynaecology staff a development by Sir William Howland continued to practice gynaecology at along the north side of College Street. In August 2005, the Honourable George Sunnybrook from 2006–2010, covering The interior included beautiful woodwork Smitherman, Minister of Health and Long- emergency services at both sites. and stained glass windows. The house Term Care, set out a three-point plan to Once the move took place in 2010, | MAVERICKS, COLLABORATORS VISIONARIES, AND was purchased by Joseph Thompson, who create a state of the art academic ambulatory comprehensive perinatal services were did his own version of a house “flip” by care hospital for women and their families consolidated at Sunnybrook in the newly selling it soon after to Joseph Donovan, including a state-of-the-art facility for high- named Women and Babies Program. a barrister. Donovan and his large family risk pregnancies and critically-ill newborns. lived there for one year, selling it to Charles Women’s College Hospital, now without Hooper in September 1886. Hooper Women’s College Hospital therefore Obstetrics and Newborn services, re- was a druggist and his family would separated from Sunnybrook in 2006 after an emerged with a beautiful new building, later establish a chain of Hooper’s Drug eight year merger to become, once again, an and an ongoing deep commitment to Stores that are still in business today. independently-governed public hospital with women’s health. In 2017, the gynaecology the Women’s College Hospital Foundation. services at Women’s College Hospital In 1901, Hooper’s brother and widow amicably joined forces with Sinai Health sold the house to George B. Smith, a The Kitts report (2009) noted that the System, creating a tri-hospital program wealthy physician. Smith was born in 80 facilities at Women’s College Hospital with the University Health Network Tipperary, Ireland, and came to Canada were dated and no longer suitable Division of Gynaecologic Oncology. at the age of eight. He received his MD opened a tea room on the premises called through its elegant staircase for work from the University of Toronto in 1880, the Pequin Tea Room. The following purposes, but also to attend lively and and spent most of his career in general year, Ruth Sterling bought the house and memorable Christmas parties. While many practice and on staff at the Hospital for continued the popular tea room until of the administrative staff appreciated Sick Children. Smith was a lifelong friend 1945, when she began renting rooms the antiquated character of the building, of the first Hollywood movie star, Mary to student nurses training at the nearby it had its frustrations, with cold winters, Pickford, who was born in Toronto in SickKids hospital. In 1953, the house was and stifling summer heat. Heather Shapiro 1893 at the present site of SickKids. In converted to office space for the Province recalls the logistical nightmare of trying fact, 92 College almost became Pickford’s of Ontario and two children’s charities.510 to accommodate the residency exams in home. After the death of her father, Dr. However, in 1961, the Province gave the the hodgepodge of rooms and offices, Smith and his wife offered to adopt her. house to the University of Toronto. For and Ted Brown will never forget the Although the young girl eventually refused unknown reasons it remained vacant for former pantry which had been turned into to leave her family, and soon after began five years, until 1966, when 92 College washrooms: “There was a hole in the wall; her acting career, she remained in touch became the new home to the Departments the exhaust fan didn’t fit properly and it with Dr. Smith until his death in 1940. of Medicine, Otolaryngology, and was freezing in there in the winter”.511 Obstetrics and Gynaecology. This was Smith sold the house around 1937 to the deemed a temporary move at the time. Sadly the deteriorating state of the industrious Mrs. Robin Hughes who building, typified by the ceiling leaks on For 48 years, the two-and- the 3rd floor, necessitated a move, which a-half storey, red brick was initiated by the incoming Chair, John Victorian building housed Kingdom. After several scouting visits by the administrative offices Kingdom in the fall of 2013, the Dean of the Department of (Catharine Whiteside) generously agreed Obstetrics and Gynaecology. to relocate Obstetrics and Gynaecology Its charming dark green to a modern office suite, which included doors, beautiful windows, a shared boardroom with the Department creaky floor boards, and a of Anesthesia, just off campus at 123 TORONTO OF UNIVERSITY winding staircase enticed Edward Street. The move took place in and welcomed faculty May 2014, expertly coordinated by the and visitors alike. John business officer Arleen Morrin. Sadly Kingdom recalls fondly there would be no more occupants in 92 College Street’s charm this stately building. On August 22nd, OBSTETRICS & GYNAECOLOGY OBSTETRICS from his recruitment 2016, the red brick Victorian house at conversations in the Chair’s 92 College Street was demolished to be office with Knox Ritchie replaced by a parking lot. Directly behind back in 1996, on a visit the building, Women’s College Hospital from London, UK. “92C” was subsequently demolished in 2016 is deeply entrenched in the to be replaced by an elegant new pink- memories of many faculty fronted building, illustrating the constant who climbed the 12 front changes that characterize our history. Signatures of faculty and staff attending the steps and passed upwards 81 Stragetic Planning launch event, 2014 Endowments fleets on the Great Lakes), and banking Rose Torno and insurance realms, Leitch also devoted Chair time and energy to philanthropic concerns, Gordon such as sponsoring children’s camps. He Rose Torno (1900- Clifford Leitch also gave substantial support to the Navy 2002) was the Chair League of Canada (including naval cadet founding president programs) which earned him the award of the Mount In 1954, a generous of Commander of the British Empire.514 Sinai Hospital endowment from Today, the Endowment funds a new (since Auxiliary in 1953. the estate of Gordon Rose and her husband Noah were major

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: 2014) initiative, the “Chair’s Summer Clifford Leitch Student Awards” and in addition supports philanthropists in the Toronto community (1890–1954), the an annual research methodology course in the late 20th century, and their legacy former chairman of the board of Toronto and additional medical student research includes the creation of the Rose Torno Western Hospital, established the Chair experience in the CREMS program. Chair in Obstetrics and Gynaecology at of the Department of Obstetrics and Mount Sinai Hospital. Dr. John Kingdom Gynaecology as a full-time professorship held the inaugural Chair in Obstetrics 512 at the University of Toronto. This J.R. McArthur and Gynaecology from 2004-2015. Dr. bequest ensured an initial annual income Fund for Mathew Sermer, Chief of Obstetrics and of $25,000 (supplemented with University Research Gynaecology at Sinai Health System since funds) for the professorship, which was In 1965, John 2013, succeeded Dr. Kingdom in this role expected to support teaching and clinical Robertson McArthur in 2015 and who currently holds the Chair. 513 investigation by junior faculty. This (1907–1964) left a donation has had a significant long-term substantial bequest, impact on the Department. Initially, being one-fifth of this endowment allowed Doug Cannell his estate to the Department of Obstetrics and Gynaecology to devote himself to teaching and to promote collaborative research with a focus administrative duties, while reducing on Gynaecology Oncology. His pioneering his clinical practice by three-quarters. A | MAVERICKS, COLLABORATORS VISIONARIES, AND radiological work (with his colleague W.G. significantly reduced clinical workload for Cosbie, pictured, as mentioned in a separate the Chair on an ongoing basis ensured that section on radiotherapy), was decisive in all future Chairs would remain devoted moving from the reliance on treating cervical cancer with radical surgery.515 McArthur to the core mission of the Department. graduated in medicine from the University in 1932 and after subsequent training and Leitch’s interest in Obstetrics and clinical work both in Canada and abroad, Gynaecology was a result of his relationship he was appointed to the teaching staff at with Toronto Western Hospital (where Toronto General Hospital, with a focus on 516 he was greatly impressed by the work Gynaecological Oncology. His legacy of work resulted in greatly improved detection of Cannell), and by his friendship with techniques and his financial legacy continues to departmental member Donald McIntosh support vital Gynaecology Oncology research. Low. While he was a strong business A biographer remembers McArthur as “a 82 leader in the shipping and grain industries dedicated Obstetrician Gynaecologist, revered (having grown one of the largest shipping by a huge following of devoted patients”.517 Our 175th Anniversary Year

Since 2013, John Kingdom has led the Department in partnership with a strong executive team that enthusiastically manages every facet of our mandate. In tandem with the move to 123 Edward Street in May 2014, we launched a redesigned website within the new University framework. In the fall of 2014, we also launched our comprehensive Strategic Plan, with subsequent updates in 2015. A renewed commitment to junior and mid-career faculty recruitment and support was fostered with the creation of the Junior Faculty Awards and the Merit Award programs, whereby resources from the University department are

matched with equal practice plan support to protect TORONTO OF UNIVERSITY academic time for clinician-investigators and scientists. John Kingdom (1959–) A comprehensive Self-Study Report was created in advance of the five-year review in April 2018 and offers an in-depth update of our progress since 2012. The review process resulted in the re-appointment of John Kingdom for a second five-year term, during & GYNAECOLOGY OBSTETRICS which time the Department will apply focussed energy and resources on education within our specialty as Competency by Design approaches. Our new Education Council, led by our incoming Vice Chair of Education, Richard Pittini, will lead us though this profound change in medical education in Canada. We follow in our predecessors footsteps, embracing the inevitable changes that come with progress, as we strive to 83 continue to advance the delivery of women’s health care. 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: | MAVERICKS, COLLABORATORS VISIONARIES, AND

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First fetal surgery for spina bifida in Canada led by Doctors Greg Ryan, Tim VanMieghem, and Jim Drake at Mount Sinai Hospital in 2017 References

1 Canniff, 189-90. Richardson 10 “Rolph, John”, Dictionary of unmarried. The other reports do 30 Connor, 67-74. Cosbie to Loudon (27 June 1899), 1. Several Canadian Biography. Canniff, 590-603. not provide similar statistics. quotes the “as dirt” remark but sources incorrectly state this first does not cite the source (59). lecture took place on 15th January 11 Geikie, 227-8. 20 Report of the Toronto Lying-In Hospital, 1857” 31 Connor, 67-8. Connor 1844. This is impossible given 12 Connor, 66-7. the reference to Herrick’s lecture (c.1858), Baldwin Collection, doesn’t identify Aikins when in the Faculty’s report of 27th 13 Wendy Mitchinson, The Toronto Reference Library. quoting the letter, but Godfrey quotes a similar excerpt – while December 1843. The mistake arises Nature of Their Bodies, 184-5, 172-3. 21 Connor, 67. from the fact that regular courses Mitchinson does note that the MB omitting the suggestion of grave began on 15th January 1844. degree required six months’ attendance 22 Rolph, John, Dictionary robbery (Godfrey, 87). at a lying-in hospital, but suggests this of Canadian Biography. 32 Connor, 74-5. 2 Canniff, 187, 427. While there was perhaps not rigorously insisted on is no direct evidence that this was the (172). In any case, such a degree was 23 Marian A. Patterson, “The 33 Connor, 67. Godfrey, 106-7. subject of his lecture, Canniff does not required to practice, and relatively Life and Times of the Hon. John The specific issue that led to their say it was Herrick’s “introductory few in this period actually took it. Rolph, M.D. (1793-1870)” Medical resignation was an advertisement lecture”. It is also a reasonable However, Cosbie does maintain that History 5.1 (January 1961): 30. placed by the faculty which had stated assumption that he was embarrassed “there were… a sufficient number 24 Baehre, 119. Canniff, 671. “no Religious Tests Required of because of the references to sex and of women going into the General Students attending these Lectures” female anatomy that any such lecture See also, “Workman, Joseph,” Hospital to provide a nucleus for Dictionary of Canadian Biography. (Godfrey, 107). From 1854, the on “midwifery” and “diseases of the teaching of midwifery” (96). Trinity School had quietly begun women” would necessarily make. 25 Rolph, John, Dictionary of admitting non-conforming students 14 Mitchinson, 183, 166. Canadian Biography. Richardson to its courses, with the expectation 3 Richardson to Loudon (27 Mitchinson cites census figures from June 1899), 1. Walter B. Geikie, to Loudon, 4-5. Richardson had that they would take their degree 1850–51 that show 17 practising also studied with Rolph for two from the University of Toronto; see “An Historical Sketch of Canadian midwives in “Upper Canada” (by Medical Education,” Canada years in Rochester, NY, before www.heritage.utoronto.ca/chronology. that time Canada West) and 382 he entered King’s College. Lancet 34.5 (January 1901): 231. physicians and surgeons. However, 34 Godfrey, 112-3. she also notes that, given the 26 Geikie, 232. Geikie quotes “the 4 Canniff, 425. He also seems 35 Geikie, 229. to have done training in London doctors’ hostility towards midwives view held by the Legislature” without (Canniff, 427) and to have briefly been and their rather vague legality, specifically indicating the source. 36 Godfrey, 116-7. these figures “are guaranteed to a resident physician at the Rotunda 27 Shorter, 19. Baehre, 120. The Hospital in Dublin (Davin, 598). underestimate considerably the 37 Shorter, 523-4. number of midwives” (166). various private medical schools 5 Canniff, 135, 186. Connor, apparently also received about $65,000 38 Godfrey, 121, 131. TORONTO OF UNIVERSITY 15 Rowsell’s City of Toronto between 1852 and 1871 in government 65. The College of Physicians and 39 See www.heritage.utoronto.ca/ Surgeons of Upper Canada was and County of York Directory, for subsidies. See “Medicine in Toronto: 1850-1 (Toronto, 1850): xxxiv. II” The Lancet, vol.168, issue 4327 (4 chronology. “Rolph, John”, abolished in 1841, however; see Rainer Dictionary of Canadian Biography. Baehre, “The Medical Profession in [Toronto Public Library]. Canniff August 1906): 332. The relevant quote Upper Canada Reconsidered: Politics, reproduces condensed versions is actually from Loudon’s 1903 address, 40 Geikie, 233. Canniff, 433. Medical Reform, and Law in a of the relevant entries, 214. not Hoskin’s, at the opening of the “Hodder, Edward Mulberry”, Colonial Society,” Canadian Bulletin New Laboratories. See the document Dictionary of Canadian Biography. 16 “Report of the Toronto “Ceremonies in connection with the of Medical History, vol.12 (1995): 117. & GYNAECOLOGY OBSTETRICS General Dispensary and opening of the New Laboratories 41 “Dr. Uzziel Ogden’s 6 Canniff, 426-7. Davin, 598-9. Lying-in Hospital; with List of erected for the Faculty of Medicine Jubilee”, The Canadian Journal Subscribers” (Toronto, 1853): 8. of the University of Toronto,” UT of Medicine and Surgery, vol. 13, 7 Shorter, 19 (quoting Archives A79-0023/“Historical” (1). no. 3 (Mar. 1903): 203-4. Richardson to Loudon). 17 “Report of the Toronto General Dispensary and 28 Connor, 68-78. See 42 See www.heritage.utoronto.ca/ 8 Geikie, 232. See also Jabez H. Lying-in Hospital; with List of also, Cosbie, 51-61. chronology. Elliott, “The Medical Faculty of the Subscribers” (Toronto, 1853): 5. University of Toronto”, The Messenger 29 Geikie, 22. See also, 43 Geikie, 230-1. of Theta Kappa Psi Medical Fraternity: the 18 “Annual Report of the www.heritage.utoronto.ca/chronology. Toronto Issue 34.3 (July 1937): 90 [held Toronto General Dispensary and Canniff states that Rolph’s school 44 Five of the new Trinity faculty in UT Archives: UTARMS 0069]. Lying-in Hospital, 1852” [for the officially incorporated in 1853, but had held positions at Victoria; see year 1851] (Toronto, 1852). Rolph had been calling his school www.heritage.utoronto.ca/chronology. 9 Geikie, 232. See also 19 In 1851, there were 51 the “Toronto School of Medicine” 45 Connor, 116-7. 85 “Hodder, Edward Mulberry,” since at least 1848 (598-9). Dictionary of Canadian Biography. married women delivered and 10 46 Cosbie, 96-8. From 1856 56 Connor, 151. See also in three instances” (Wright, 1159). in the 1870s, and three Canadian onwards, city directories only list Mitchinson, 183. Connor notes that Forceps may have been used in perhaps universities – Dalhousie, Bishop’s, and one Lying-In Hospital, located at in 1938 there were “an equal number 20 other cases of non-induced labour the University of Manitoba – began what were probably the premises of of births in and out of hospital” (151). to get the 1 in 20 overall figure stated admitting women to their medical the Provincial Lying-In Hospital by Wright in the same article. schools in the 1890s. See Cheryl and Vaccine Institution. Cosbie 57 “The Mortality in the Lying-In Krasnick Warsh, Prescribed Norms, states that only the hospital at this Hospital,” [a letter to the editor signed 64 Mitchinson, 175- 175-87. See also Carlotta Hacker, location endured, though he says “Dr. R.”] The Globe (18 February 80. Godfrey, 198. The Indomitable Lady Doctors, 242-6. that in 1865 the “Toronto Lying-In 1878). Quoted by Connor, 124. The correspondent believed these to be 65 Mitchinson, 233. Hodder’s 72 Shorter, 20. See also Hospital and General Dispensary” professorship at Trinity was in associated with Hodder closed for lack quite low. However, these figures may Sheinin and Bakes, 97-8. See be unreliable. Adam H. Wright, in his “Obstetrics, and Diseases of also Hacker, 21-2, 26-9. of funds (96). However, it seems to Women and Children” (see e.g. have been this hospital’s organization report from 1897 presenting mortality figures for the preceding decade, noted the advertisement in The Canada 73 Shorter, 22. (particularly Rev. Grasset) that Lancet, 7.12 (1 Aug 1875): 16). developed into the Burnside. that “the mortality rate was high 74 Shorter, 21. “Medicine in

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: James Algernon Temple succeeded [Perhaps this was a temporary closure before the amalgamation took place Toronto: II” The Lancet, vol.168, and became considerably less after him in 1878 with the same title, leading to amalgamation?] Also, in but by 1903 he was officially titled issue 4327 (4 August 1906): 332. 1863, there was a provincial bill “to the erection of the new building”; see Adam H. Wright, “Notes On “Professor of Operative Obstetrics 75 “Medicine in Toronto: incorporate the Burnside Lying- and Gynaecology” (Shorter, 525). The in Hospital, of Toronto” which Methods And Results In The Burnside II” The Lancet, vol.168, issue Lying-In Hospital, Connected With Professorship at the Toronto School 4327 (4 August 1906): 332. doesn’t seem to have passed its third of Medicine, up to its incorporation reading [Early Canadiana Online]. The Toronto General Hospital, Toronto, Canada” The British Medical into the University in 1887, continued 76 Godfrey, 271-4. 47 Godfrey, 160-73. Journal 2.1921 (October 1897): 1156. to be in “Midwifery and Diseases of Women and Children” (Shorter, 524). 77 Godfrey, 278. 48 See “Annual Announcement 58 Wright, 1156. Quoted by 66 “The Neglect of Gynaecology 78 Ibid. p. 53. On Wright having of the Toronto School of Medicine” Shorter, 522-3. Wright’s figures won one of the silver medals in the for the 1882–83 session for the whole period 1888-1897 at the Toronto General Hospital,” The Canadian Journal of Medical class of ’73, see Faculty of Medicine [Baldwin Collection, Toronto are also quoted by Connor, 151. calendar for 1912-12, p.90. Reference Library: http://static. Science 6.7 (July 1881): 210. torontopubliclibrary.ca/da/ 59 See also Mitchinson, 250. Quoted by Connor, 153. 79 “Banquet to Dr. Adam pdfs/37131055446579d.pdf]. Cf. Mitchinson argues that the generation H. Wright”, p. 43. of Canadian doctors trained in 67 Cosbie, 114. Connor, 153. The Announcement for the 1883-84 number of beds seems to have been session [ibid.: the 1860s and 70s, and who were 80 Wright claimed that he “became in positions of authority from the increased to 40 in the mid-1890s by associated” with the Toronto School http://static.torontopubliclibrary.ca/ an expansion of the building; see the da/pdfs/37131055446330d.pdf]. 1880s, were more conservative in of Medicine in 1878; ibid., p.53. their treatments and their recourse pamphlet “Toronto General Hospital” However, the school’s “Annual 49 Shorter, 524-5. to surgery as, before the widespread (1896), p.41 [source: archive.org]. Announcement” for 1880-81 institution of asepsis and antisepsis, There is also a map of the General’s states that Wright was appointed 50 J.F.W. Ross [“Scugog”], A such a conservative approach was the Gerrard Street East grounds, pp.62-3. at the start of that session; p. vi. medical student’s letters to his parents best way to reduce the patient’s overall (Toronto, 1909), 24-25. The collection 68 Shorter, 20. The address 81 The “Annual Announcement” risk of infection. Indeed, Mitchinson is given as 289 Sumach Street of letters was published under the quotes one doctor who complained for 1882-83 is the first to note pseudonym, which has been attributed in “Our History” [http://www. Wright’s title as “Surgeon to the | MAVERICKS, COLLABORATORS VISIONARIES, AND in 1898 that stricter hygiene had to Ross by Bernard Amtmann in womenscollegehospital.ca/about-us/ Toronto General Hospital”. That he made some obstetricians use forceps our-history/]. See also, “The Medical Contributions to a dictionary of Canadian with harmful and needless frequency regularly attended the Burnside and pseudonyms and anonymous works relating Schools of Canada” The Canadian the Women’s Pavilion may be safely because they no longer feared the Practitioner 8.11 (Nov 1883): 338. to Canada (1973). I have completed reduced risk of infections (215). assumed given his appointment as the line which reads “___ and ___ 69 Sheinin and Bakes, 102. See lecturer on obstetrics at the Woman’s are fighting for their schools” with 60 Wright, “Prevention,” 232. also, “The Medical Schools of Medical College the following year, “Trinity” and “Victoria”. The and given I.H. Cameron’s account 61 Adam H. Wright, “The Canada” The Canadian Practitioner original letter may also have referred 8.11 (Nov 1883): 338. of his activities as a gynaecological to the heads of these schools instead, Prevention of Puerperal Fever,” surgeon in “the new wing” (i.e. but the sense would be the same. The Canadian Practitioner 9.8 70 Shorter, 20, 561-2. Cheryl the pavilion); see “Banquet to (Aug. 1884): 231. See also Krasnick Warsh, Prescribed Norms, 180. Dr. Adam H. Wright”, p. 44. 51 “Medicine in Toronto: Connor, 152; Godfrey, 196-7. II” The Lancet, vol.168, issue 71 Many American homeopathic 82 See “Annual 4327 (4 August 1906): 332. 62 See Mitchinson, 210-5. medical colleges accepted women Announcement” for 1883-4. 63 Wright, “Notes,” 1157. Connor from the 1840s onwards. The New 52 Shorter, 22. England Female Medical College was 83 See “Banquet to Dr. Adam offers the figure of forceps use in only H. Wright”, Canadian Practitioner 53 Ross, 28. 3 of 500 deliveries (152). However, this established in 1848, amalgamating with Boston University’s medical and Review (Jan 1913): 51ff. [vol.38, seems to be a misreading of Wright’s p.31ff.archive.org ]. See also Shorter, 54 Connor, 123, 151. Shorter, 522. statement that in the 500 cases, they school in 1874. The Women’s Medical College of Pennsylvania was 522. See also “Wright, Adam Henry,” 86 55 Connor, 123-4. “assisted labour by digital dilation of Dictionary of Canadian Biography. the cervix and the use of the forceps founded in 1850. Several American universities became co-educational See also Obituaries, Canadian Medical Association Journal, vol. 23, 93 “Dr. Uzziel Ogden’s Jubilee”, 114 Adam H. Wright, “Notes On residency at TGH in 1881). H. B. no. 5 (Nov 1930): 725-726. The Canadian Journal of Medicine Methods And Results In The Burnside Anderson’s and J. A. Temple’s accounts and Surgery, vol. 13, no. 3 (Mar. Lying-In Hospital, Connected With accord closely with Ross’s letters. 84 Quoted in Godfrey, 294. 1903): 205. Shorter, 17, 523. The Toronto General Hospital, For note of the award of MD, Toronto, Canada” The British Medical 128 Shorter, 524. see the 1889-90 calendar of the 94 “Death of Dr. Uzziel Ogden” Journal 2.1921 (October 1897): 1156-7. Faculty of Medicine, p. 105. The Canadian Journal of Medicine and 129 “Annual Announcement of the Surgery, 27.2 (Feb 1910): 114. For 115 Mitchinson, Giving Birth Woman’s Medical College, Toronto… 85 “Banquet to Dr. Adam context, see H. E. MacDermot, in Canada, 1900-1950, 232-5. 1886-1887” (1886). [WCH Archives, H. Wright”, p. 51. “Early Medical Journalism in Board of Directors fonds, ‘Annual 116 Mitchinson, The Nature reports and annual meeting records, 86 Shorter, 522-3. Canada”, Can Med Association Journal 72.7 (1 Apr 1955): 536–539. of Their Bodies, 250. A7-1 to A7-15, 1886-1912,’ Box 1.] 87 Shorter, 523-4. See also 117 Mitchinson, Giving Birth 130 H.B. Anderson, “Dr. James F. “Ogden, Uzziel,” Dictionary 95 “Dr. Uzziel Ogden’s Jubilee”, The Canadian Journal in Canada, 1900-1950, 207. W. Ross,” University of Toronto Monthly, of Canadian Biography. vol. 12 (1911-12): 185. J. Algernon of Medicine and Surgery, vol. 13, 118 Connor, 153. 88 Godfrey describes Ogden’s no. 3 (Mar. 1903): 204-5. Temple, “Dr. Ross as a Surgeon,” recruitment to the TSM, insisting 119 James Russell, “The After Canada Lancet 45.5 (Jan 1912): 330. that Ogden didn’t join the staff until 96 “Ogden, Uzziel,” Dictionary Effects of Surgical Procedure on the of Canadian Biography. 131 N. A. Powell, “The 1855 (Aikins of the U of T Medical Generative Organs of Females for President’s Remarks on the Faculty, 81-3). However, given 97 [Dr. Alexander Primrose], the Relief of Insanity,” The Canadian Late Dr. J. F. W. Ross,” Canada that Ogden celebrated his 50-year “History of the Faculty of Practitioner 23.10 (October 1898): Lancet 45.5 (Jan 1912): 328. jubilee in 1903, it is likely that he Medicine (cont’d),” 2; quoted 579. Quoted in Mitchinson, The had been occasionally lecturing at in Shorter, 22. The attribution Nature of Their Bodies, 276. [Russell 132 “Annual Announcement of the TSM before this appointment while to Primrose is Shorter’s. was Medical Superintendent of Woman’s Medical College, Toronto… concurrently studying scientific the Hamilton Insane Asylum.] 1888-1889” (1888). [WCH Archives, subjects from early 1853 at the 98 Ibid., 6 (table). Board of Directors fonds, ‘Annual University of Toronto. Through 120 Shorter, 525. reports and annual meeting records, 99 Shorter, 25; see also, “U the influence of Rolph, Workman 121 Mitchinson, The Nature A7-1 to A7-15, 1886-1912,’ Box 1.] had taken over as Superintendent of of T Chronology” webpage. of Their Bodies, 258-62. 133 Anderson, 184-5. the Toronto Lunatic Asylum from 100 Shorter, 541. July 1853 (see “Workman, Joseph,” 122 Shorter, 522. Connor, 153. 134 Cosbie, 134. Shorter, 524. Dictionary of Canadian Biography). 101 Shorter, 23-4; “U of T However, Workman continued Chronology” webpage. 123 Quoted in Mitchinson, The 135 Marlow, 337. to lecture “until 1854” (Canniff, Nature of Their Bodies, 267. 102 Shorter, 24; Godfrey, Aikins 136 Anderson, 184-6. See also 671), so Ogden may only have been 124 Mitchinson, The Nature of Their fully appointed in 1854-55 after of the U of T Medical Faculty, 279. Ross Obituary, The Dominion Bodies, 266, 277. See also Connor, 153. medical monthly and Ontario medical Workman formally left the school. 103 Godfrey, 279. 125 Russell, 579-80. journal, vol. 38, no. 1 (Jan. 1912): 89 Shorter, 523-4. “Ogden, Uzziel,” 104 Shorter, 648-50. 31-32; The Canada Lancet, vol. Dictionary of Canadian Biography. “Dr. 126 Frederick W. Marlow, “A 45, no. 5 (Jan 1912): 327-341.

Uzziel Ogden’s Jubilee”, The Canadian 105 “University of Toronto Medical Few Notes Referring to the TORONTO OF UNIVERSITY Journal of Medicine and Surgery, vol. Faculty Calendar for 1889-90,” 30. Contributions to Medical Literature 137 Cosbie, 149. 13, no. 3 (Mar. 1903): 203. “Death and the Writings of the Late Dr. 106 Ibid., 21. 138 “President’s report for the of Dr. Uzziel Ogden” The Canadian James F.W. Ross, Toronto,” Canada year ended June 1912” (1912), Journal of Medicine and Surgery, vol. 27 107 “University of Toronto Lancet 45.5 (Jan 1912): 339. p. 9. [Web – archive.org]. (Jan-June 1910): 114. “The Late Uzziel Medical Faculty Calendar 127 Biographical sources for Ross are Ogden, M.D.” University of Toronto for 1899-1900,” 30-1. 139 Mitchinson, Giving Birth in Monthly, vol. 10 (1909-1910): 301-2. principally: Cosbie, 133-4; Shorter, Canada: 1900-1950, 57. Mitchinson 108 “Toronto General 524-5; “In Memoriam of Dr. J. F. seems to be mistaken in stating

90 Quoted in Godfrey, 294. Hospital” (1896), 25. [Pamphlet: W. Ross: A Series of Papers Read at that William Gardner held the & GYNAECOLOGY OBSTETRICS the Toronto Academy of Medicine, 5 91 “Death of Dr. Uzziel Ogden” Gerstein; archive.org]. professorships of both Obstetrics December, 1911,” Canada Lancet 45.5 and Gynaecology at McGill before The Canadian Journal of Medicine and 109 McDonald, For the Least (Jan 1912): 327-41; H.B. Anderson, Surgery, 27.2 (Feb 1910): 115. See also 1910. Walter Chipman was head of of My Brethren, 47-8, 60. “Dr. James F.W. Ross,” University of Obstetrics and succeeded Gardner the Toronto School of Medicine’s Toronto Monthly, vol. 12 (1911-12): Annual Announcements for 1864- 110 Connor, 151. in Gynaecology to combine the 181-7. There is also A Medical Student’s two departments (officially so from 65, 1871-72, 1875-76, 1878-79, Letters to His Parents, a collection of and 1880-81. The obituary’s claim 111 “Toronto General 1912). Gardiner doesn’t seem to have Hospital” (1896), 13. [Pamphlet: Ross’s letters from his first European ever held a position in Obstetrics that Ogden “became attached” to travels, published under the name TGH is not reflected in the 1875- Gerstein; archive.org]. at McGill. See website [https:// “Scugog” in 1909. Cosbie and Shorter www.mcgill.ca/obgyn/history]. 76 announcement. Ogden seems to 112 McDonald, For the Least make a few mistakes regarding Ross’s have become attached to TGH via For the history of the Department of My Brethren, 60-1. training. Ross initially went to Europe of Obstetrics and Gynaecology, his appointment at the Burnside. for about two and a half years, not 113 Connor, 151. Queen’s University, see its website 87 92 Godfrey, 316-7. four (Shorter neglects Ross’s one-year [http://meds.queensu.ca/medicine/ she suggested it counted all medical Toronto, Ontario, Canada,” p 2. 163 Connor, 192-5. obgyn.20150116/history/history.htm]. graduates who attended OMCW [WCH Archives, Jennie Smillie and its predecessors, including those Robertson personal file.] 164 Shorter, 526. 140 The chronology of the opening who graduated after it closed, such as 165 Shorter, 623. up of the Faculty to women is Smillie Robertson. However, Shorter 151 Shorter, 525. Faculty somewhat muddled in the primary (p.21) gives the figure of 112 graduates, calendars (e.g. for 1911-12) show 166 Cf. calendars of the Faculty and secondary sources. The University citing Torontonensis, vol. 8 (1906), Temple listed as a member of the of Medicine for the 1912-13, yearbook for 1908 notes that women p. 189. It is uncertain whether this Gynaecology Department. His 1913-14, and 1914-15 sessions. attended medical lectures for the first figure includes those who graduated title was retained from his previous time there in the 1904-05 session; from the Kingston Women’s Medical position in the Trinity Medical 167 Cosbie, 149. Berkow, 106. In Torontonensis, vol. 10, p. 153. In the College before it was absorbed to School after amalgamation in 1903. Berkow’s article, Watson states that following year’s yearbook Jennie form OMCW. Gardiner also advised the laboratory he established was for Smillie herself records that she began 152 McDonald, For the Least “gynaecologic pathology,” while that the latter’s formation was not of My Brethren, pp. 61, 91. her course in the 1905-06 session, at strictly speaking an “amalgamation” Cosbie simply notes that he set up the end of which the OMCW closed or “merger” of the two women’s 153 “Banquet to Dr. Adam H. a “pathological laboratory” at the 175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: and she and her colleagues transferred colleges, but rather a closure and Wright”, Canadian Practitioner and Burnside. One can probably assume to the University; Torontonensis, vol. subsequent transfer of students. Review 38.1 (Jan 1913): 54. [Vol.38, that it handled both gynaecological 11, p. 174-5. Over 70 years later pp.31-56. Web. Archive.org.] See also and obstetrical samples. (so somewhat unreliably), Smillie 145 Biographical sources for Smillie “President’s report for the year ending 168 Cosbie, 245. Robertson said she began at OMCW Robertson are principally: “Dr. June 1913” (1913), p. 2. [Web – archive. at the age of 25 (which, impossibly, Jennie Smillie Robertson: Toronto, org]. Around June 1912, Wright 169 Shorter, 43-6. J. G. Gallie is would have been in the 1903-04 Ontario, Canada,” [WCH Archives, tendered his resignation, asking “to not listed in the Faculty calendar session), and that her first year was also Jennie Smillie Robertson personal be relieved of the duties of his chair until the 1914-15, which would the first year that OMCW students file]; “Robertson, Jennie Smillie” in in the autumn of 1912.” However, suggest he was appointed to took courses at the University (which Sheinin and Bakes, 84-5; Shorter, this was only officially accepted TGH first, and then received an contradicts the yearbook pieces), after 21, 564; Debrah A. Wirtzfeld, “The on 14 November 1912, when the academic appointment in 1914. which OMCW closed (which was History of Women in Surgery,” Faculty formally appointed Watson. after the 1905-06 session); [see citation Canadian Journal of Surgery 52.4 (2009): It seems uncertain whether Wright 170 Shorter, 527-8. Cosbie, 150. below]. Adding to the confusion, 317–320; the newspaper features continued teaching in the Fall term, Shorter (in what is perhaps a typo) “Pioneer woman doctor had to intern 171 For further details on or if Watson had begun teaching in Brown, see Shorter, 245-52. states that Smillie Robertson entered in U.S.”, Toronto Star (16 June 1973), October before his appointment was OMCW in 1906; p.21. Sheinin and “Canada’s first woman surgeon formalized, or if other members of 172 Cosbie, 175-6. Cosbie states and Bakes (going from Smillie approaches 100”, Toronto Star (31 the Department(s) covered for them. this nursery was opened in 1919. Robertson’s 1978 recollection) state Jan 1978); and the obituaries “Dr. However, an item headlined that she entered in 1903 (implicitly Jennie Smillie Robertson, Woman 154 Shorter, 522-3, 525. Cosbie, 149. “Science Does Wonders For Wee because she was then 25); p. 84. surgeon was first to enter practice in 155 MacMurchy, 1934 Babies At ‘Burnside’” in The Toronto Canada”, The Globe and Mail (3 Mar Daily Star (27 January 1917) reports 141 Kendrick and Slade, Spirit of Life: 1981), “Dr. J. Robertson pioneer the Story of Women’s College Hospital, 26. 156 CMAJ, Sep; 31(3),1934 on the “premature ward” at the surgeon,” Toronto Star (3 Mar 1981), Burnside Hospital, “which is only 142 “Dr. Jennie Smillie Robertson: and in the Canadian Medical Association 157 McLaren, 1990 the third of its kind in America”. Journal 124.10 (15 May 1981): 1398. Toronto, Ontario, Canada,” pp. 158 Dagg, 2006 The establishment of this ward may 2-3. [WCH Archives, Jennie 146 “Dr. Jennie Smillie Robertson: tentatively be dated to August 1914, | MAVERICKS, COLLABORATORS VISIONARIES, AND Smillie Robertson personal file.] Toronto, Ontario, Canada,” pp. 159 Biographical sources for as Alan Brown and Ruggles George This autobiographical essay was 3-4. [WCH Archives, Jennie Watson are principally: Samuel published a research paper, “The prepared by Margaret Donnell Smillie Robertson personal file.] Gordon Berkow, “A Visit with Dr. Care and Feeding of the Premature (drawing from interviews Donnell Benjamin P. Watson”, Obstetrics and Infant,” Archives of Pediatrics 34 (1917): conducted with Robertson; also held 147 Shorter, 564. Gynaecology, 10.1 (July 1957): 105- 609-16. Ruggles and Brown, who by WCH Archives) in the run-up 111; Harold Speert, “Memorable is also described as an attending to Robertson’s 100th birthday. The 148 Kendrick and Slade, 26-8. Medical Mentors: XVI: Benjamin physician at “The Infants’ Ward, essay was also collected in Leone 149 Shorter, 562-4. For further P. Watson (1880-1976)”, Obstetrical Toronto General Hospital,” use data McGregor Hellstedt (ed.), Women information on Hume and Wildman, and Gynaecological Survey, 61 (2006): on premature infants at the Burnside Physicians of the World: Autobiographies see Sheinin and Bakes, 44-5, 106-7. 287-292; and Shorter, 525-7. from August 1914 to September 1916, of Medical Pioneers (1978), pp.1-4. Hume also lived a quite a long life, and discuss their use of a specialised 160 Berkow, 110. incubator (612). [http://www.anslab. 143 “Passing of the Woman’s Medical though in 1966 she was murdered in her home at age of 89. Sheinin 161 Berkow, 106. iastate.edu/class/ans536w/08%20 College,” Torontonensis, vol. 10 Prematurity/Neonatology%20 (1908), p. 158. See also Shorter, 21. and Bakes’ assertion that Hume had delivered her own murderer seems to 162 Berkow, 106. Shorter on%20the%20Web_%20Brown%20 144 Kendrick and Slade, 25-6. be a misunderstanding. Rather, the misinterprets Watson’s statement and%20George%201917.pdf]. here when he quotes it (527). Kendrick and Slade give the total lead investigator of her murder case 173 Shorter, 527. number of graduates as 128, without had been delivered by her [see “Slain Watson meant that the “Edinburgh citing their source for this figure. MD delivered key detective in case,” school” viewed teaching as “their 174 Berkow, 106. Heather Gardiner, the archivist at The Globe and Mail (06 Oct 1966): 2]. second most important assignment” 88 WCH, advised me that she has been after patient care, rather than such 175 Cosbie, 152-3. unable to verify this figure, though 150 “Dr. Jennie Smillie Robertson: already being the case in Toronto. 176 Shorter, 531. Cosbie, 246. Van of the hospital at Salonica in a drick’s service records: http:// she interned for one year at TGH Wyck’s first Faculty appointment somewhat jauntier light (34-94). central.bac-lac.gc.ca/.item/?op=p- prior to her marriage (to Malcolm was as a demonstrator in Anatomy; df&app=CEF&id=B4263-S021. Cameron in May 1917). The list see Faculty calendar, 1920-21. 183 Cosbie, 153. is therefore probably prospective 195 His citation for the MC is quoted – or rather, lists those currently 177 See Robert B. Meiklejohn, 1936- 184 See University of Toronto in “The War,” The British Medical Monthly 17.1 (October 1916): 42. serving at the (September) year- 1985, The First Fifty Years: The Can- Journal, 2.2953 (4 Aug 1917): 1632. See end of the Annual Report. She adian Gynaecological Society, 56. See also 185 See Gallie’s CAMC ser- also Cosbie’s service records: [http:// does not seem to have continued Dafoe’s CAMC service records [http:// vice records: http://central. central.bac-lac.gc.ca/.item/?op=p- in practice after her marriage. central.bac-lac.gc.ca/.item/?op=p- bac-lac.gc.ca/.item/?op=pd- df&app=CEF&id=B2020-S050]. df&app=CEF&id=B2407-S031]. f&app=CEF&id=B3383-S021. 202 From A brief history of the Dafoe seems to have lied on his 196 Robert B. Meiklejohn, Ontario Medical College for Women by enlistment form, giving his occu- 186 Cosbie, 153. See also 1936-1985, The First Fifty Years: Augusta Stowe Gullen, M.D. 1906 pation as “Student, Medicine 5th Yellowlees’ obituary in the The Canadian Gynaecological Society, year” when he had yet to finish his CAMJ 6.7 (July 1916): 628. 67. McDonald, For the Least of My 203 Shorter, 527. Shorter states second year. He entered the Faculty Brethren, 125, 148. There is a slight that he was recalled “to help train in Fall 1913. On his war service 187 Interview with Helen discrepancy about the year he became young military physicians”. In any gratuity application, Dafoe indicates Sibbald, Margaret May Allemang chief at SMH. Meiklejohn says 1945. case, this would have been conducted that he served with the Royal Navy fonds, University of Toronto McDonald alternately says both at the University and Toronto Volunteer Reserve for “5 mos”, which Archives, B2006-0016/15(01). 1945 and, more definitively, 1947. General as part of the regular (but The obituary of his predecessor, accelerated) medical course. suggests that he resumed his course 188 See Davis’ CAMC ser- in Fall 1917 to finish his last three Nicholas D’Arcy Frawley, says 1947; vice records: http://central. see Canadian Medical Association 204 Shorter, 369. See also years with the class of 1920. Dafoe’s bac-lac.gc.ca/.item/?op=pd- Connor, Doing Good, 198-201. graduation photograph and bio appear Journal 101.11 (29 Nov 1969): 99. f&app=CEF&id=B2351-S021. See also O’Leary’s obituaries in the in Torontonensis, vol.22 (1920), 115. Davis is referred to, but not 205 “Annual Report of the Toronto 4 February 1952 issues of the Toronto General Hospital” (1915), 33. 178 His training with Watson took named, in Cosbie, 153. Daily Star and The Globe and Mail, place at Edinburgh, after Watson 189 See Crawford’s obituary in and in Canadian Medical Association 206 Ibid., 30. returned there in 1922. See also Journal 66.4 (April 1952): 403. CAMJ 37.1 (July 1937): 94. See also 207 Quoted by Clarence M. Hinks Dafoe’s obituary, “Dr. William two items in The Globe and Mail of Dafoe advised on care of quints,” 197 Shorter, 565. Sheinin and in “Annual Report of the Toronto 15 May 1937, “More Than a Coroner Bakes, 35-7. See also S. Bhimji and General Hospital” (1916), 35. Toronto Star (8 November 1974). Lost” (p.6) and “Sports World Mourns The article notes that his ship was R. Sheinin, “Dr. Edna Mary Guest: Loss of Dr. Crawford, Friend of She Promoted Women’s Issues 208 This increase in the number sunk in the English Channel after Sportsmen” (p.18). See also Craw- of unmarried women giving birth colliding with another ship. Before It Was Fashionable.” CMAJ: ford’s service records here: [http:// Canadian Medical Association Journal at the Burnside is largely anecdotal; 179 See “The No. 4 Canadian central.bac-lac.gc.ca/.item/?op=p- 141.10 (15 Nov 1989): 1093–1094. see Cosbie, 156-7. According to the General Hospital,” University of Toronto df&app=CEF&id=B2123-S053]. TGH report for 1915, 129 of the 844 Monthly 16.3 (December 1915): 119. 198 McDonald, For the (not 462, as stated incorrectly on p.33) 190 See Cleland’s obituary in CAMJ Least of My Brethren, 79. women admitted to the Burnside Pearson’s enlistment form and some 30.1 (January 1934): 107-8. See also letters concerning his service are were unmarried. According to the Cleland’s service records: [http:// 199 Shorter, 548-9. See also, TGH report for 1916, 116 (the sum found here: [http://www.bac-lac. central.bac-lac.gc.ca/.item/?op=p- President’s Report for 1917-18, TORONTO OF UNIVERSITY gc.ca/eng/discover/military-heritage/ of maternal figures on p.33) of the df&app=CEF&id=B1785-S051]. p.14 [https://archive.org/details/ 845 women admitted to the Burnside first-world-war/personnel-records/ presidentsrepor1918univ]. Pages/item.aspx?IdNumber=562397]. 191 See Magwood’s ser- were unmarried. Additionally, vice records: [http://central. 200 See Annual Report of the paternity was identified as someone 180 J. J. Mackenzie, Number bac-lac.gc.ca/.item/?op=pd- Toronto General Hospital for 1915, in military service in 19 of those 4 Canadian Hospital: the Letters f&app=CEF&id=B5842-S034]. p.7 and for 1916, p.7. The “Smellie” cases (as “soldiers overseas” or by of Professor J. J. Mackenzie from mistake was corrected in 1916. Smillie referral to the Militia Department). the Salonika Front (1933), 50. 192 See Faculty calendars for Robertson, in her autobiographical 209 “Annual Report of the Toronto

1916-17 (pp.107-112) and 1918-19 & GYNAECOLOGY OBSTETRICS 181 See “Guide to Sources essay never mentions serving on staff at General Hospital” (1915), 37. In that (pp.109-117). Clutterbuck’s RAMC Toronto General. She was also on staff Relating to Units of the Canadian records would have been destroyed year, 68 of 129 unmarried women Expeditionary Force: Canadian in gynaecology at WCH at this time. were discharged to institutional by the War Office in the early For Oakley, see Sheinin and Bakes, Army Medical Corps,” 87. [https:// 1920s along with all such records care, and 48 were referred to courts www.bac-lac.gc.ca/eng/discover/ 73. For Sproule Manson, see Shorter, or other agencies. For 1916, only a for RAMC officers commissioned 548, and Sheinin and Bakes, 62-3. military-heritage/first-world- only for the duration of the war. small number of Burnside patients war/Documents/canadian%20 201 Curiously, Patterson is listed were examined (of whom only two army%20medical%20corps.pdf]. 193 Ibid. See also Marlow’s with the house staff for 1915–16. were found “normal”) and so cannot service records: http://central. Residencies were for graduates and be compared to the preceding year 182 Interview with Mary Darling, bac-lac.gc.ca/.item/?op=pd- (1916 “Report”, 34). Of that year’s Margaret May Allemang fonds, started around July, lasting one f&app=CEF&id=B5931-S023. year. But Patterson received her 116 unmarried maternity patients, University of Toronto Archives, 33 were institutionalised, with B2006-0016/14(18). In his letters, 194 Hendrick is not listed in MB in spring 1916. Furthermore, her obituary in The Globe and Mail 15 also referred to courts or other Mackenzie in fact mentions Darling the calendars’ sections of Faculty agencies, and 3 deported (33). 89 (p.46), and describes the first months staff on active service. See Hen- of 19 September 1951 states that 210 Cosbie, 156. See also of female students can be accurately discussed elsewhere. However, his see Sari Tudiver, “Exploring Fertility Carolyn Strange, Toronto’s Girl reckoned by using the keyword “miss” service records corroborate much of Trends in Canada through a Gender Problem: the Perils and Pleasures of and counting the hits on pp.124-36.] the biographical information: [http:// Lens,” Health Policy Research Bulletin, the City, 1880-1930, 204-5. www.canadiangreatwarproject.com/ issue 10 (2005): 7-10. Cosbie also 222 Boyd seems to have been searches/soldierDetail.asp?ID=95457]. notes the national trend toward 211 For the spike in syphilis cases the first female clinician on staff at On his enlistment form, he also hospital birth, p.41. See also Wendy at TGH between 1913 and 1915, HSC, though Shorter notes that seems to have jokingly given his Mitchinson, Giving Birth in Canada, see “Annual Report of the Toronto Angelia Courtney was hired in ethnic origin as “Oriental”. 1900-1950, pp.175 (Table 1). General Hospital” (1916), 41. Note 1920 as a research director; Shorter, also the jump in cases of gonorrhea in 247. For Boyd, see Sheinin and 229 Obituary, The Globe and 239 Mitchinson, Giving Birth in 1914. The Special Treatment Clinic Bakes, 10; and Shorter, 247, 264. Mail. Goodwin states that Hendry Canada, 1900-1950, pp.173-80. was set up in 1915, so the increase See also Boyd’s obituary in the taught at Ridley College for three in the number of syphilis cases after Canadian Medical Association Journal years, but four years seems correct; 240 Goodwin, James W. “The that year may partly be attributed to 104.4 (20 February 1971): 339. Goodwin, Our Gallant Doctor, p.29. Casebooks and Journals of a Toronto the resources devoted to detecting General Hospital Houseman:

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: the disease and treating more of its 223 McDonald, 79, 79n33. In the 230 Hendry must have enrolled J.C. Goodwin MB 1927-1928,” sufferers. See also Connor, 200-1. 1921 volume of Torontonensis, “Esther in medicine in 1900–01, as he is in T. F. Baskett (ed.), Pages of Doan Harrison” is noted as having registered as a fourth-year student History in Canadian Obstetrics 212 Edna Guest established a “gained her practical experience by in the Faculty calendar for 1904–05, and Gynaecology, pp.25-34. Venereal Disease Clinic at WCH in four months in Labrador and one and p.119 [https://archive.org/details/ 1920. Another sign of the increasing a half years at St. Michael’s Hospital” calendarmed1904univ]. Though the 241 Cairns, John D. “Memories of prevalence (as well as of increasing (p.131). In 1921, Harrison married medical course had been lengthened to the 1930s: A Conversation with Dr. resources devoted to treating sexually Julian Loudon and used his surname five years in 1899, the final year does Leslie Watt,” in T. F. Baskett (ed.), transmitted infections) was the number thereafter. His obituary in the British not seem to have been compulsory Pages of History in Canadian Obstetrics of Wassermann tests conducted by Medical Journal of 28 November 1959 until 1908–09; Shorter, p.648, 870n3. and Gynaecology, pp.72-5 (p.75). TGH’s Special Treatment Clinic. notes that she was still a gynaecologist 231 Obituary, The Globe and Mail. 242 Cosbie, “Maternal Mortality,” In 1916, the Clinic conducted 1207 on staff at Women’s College Hospital, pp.40-1. For a more detailed account Wassermann tests; see “Annual Report Toronto (1118). Esther Loudon’s own 232 For Hendry’s appointments of the outbreak, see Cosbie, The of the Toronto General Hospital” obituary in the CMAJ of 6 September in the Faculty of Medicine, see the Toronto General Hospital, 1819- (1916), 36-7. Cosbie states that by 1969 states that she was on staff at University of Toronto President’s 1965: A Chronicle, p.203. 1918, about 9500 tests were being Women’s College Hospital “from Report for the year ending June done annually (Cosbie, 156); however, the time of its foundation” (308). 1934, p.5 [https://archive.org/stream/ 243 Cosbie, “Maternal Connor gives the more substantiated This would be impossible, but may presidentsreport1935univ#page/4/ Mortality,” p.43. For the national figure of 3200 (Connor, 200-1). indicate she joined the hospital in mode/2up/search/Hendry]. See also rate, see Mitchinson, Giving 1924 when it changed its name, or Birth in Canada, pp.233-4. 213 See Faculty of Medicine the Faculty of Medicine calendars perhaps in 1926 when obstetrics and [1907–08 to 1921–22] [https:// calendar (1919–20), 124-8. gynaecology were combined there. 244 Mitchinson, Giving Birth in archive.org/search.php?query=cre- Canada, p.234. Leslie Watt twice notes 214 “McCrae, John,” Dictionary 224 Kendrick and Slade, 30-2. The ator%3A%22University+of+Toron- that Scott pioneered the technique of Canadian Biography [ ht t p:// new wing was at 149 Rusholme to.+Faculty+of+Medicine%22]. at TGH; see Cairns, p.73, 75. Watt www.biographi.ca/en/bio/ Road, next door to the hospital’s also notes Scott’s conservative policy mccrae_john_14E.html]. 233 Douglas E. Cannell, interview School of Nursing. It added 52 beds with Valerie Schatzker (transcripts, on performing the procedure: “Each 215 Heather McDougall, “Toronto’s and 25 infant cots to the 25 beds p.28), [24 April 1979 – 19 June caesarian section performed at | MAVERICKS, COLLABORATORS VISIONARIES, AND Health Department in Action: and 10 cots at 125 Rusholme. 1979, (17 May 1979)]. UT Archives, the Toronto General Hospital was reviewed personally with the professor Influenza in 1918 and SARS in 2003,” 225 Kendrick and Slade, 33. “Hannah Institute fonds”. in Magda Fahrni and Esyllt W. Jones [Scott] and only strictly defined Shorter, 563-4. For Edna Guest, 234 Quoted in Shorter, p.528. indications were acceptable” (p.75). (eds.), Epidemic Encounters: Influenza, see also note 36 above. Society and Culture in Canada, 1918- 235 Robinson, Marion O. 245 Cosbie, “Maternal Mortality,” 1920, 230. See also McDonald, 67. 226 Sheinin and Bakes, 106-7. Give My Heart: the Dr. Marion p.43. [There is a conflict between the 216 Cosbie, 160. 227 Sheinin and Bakes, Hilliard Story, p.127. figures Cosbie gives here in Table 44-5. Shorter, 564. IX, stating c-section incidence for 217 Kendrick and Slade, 236 “President’s Report for the year private patients at TGH was 7.4 per Spirit of Life, 31-2. 228 Shorter, Edward. Partnership for ending June 1934,” pp.4-5. Hendry cent and for public 2.7 per cent, with Excellence: Medicine at the University “retired under the age limit after his statement that the rate at TGH 218 McDougall, 232. of Toronto and Academic Hospitals, spending the full vigour of [his] life in 1938 was 1.7 per cent. Either pp.527-8. For further biographical in the service of the University” the data in the table is aggregate 219 Cosbie, 175. Shorter, 527. (p.4). He was 61 on stepping down. The first resident in Obstetrics and information on Hendry, see James for the period 1926–1937, or the Gynaecology was Donald M. Low. Goodwin, Our Gallant Doctor: Enigma 237 [Population stats for Toronto, figure “2.7” is a misprint of “1.7”.] and Tragedy: Surgeon Lieutenant George based on censuses in 1921 and 1941] 220 McDonald, 79. Hendry and HMCS Ottawa, 1942, 246 Mitchinson, Giving Birth ch.1. See also Hendry’s obituaries in 238 Cosbie, W.G. “Maternal in Canada, pp.234-5. 221 See the register of students in The Globe and Mail (25 March 1939), Mortality,” CAMJ 43.1 (July 1940): the Faculty of Medicine calendar 247 Mitchinson, Giving Birth 90 p.13; and in CMAJ 40.5 (May 1939): 38-44 (p.41). For information on in Canada, pp.255-6. (1921–22), 124-36. [While not stated 524, 526. Hendry’s war service is long-term national trends in fertility, in the statistics on p.136, the number 248 Cairns, p.74. chief of Obstetrics and Gynaecology Hospital”, while M.M. was chief of SMH, 25 October 2012]; [http:// at TWH in the Faculty of Medicine obstetrics there. In the calendar for www.stmichaelshospital.com/ 249 Wendy Mitchinson focusses calendar for 1920–21, p.12. He is 1919–20, Frawley had also become media/detail.php?source=hospital_ on “the ability of Canadians to not listed for the following session, “Assistant in Obstetrics” (p.17). For news/2012/20121025_hn]. control their fertility” in explaining though Wesley is still listed as assistant 1920–21, Frawley is listed as “Assistant the changes in the national birth in Obstetrics and Gynaecology at in Obstetrics and Gynaecology, 275 Arthur Hudson, quoted rate in the first half of the 20th TWH; see calendar (1921–22), p.26. St. Michael’s Hospital” (p.19) but in McDonald, For the Least of century; Mitchinson, Body Failure: However, Wesley’s obituaries, in Crawford is no longer listed – My Brethren, p.141. Recall that Medical Views of Women, 1900–1950, The Globe and Mail (27 March 1962) effectively making Frawley chief of O’Leary had lost his leg as a result pp.159-88 (p.163). Tudiver also and in CMAJ 86.24 (16 June 1962), the combined services at SMH. of German shelling during WWI. notes the contributing factors of state that he was chief at TWH from 276 Kopplin, p.12. industrialisation, urbanisation, 1919 to 1946. He was definitely chief 265 Frawley obituary in CMAJ child labour laws, improving public there by 1924; see Annual Report 66.4 (April 1952): 403. 277 Budhram, “Ghost of Sister health, and socioeconomic upheavals for Toronto Western Hospital (1924), Vinnie a soothing sight”. Shevlen is such as the Depression and the two 266 McDonald, For the Least TWH Archives [TW 1-1-6]. of My Brethren, p.124. the only source named who discusses World Wars; Tudiver, p.8. See also the ghost. She also mentioned Mitchinson’s observation that “access 256 See TWH Annual Report 267 “Dr. Frank Joseph O’Leary Sister Vincentia’s ghost to me in to birth control across Canada… was (1925), p.5, 9; TWH Archives Dies Suddenly at 61,” The Globe and interview, 8 November 2016 [no still class-based” in the first half of the [TW 1-1-7]. The report notes that Mail (4 February 1952), pp.1-2. recording]. Also on SMH website. 20th century, and that “those who “through arrangements made with were poor and members of minority the University of Toronto a year 268 For biographical information on 278 Marrus Barsky, Lesley. From groups did not always have access to ago, bedside clinics are being given O’Leary, see Robert B. Meiklejohn, Generation to Generation: A History of safe abortions because they lacked in obstetrics” (p.9). Evidently then, 1936-1985, The First Fifty Years: The Toronto’s Mount Sinai Hospital, pp.23-5. both funds and a [social class] position there had not been any clinical Canadian Gynaecological Society, p.67; See also “Our History,” Mount Sinai of negotiation with those who could teaching in obstetrics until 1924. and McDonald, For the Least of My Hospital; [http://www.mountsinai. provide them with a safe abortion”; Brethren, p.125. See also O’Leary’s on.ca/about_us/history/history]. Mitchinson, Body Failure, p.164, 176. 257 See “Toronto Western Hospital obituaries in the Toronto Daily Star fonds” finding aid, UHNA. (4 February 1952) and The Globe 279 Marrus Barsky, pp.9-10, 12, 25. 250 Goodwin, “Casebooks”, p.26 and Mail (4 February 1952), and in (Table 1). [The figures are only for 258 For the 1924 figure, see TWH 280 Marrus Barsky, pp.3-4. Annual Report (1924). For the 1929 CMAJ 66.4 (April 1952): 403. the month of September 1927, and 281 Marrus Barsky, p.25. there is no sense of how many of these figure, see the draft annual report for 269 Meiklejohn, p.67. were self-induced or therapeutic.] 1929; TWH Archives [TW 1-1-8]. 282 Marrus Barsky, pp.17-19. Irene McDonald also notes that TWH 270 There is a slight discrepancy 251 Cosbie, “Maternal Mortality,” had the busiest obstetrical service about the year O’Leary became 283 Marrus Barsky, p.28, 30-1. p.39. [Likewise, Cosbie gives no in Toronto in 1934; see McDonald, chief at SMH. Meiklejohn says 1945 sense of how many of these were For the Least of My Brethren, p.124. (p.67), as does his obituary in the 284 Marrus Barsky, pp.32-3. self-induced or therapeutic. However, Globe and Mail (the one in CMAJ 285 Marrus Barsky, p.44. he does state that “it has been 259 See TWH Annual doesn’t specify). McDonald alternately conservatively estimated that two- Report (1940), p.3; TWH says both 1945 (p.125) and, more 286 Marrus Barsky, p.56. thirds of the deaths from abortion Archives [TW 1-1-9]. definitively, 1947 (p.148). Frawley’s 287 “Dr. Bertha Wilensky: College follow criminal interference” – which 260 For biographical information CMAJ obituary says 1947; CMAJ TORONTO OF UNIVERSITY gives some sense at least of the 101.11 (29 November 1969): 694. Hospital Staff Member,” The Globe on Wesley, see his obituaries, in The and Mail (13 February 1951), p.7. suspicion with which even medical Globe and Mail and in CMAJ. The professionals viewed miscarriages.] 271 “Sister Vincentia: 60,000 Babies See also Torontonensis (1929), p.84. latter misspells his name as “Westley”. Had Her Care in 30 Years,” The Globe 288 See note to “Dr. Rose Abron 252 Goodwin, “Casebooks,” p.25. 261 Grosso, Francesca. The and Mail (28 February 1958), p.5. It should be noted that from 1929, [graphic material] – July 1943” in History of Sunnybrook Hospital: 272 For biographical information “Sylvia Schwartz fonds,” Ontario TGH did begin accepting one Jewish Battle to Greatness, p.348. intern per year, and subsequently two on Sister Vincentia, see McDonald, Jewish Archives; [http://search. p.126; and P.A. Kopplin, On Call in the ontariojewisharchives.org/Permalink/ per year; see Edward Shorter, p.542. 262 See draft of TWH Annual & GYNAECOLOGY OBSTETRICS Report (1947), TWH Archives [TW Heart of the City: 100 Years of Resident descriptions23566]. See also “Rose 253 For particulars on Stowe- 1-1-11]. Both Wesley and Magwood and Intern Life at St. Michael’s Hospital, Lahman and Dora Smith Head Gullen, see Kathleen Smith, “Dr. are listed as consultants, as well as p.12; see also her obituary in The Globe Workers for Lady Fergusson Tea,” Augusta Stowe-Gullen: a pioneer Manning. For further information and Mail (28 February 1958), p.5. The Southern Israelite (31 October of social conscience,” CMAJ 126.12 on Magwood, see his obituary in Miss Mary Mullen of Toronto took 1958); [http://israelite.galileo.usg.edu/ (15 June 1982): 1465-7 (p.1467). CMAJ 113.7 (4 October 1975): 659. her vows and the name Sister Mary israelite/view?docId=bookreader/ Vincentia on 15 August 1925; see the asi/asi1958/asi1958-0782.mets. 254 See the account of the history of 263 See TWH Annual item, “Sisters Take Vows,” Toronto xml#page/1/mode/1up]. See also TWH in University Health Network Report (1940). Daily Star (17 August 1925), p.3. “Obituaries,” Mobile Journal-Inquirer Archives, online finding aid for (11 January 2001); [http://m. “Toronto Western Hospital fonds” and 264 See Faculty of Medicine calendar 273 Kopplin, p.12. journalinquirer.com/mobile/archives/ related series; [https://www.archeion. (1916-17), p.17. Frawley is listed as obituaries/article_9506c44c-e975- ca/toronto-western-hospital-fonds]. “Demonstrator in Anatomy; Assistant 274 Margaret Riddell, quoted in Navindra Budhram, “Ghost of Sister 51c6-a852-46eb842f1997.html]. in Gynaecology; Gynaecologist, See also Torontonensis (1932), p.87. 91 255 A.A. MacDonald is still listed as Chief of Service, St. Michael’s Vinnie a soothing sight,” [posted by 289 Marrus Barsky, pp.52-3, 61-3. 304 “Our History,” Kensington rchives%22+AND+%28president% 323 Cosbie, The Toronto Marrus Barsky describes how MSH Health; [https://www. 27s+report+AND+collection%3Ato General Hospital, p.223. initially secured a site adjacent to kensingtonhealth.org/Kensington- ronto%29&sort=-date&page=2]. In HSC, much to HSC’s chagrin. In Hospice/About-Us/Our-History.aspx]. 1928–29, Scott was promoted from 324 Shorter, pp.663-4. 1944, the two hospitals negotiated an associateship to assistant professor, 325 President’s Report (1945), for MSH to develop a different site at 305 [David Harrison], “The then to full professor in 1935–36 First SSJD Convent,” [blogpost p.30; [https://archive.org/details/ University and Elm, in exchange for once he became chair; see President’s presidentsreport1945univ]. HSC’s support for MSH eventually from 27 April 2012]; [https:// Report (1929), p.4 [https://archive. becoming a teaching hospital, and lostanglicanchurches.wordpress. org/details/presidentsreport1929univ]; 326 Douglas E. Cannell, for HSC to begin accepting Jewish com/category/sisterhood- and President’s Report (1936), interview with Valerie Schatzker interns and residents; p.53. of-st-john-the-divine/]. p.9 [https://archive.org/details/ (transcripts) [24 April 1979 – 19 presidentsreport1936univ]. June 1979, (7 June 1979)]. 290 Marrus Barsky, p.66, 69, 84. 306 Shorter, pp.563-4. See also Kendrick and Slade, Spirit 315 Cairns, John D. “Memories 327 Cosbie, The Toronto 291 See Torontonensis (1926), p.32. of Life, p.102; and Sheinin and of the 1930s: A Conversation with General Hospital, p.239.

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: Bakes, pp.44-5, 106-7. Dr. Leslie Watt,” in Thomas F. 292 Marrus Barsky, pp.93-4, 152-3. 328 Douglas E. Cannell, interview 307 Kendrick and Slade, Spirit of Baskett (ed.), Pages of History in 293 Quoted in Marrus Barsky, p.152. Canadian Obstetrics and Gynaecology, with Valerie Schatzker (transcripts, Life, p.102. [See notes to section on pp.55-6). For Cannell’s work on Marion Hilliard for further details.] pp.72-5 (pp.72-3). See also [Robert 294 See “Obituary: Born in Toronto? B. Meiklejohn], The Canadian venereal disease following his return, You may know Dr. Ludwig,” 308 Kendrick and Slade, Gynaecological Society, 1936-1985: see the Annual Report for Toronto Toronto Star (30 September 2012). Spirit of Life, pp.34-7. The First Fifty Years, p.5. Western Hospital (1944), pp.30-1, TWH Archives [TW 1-1-10]. 295 Marrus Barsky, pp.87- 309 “The Story of Grace, a Century 316 Cosbie, W.G. The History of the 88 (photo caption, p.87). of Service,” Toronto Grace Health Society of Obstetricians and Gynaecologists 329 [Robert B. Meiklejohn], The Canadian Gynaecological Society, 1936- 296 Marrus Barsky, pp.102-5. Centre; [http://www.torontograce. of Canada, 1944-1966, pp.13-5. See org/about-tghc/story-of-grace/]. also H. Oxorn, SOGC: The First 1985: The First Fifty Years, p.66. 297 Marrus Barsky, p.119. Fifty Years 1944-1994, pp.10-1. 310 “Hospital Grew From Small 330 [Robert B. Meiklejohn], The 298 It is unclear precisely when Start: Among Ourselves,” The Globe 317 Douglas E. Cannell, interview Canadian Gynaecological Society, 1936- Harris retired, but Papsin became and Mail (2 December 1938), p.14. with Valerie Schatzker (transcripts, 1985: The First Fifty Years, p.72. See chief in early March 1971, taking over p.55), [24 April 1979 – 19 June also Watson’s obituary in The Globe from Sidney Tobin, who had been 311 “6,000 PERSONS BORN IN 1979, (12 June 1979)]. UT Archives, and Mail (25 July 1989). John Mann’s acting-chief; Marrus Barsky, p.151. WOMEN’S HOSPITAL SINCE ITS “Hannah Institute fonds”. service in Watson’s unit is suggested by INCEPTION: Its Splendid History the photograph of Mann in uniform 299 “Our History,” St. Reviewed at Opening of New Wing 318 See President’s Report (1920), “at Niagara Camp, 7th Cavalry Field Joseph’s Health Centre; [https:// SALVATION ARMY’S WORK,” p.65; [https://archive.org/stream/ Ambulance Reserve” in Thomas stjoestoronto.ca/your-health- The Globe and Mail (1 July 1925), p.14. presidentsrepor1920univ#page/64/ F. Baskett, “John Mann and His centre/about-us/our-history/]. mode/2up/search/scott]. Obstetric Forceps,” in Baskett (ed.), 312 In 1938, 745 babies were born at Pages of History in Canadian Obstetrics 300 “Our History: Celebrating the Grace; see “Hospital Grew From 319 Douglas E. Cannell, and Gynaecology, pp.44-6 (p.44). 130th Anniversary!” Sisterhood Small Start: Among Ourselves,” The interview with Valerie of St. John the Divine; [http:// Globe and Mail (2 December 1938), Schatzker (transcripts, p.55). 331 Cosbie describes M.C. Watson’s www.ssjd.ca/history.html]. p.14. In 1947, there were 2542 births service with the 3rd Division in | MAVERICKS, COLLABORATORS VISIONARIES, AND at the hospital, and 2735 births in 320 Cosbie notes that many Normandy; Cosbie, The Toronto 301 “ST. JOHNS HOSPITAL: 1948; see “NOT ONE DEATH older physicians retired after General Hospital, p.237. For further Opening of a New and Important IN CHILDBIRTH AT ARMY the war; Cosbie, The Toronto details of Watson’s service in Surgical Institution,” The HOSPITAL,” The Globe and Mail (30 General Hospital, p.243. Normandy, see Watson’s own account, Globe (1 April 1889), p.8. April 1948), p.15; and “Grace Hospital 321 Douglas E. Cannell, interview “Medical Aspects of the Normandy 302 “Dr. R. V. B. Shier: In Practice Takes in Unmarried Mothers-to-Be,” with Valerie Schatzker (transcripts, Invasion” CMAJ 53.2 (August 1945): As Surgeon For 40 Years,” The Globe The Globe and Mail (6 May 1949), p.17. pp.55-6). This reasoning is 99-111. The assertion that Watson was one of (if not) the first medical officers and Mail (12 Dec 1961), p.4. He 313 See the calendar of the Faculty of attributed to Scott by Cannell. was the father of Crawford Shier, a to land on D-Day is made by his son- Medicine for 1915–16, listing Scott as 322 Shorter, Edward. Partnership for in-law, quoted in Watson’s obituary TGH Obstetrics and Gynaecology, “Assistant Demonstrator in Obstetrics who was the father of R. Michael Excellence: Medicine at the University of in The Globe and Mail (25 July 1989). and Gynaecology, Demonstrator Toronto and Academic Hospitals, pp.530- Shier, currently a member of the in Anatomy, In charge of Out- 332 McArthur does not seem to department based at Sunnybrook. 1. For further biographical information patient Department in Obstetrics on Scott, see W.G. Cosbie, The have served overseas. His obituary 303 “The Sisters’ Mission at St. and Gynaecology, Toronto General Toronto General Hospital, 1819-1965: in The Globe and Mail (16 November John’s Rehab’,” Sisterhood of St. Hospital” (p.21); [https://archive. A Chronicle, pp.245-6. See also Scott’s 1964) states that “during the Second John the Divine; [http://www. org/details/calendarmed1915univ]. obituaries in The Globe and Mail, World [War] he served as an officer with Royal Canadian Naval Volunteer ssjd.ca/stjohnsrehab.html]. See 314 For Scott’s promotions, see (20 February 1960), in The Toronto also Pamela E. Klassen, Spirits of Daily Star (20 February 1960), and in Reserve.” Cosbie notes his rank as University of Toronto President’s Surgeon Lt.-Commander; Cosbie, Protestantism: Medicine, Healing, Reports [http://archive.org/search. CMAJ 82.17 (23 April 1960): 898. 92 and Liberal Christianity, pp.93-4. The Toronto General Hospital, p.237. php?query=collection%3A%22uofta Cosbie also describes George Hendry’s service and death, p.241. 343 Millar and Gidney, “Medettes,” 352 For his appointment as chair of 363 Shorter, p.530. See also For Hendry’s service, see also James p.225. See also “Open Army Ranks Pharmacology, see President’s Report McArthur’s obituaries in The Goodwin, Our Gallant Doctor: Enigma to Women Doctors,” Toronto (1946), p.30. For details of his research Globe and Mail (16 November and Tragedy: Surgeon Lieutenant George Daily Star (10 July 1942), p.2. on addiction, including his scientific 1964), in The Toronto Daily Star (17 Hendry and HMCS Ottawa, 1942. martini-drinking, see National Post November 1964), and in CMAJ 344 President’s Report (1940), (27 December 1999), p.(A)20. See 92.2 (9 January 1965): 97. 333 Cosbie, The Toronto p.147; [https://archive.org/details/ also President’s Report (1954), p.163. General Hospital, p.238. presidentsreport1940univ]. 364 Mitchinson, Body Failure, 353 National Post (27 pp.222-3. For further details 334 See ”TWH Annual 345 Quoted in Jaclyn Duffin, “The December 1999), p.(A)20. on Hilliard’s contribution, Report” (1944), p.30-1. Quota: ‘An Equally Serious Problem’ see section on Hilliard. for Us All,” Canadian Bulletin of Medical 354 Shorter, Partnership 335 Cosbie, The Toronto History 19.2 (2002): 327-50 (p.339). for Excellence, p.530. 365 Cosbie describes his and General Hospital, pp.228-9. Also quoted in Shorter, p.545. McArthur’s own work in Cosbie, 355 Shorter, p.530. See also 336 Cosbie, The Toronto The Toronto General Hospital, 346 For a discussion of the post- Torontonensis (1915), p.167. pp.206-7. See also Shorter, p.530; General Hospital, p.226. war quota system for medicine at 356 Shorter, p.530. For further and Cosbie, “The Contribution 337 Cosbie notes the number of University of Toronto, see Duffin. of Radiotherapy to the Modern Jan Steiner became chair of the details on Cosbie’s war service, TGH nurses and graduates who see “Chapter 3 (1912–1922)”. Treatment of Female Pelvic Cancer,” served in the war, citing a plaque Admissions Committee for the BJOG 66.5 (Oct 1959): 843-8. in the Nurses’ Residence; Cosbie, Faculty of Medicine in 1961. He 357 Cf. Cosbie, W.G. “The The Toronto General Hospital, p.240. stopped adhering to the quotas and Obstetrical Causes and Prevention of 366 Shackleton, Kevin R. Second For the contribution of SMH began accepting students solely based Stillbirth and Early Infant Mortality,” to None: The Fighting 58th Battalion nurses, see Irene McDonald, For the on marks (the ostensible admissions CMAJ 13.12 (December 1923): 877– of the Canadian Expeditionary Force, Least of My Brethren, p.143. For the policy). Despite decreasing in the 880. I infer 1928 as the beginning of pp.295-6. [Shackleton does not contribution of TWH nurses, see 1960s, the number of female medical their collaboration given that Richards give any source for this anecdote.] students began to increase after 1970. “TWH Annual Report” (1944), p.31. and Cosbie state that the departments 367 Item, “Leaves $144,000 Steiner’s policy change also had of Radiology and Obstetrics and 338 Cosbie, The Toronto General the effect of opening up medicine for research,” Toronto Daily Star Gynaecology at TGH began (23 February 1965), p.31. Hospital, p.225. McDonald notes to vastly more Asian students, who collaborating in that year, and that similar labour shortages at SMH, constituted 40 per cent of the class by “the same group” had continued the 368 See President’s Report (1954), p.142. There was a similar shortage the mid-1960s. See Duffin, pp.341-4. project throughout the data-gathering p.60. See also “5 Department at TWH, especially because support (a group which would have included Heads Appointed at U of T,” The staff were shifting to better-paying 347 National Post (27 December 1999), p.(A)20. Cosbie); see G.E. Richards and W.G. Globe and Mail (1 July 1965), p.5. jobs elsewhere; see the Annual Report Cosbie, “The Radiological Treatment for Toronto Western Hospital (1940), 348 Baskett, “Ferguson’s of Cancer: Methods and Results II. 369 Cosbie, The Toronto General TWH Archives [TW 1-1-9]. Reflex,” p.22. Carcinoma Cervicis Uteri,” CMAJ Hospital, 1819-1965: A Chronicle. 35.4 (October 1936): 381–385 (p.381). 339 Marrus Barsky, Lesley. From 349 For the most detailed summary 370 Shorter, Partnership for Excellence, Generation to Generation: A History of Shorter dates their collaboration in p.531. See also Van Wyck’s obituaries of Ferguson’s career prior to 1946, oncology to the “late 1930s” (p.530) Toronto’s Mount Sinai Hospital, p.56. see the University of Toronto in The Globe and Mail (12 March 1952), – neglecting that Richards and Cosbie and in CMAJ 66. (May 1952): 508.

President’s Report for 1946, p.30. TORONTO OF UNIVERSITY 340 Shorter, p.543, 545. Until co-authored a multi-year study on See also Torontonensis (1911), p.120. about the end of the war, TGH 350 Baskett, “Ferguson’s Reflex,” gynaecological carcinoma in 1936. would offer internships to two Jewish 371 Shorter, p.531. See also p.22. See also National Post (27 358 See President’s Report medical graduates from University December 1999), p.(A)20. Torontonensis (1915), p.181. of Toronto, while TWH would offer (1933), p.44. He seems to have one. SMH evidently offered none. 351 Ferguson, J.K.W. “A Study of stopped this research by 1936; see 372 For details on Van Wyck’s the Motility of the Intact Uterus President’s Report (1937), pp.59- service with the CAMC, see Chapter 341 Millar, W.P.J. and Gidney, at Term,” Surgery, Gynecology, and 60, where only the radiotherapy 3, (1912–22). For the anecdote about R.D. “‘Medettes’: Thriving or Just Obstetrics, vol.73 (1941): 359-366. research is now mentioned. Van Wyck teaching patients French, Surviving? Women Students in the see Buxton, William, et al. (eds.), & GYNAECOLOGY OBSTETRICS For discussions of the significance 359 Shorter, pp.501-2. The Faculty of Medicine, University of of Ferguson’s discovery and for Harold Innis Reflects: Memoir and WWI Toronto, 1910-1951,” in Smyth et al. clinic was run by William Henry Writings/Correspondence, p.70, 218. biographical information, see Thomas Beaufort Aikins, nephew of (eds.), Challenging Professions, pp.215- F. Baskett, On the Shoulders of Giants: 33 (p.225). See also Shorter, p.567. William Thomas Aikins, Dean of 373 Shorter, pp.528-9, 531. Eponyms and Names in Obstetrics and Medicine from 1887 to 1893. See also Cosbie, The Toronto 342 For biographical information Gynaecology, pp.72-3; and Thomas F. General Hospital, pp.202-3. on Davis, see Rose Sheinin and Baskett, “Ferguson’s Reflex: Then 360 Shorter, pp.503-5. and Now,” in Thomas F. Baskett 374 Shorter, p.530. Scott, W.A. Alan Bakes, Women and Medicine 361 Mitchinson, Wendy. Body in Toronto since 1883, p.23. See also (ed.), Pages of History in Canadian and H.B. Van Wyck, The Essentials Obstetrics and Gynaecology, pp.20-3. Failure: Medical Views of Women, of Obstetrics and Gynecology (1947). Martin Kendrick and Krista Slade, 1900-1950, pp.223-6. Spirit of Life: The Story of Women’s 375 President’s Report College Hospital, p.39, 102. 362 Quoted in Wendy (1947), p.10, 30. Mitchinson, Body Failure, p.224. 93 376 Douglas E. Cannell, interview certified by the American Board of 398 Walter Hannah, interview 413 Shorter, p.571. with Valerie Schatzker (transcripts, Obstetrics and Gynecology in 1934, with Christopher Geary (11 p.56), [24 April 1979 – 19 June which suggests that he remained September 2016); [see recording]. 414 Shorter, p.570. Kendrick and 1979, (12 June 1979)]. UT Archives, in Cleveland until that year. Slade, p.42. See President’s Report’s “Hannah Institute fonds”. 399 Douglas Gare, interview [1955-62] for further details. 388 Cannell describes his war with Christopher Geary (28 377 Cannell, interview with service; Cannell, interview with November 2016); [no recording]. 415 Ibid., p.569. Schatzker (transcripts, p.55). See also Schatzker (transcripts), [(7 June 1979)]. 416 For biographical accounts President’s Report (1947), p.10. Cannell was never chief surgeon to 400 Cf. list of members of the “Cannell Club” in Bryans, “Douglas of Hilliard, see Edward Shorter, the No. 15 CGH, as Bryans contends; Partnership for Excellence: Medicine at 378 Shorter, p.531. Bryans, in Baskett (ed.), p.14. Cannell and the Cannell Lectureship,” in Baskett (ed.), p.16 (Table 1). the University of Toronto and Academic 379 Shorter, p.531; Cosbie, p.247. See 389 Cannell, interview with Hospitals, pp.568-71; Rose Sheinin also President’s Report (1950), p.124. Schatzker (transcripts), [(12 June 401 Shorter, p.533 and Alan Bakes. Women and Medicine 1979)]. Cannell does not state what in Toronto Since 1883: A Who’s Who, 380 See President’s Report 402 Bryans, “Douglas Cannell and pp.40-3; and Martin Kendrick and

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: year he returned from service. Cosbie, (1950), p.12, 45. the Cannell Lectureship,” in Baskett Krista Slade, Spirit of Life: The Story Bryans, and Meiklejohn all say 1943, (ed.), p.16. See also “5 Department 381 President’s Report (1952), p.59. but Shorter says 1944. Shorter seems of Women’s College Hospital, pp.97-8. Heads Appointed at U of T,” The See also Marion Robinson’s full- to be supported by R.W. Wesley’s Globe and Mail (1 July 1965), p.5. 382 Douglas E. Cannell, interview report welcoming Cannell’s return in length biography of Hilliard, Give My with Valerie Schatzker (transcripts), the TWH Annual Report for 1944, 403 Meiklejohn, pp.54-5. Heart: the Dr. Marion Hilliard Story. [24 April 1979 – 19 June 1979, pp.30-1; TWH Archives [TW 1-1-10]. (24 April 1979)]. UT Archives, 404 Bryans, “Douglas Cannell 417 “Dr. Marion Hilliard Dead; A “Hannah Institute fonds”. 390 Cannell describes his and the Cannell Lectureship,” Specialist in Obstetrics,” New York appointment as chair; Cannell, in Baskett (ed.), pp.16-18. Herald Tribune, 17 July 1958. On her 383 See Torontonensis (1927), p.74. interview with Schatzker collaboration with the ghostwriter For Cannell’s acquaintance with (transcripts), [(12 June 1979)]. For 405 For Hilliard’s friendship with June Callwood, see “Journalist, Hilliard, see section on Hilliard. Cannell as “something of a dark Maryon Pearson (nee Moody), activist June Callwood dies at 82,” For the discontinuation of the MB horse,” see also Shorter, p.531 see Robinson, p.62 and passim. The Globe and Mail (16 April 2007). degree, see the University of Toronto President’s Report (1928), pp.72-3. 391 For further details on Dean 406 See Torontonensis (1927), 418 Kendrick and Slade, p.98. p.74, 76. [https://archive.org/ MacFarlane, see Shorter, pp.720-2, 419 Robinson, p.300. 384 F.E. Bryans, “Douglas Cannell and “Joseph Arthur MacFarlane,” details/torontonensis27univ]. and the Cannell Lectureship,” in “Living History,” University of 420 For biographical information T.F. Baskett (ed.), Pages of History in 407 Shorter, p.569; Sheinin Toronto Faculty of Medicine; [http:// and Bakes, p.40. on Maloney, see Rose Sheinin and Canadian Obstetrics and Gynaecology, livinghistory.med.utoronto.ca/ Alan Bakes, Women and Medicine in pp.14-19 (p.14). See also Edward people/joseph-arthur-macfarlane]. 408 Shorter follows Kendrick and Toronto Since 1883: A Who’s Who, Shorter, Partnership for Excellence, Slade in stating that obstetrics and pp.60-1; and Edward Shorter, pp.531-4; W.G. Cosbie, The 392 Cannell, interview gynaecology were combined at Partnership for Excellence: Medicine Toronto General Hospital, 1819- with Schatzker (transcripts), WCH under Marion Grant Kerr in at the University of Toronto and 1965: A Chronicle, pp.311-2; and [(12 June 1979)]. 1926; Shorter, p.564, and Kendrick Academic Hospitals, p.571. See also Robert Meiklejohn, The Canadian and Slade, p.102. However, Marion Maloney’s obituary, “Geraldine Gynaecological Society, 1936-1985: 393 For details on the “Gallie course,” see Shorter, pp.43-6, 116-8. Robinson provides the fullest Maloney was head of obstetrics at The First Fifty Years, pp.54-5. account of the WCH department’s Women’s College,” Toronto Star (24 | MAVERICKS, COLLABORATORS VISIONARIES, AND 385 Cannell, interview with 394 William Whittaker seems reorganisation, which was only October 1985); and the account of Schatzker (transcripts), [(17 May 1979)]. to have had a typical run of the effected in 1935; Robinson, p.183. her career upon stepping down as “Cannell course;” see Whittaker, Sheinin and Bakes also state that WCH chief in “Women’s hospital 386 Cannell, interview with “Part 9. 1954–1958 Toronto Obs,” Kerr became chief of the combined names 1st male department head,” Schatzker (transcripts), [(17 May [document]. Cf. University of Toronto department in 1935, but are mistaken The Globe and Mail (25 June 1966). 1979)]. See also Shorter, p.532; and Academic Divisions Calendar, in contending that Kerr only came on Bryans, in Baskett (ed.), p14. 1961–62 (L to Y) [Division of staff there in 1929 (which is impossible 421 “Geraldine Maloney was head Postgraduate Medical Education], if she appointed Hilliard her assistant of obstetrics at Women’s College,” 387 Cannell describes his pp.23-5; [https://archive.org/stream/ in 1928); Sheinin and Bakes, p.49. It is Toronto Star (24 October 1985). postgraduate training and early career; uoftcalendaracad1961ly#page/n195/ possible that Kerr had been in charge See also Torontonensis (1930), p.69; Cannell, interview with Schatzker mode/2up/search/Obstetrics]. of both separate services before 1935. and Torontonensis (1937), p.112. (transcripts), [(17 May 1979) and (7 June 1979)]. Bryans seems correct 395 Cannell, interview with 409 Robinson, pp.171-5. 422 “Geraldine Maloney was head in stating that Cannell had seven Schatzker (transcripts), [(12 June of obstetrics at Women’s College,” years of postgraduate training, but 1979)]. See also Shorter, p.531. 410 Shorter, p.569. See also Toronto Star (24 October 1985). is mistaken in asserting that Cannell Robinson, pp.241-4. 396 Cannell, interview 423 “Open Army Ranks to Women returned to Toronto from Cleveland 411 Shorter, p.566. Kendrick Doctors,” Toronto Daily Star (10 in 1938 to come on staff at TWH; with Schatzker (transcripts), [(12 June 1979)]. and Slade, p.40. July 1942). Note that Maloney had Bryans, in Baskett (ed.), p14. Cannell already enlisted in the RCAMC 94 himself states that he was associated 397 Goodwin, quoted 412 Shorter, p.570. Kendrick before this change was made. with Salvation Army Grace Hospital in Shorter, p.532. and Slade, p.41. from 1934. He also states that he was 424 “Women’s hospital names 430 For an account of the Dr. Goran Enhorning Foundation for first year at SickKids, which was 1st male department head,” The affiliation of the WCH department, Pulmonary Research; [http://www. 1998–1999. Cowell’s obituaries in Globe and Mail (25 June 1966). see Shorter, pp.570-1. enhorningfoundation.org/about/]. The Calgary Herald and The Globe and Mail note the OMA award in 2008. 425 “VICTIM OF ROBOT, CWAC 431 Shorter, p.571. 442 Lockwood and Bocking, MEDICO HOME,” The Globe and “William M. Paul MD”. 452 Charney, “A Tribute to Mail (19 July 1944). Maloney does not 432 Hannah, Walter. A Dr. Carol Cowell,” Turner seem to have been seriously injured, Glimpse of My Life, p.50. 443 R. Derek Nicholson, Syndrome Society of Canada interview with Christopher Geary (1 if at all, though she did present as 433 Hannah, A Glimpse [from society’s newsletter. 2011]. the first patient at the Army’s female November 2016); [see recording]. of My Life, pp.50-2. 453 Obituary in the veterans’ hospital a few months later. 444 Bryans, Fred, “Dr. Douglas 434 “Tradition Ends as 2 Men Toronto Star (c. 1994). 426 “Women’s hospital names Cannell and the Cannell Lectureship,” Named to Women’s College Hospital JOGC (December 1997): 1444 (Table 454 For Harkins’ internship and 1st male department head,” The Staff,”The Globe and Mail (12 April Globe and Mail (25 June 1966). 1). Cowell is the only woman listed marriage, see Douglas Gare, personal 1961). See also Kendrick and Slade, among members of the “Cannell interview with Christopher Geary, 427 There is some confusion about Spirit of Life, pp.44-5; and Hannah, Club,” composed of those who had 28 November 2016. For dates of when Maloney passed her fellowship A Glimpse of My Life, pp.54-5. trained in OBGYN under Cannell. his training and staff appointment, examinations. Shorter says 1945 435 “Women’s hospital names See also her Globe and Mail obituary. see obituary in the Toronto Star. (p.571), as do Sheinin and Bakes 1st male department head,” The Anne Claessens, the second chief It can be inferred that Harkins (p.60). However, the specialty was Globe and Mail (25 June 1966). resident in OBGYN at TGH, noted undertook the OBGYN residency not recognised for fellowship until that Cowell had been the first. See from July 1951 to June 1955. 1947; see David A.E. Shephard, The 436 For biographical information Claessens, E. Anne. Interview with Royal College of Physicians and Surgeons on Paul, see Shorter, Partnership Christopher Geary. 16 January 2017. 455 See PubMed database, using of Canada, 1960-1980: The Pursuit of for Excellence, pp.533-4; and Paul’s search term: “Harkins JL”. 445 “Today’s teen-agers want Unity, p.337. 1947 makes the most obituary in The Globe and Mail (22 456 For the decline in research sense as Maloney seems to have done November 2006). See also Charles. answers on sexual development, MD says,” The Globe and Mail, 4 impact and output, see Shorter, two years of training after the war, J. Lockwood and Alan D. Bocking, pp.534-5. For Harkins’ focus and only came on staff at TGH in “William M. Paul MD, November February 1971, p.(W)4. See also “Doctor studies adolescence,” on pedagogy, see his obituary 1947 (which would have been after 19, 2006” American Gynaecological in the Toronto Star. securing her fellowship). In 1945, and Obstetrical Society; [http:// Toronto Daily Star, 4 Febraury 1971. Jean Davey, a physician at WCH agosonline.org/public/PDF/paul- 446 “Dr. Carol Cowell,” obituary in 457 Jerry Shime, personal and chief of medicine there from wm-2006.pdf]. The latter provides The Calgary Herald (29 January 2011). interview with Christopher 1950 to 1965, became the very first the fullest account of Paul’s career. See also her obituary in The Globe Geary, 4 January 2017. Canadian woman to gain fellowship and Mail, 29 January 2011, p.(S)8. in the RCPSC. She was also the first 437 Lockwood and Bocking, 458 Obituary in the female doctor to serve in the Canadian “William M. Paul MD”. 447 Allen, Lisa. Interview Toronto Star (c. 1994). armed forces (specifically with the 438 Lockwood and Bocking, with Christopher Geary. 459 Jerry Shime, personal RCAF). See Martin Kendrick and “William M. Paul MD”. For 21 December 2016. interview with Christopher Krista Slade, Spirit of Life: The Story further details on Paul’s research Geary, 4 January 2017. of Women’s College Hospital, p.94. 448 Jerry Shime, personal in this period, see President’s interview with Christopher Report (1957), pp.149-50. 460 For an indication of this TORONTO OF UNIVERSITY 428 See “Tradition Ends as 2 Geary, 4 January 2017. discrimination, see the list of the Men Named to Women’s College 439 Shorter, p.533. See also Walter almost entirely white and male Hospital Staff,” The Globe and Mail 449 Allen. Interview. See also Hannah, A Glimpse of My Life, p.83. Susan Charney, “A Tribute to Dr. members of the “Cannell Club” in (12 April 1961); and “Women’s Fred Bryans’, “Dr. Douglas Cannell hospital names 1st male department 440 “Our History,” Department Carol Cowell,” Turner Syndrome Society of Canada [c.2011]. and the Cannell Lectureship,” JSOGC head,” The Globe and Mail (25 June of Obstetrics and Gynecology, 19.13 (December 1997), p.1444. 1966). Maloney became an associate University of Alberta; [https:// [https://www.yumpu.com/en/ in obstetrics and gynaecology in www.ualberta.ca/obstetrics- document/view/35273455/ 461 Jerry Shime, personal interview tribute-to-dr-carol-cowell-turner- the Faculty of Medicine in 1955 on gynecology/about-us/our-history]. with Christopher Geary, 4 January & GYNAECOLOGY OBSTETRICS becoming associate chief at WCH; Goodwin returned to Toronto syndrome-society-of-canada]. 2017. See also “History of Obstetric see President’s Report (1956), p.40. in 1967; Shorter, p.534, 571-2. 450 Cowell is referred to as an Medicine in Toronto,” www. Note that Maloney’s associateship obstetricmed.utoronto.ca; [http://www. 441 Shorter, p.572. For further associate professor in October 1979 is listed under “Promotions” and article in the Toronto Star [“Teen obstetricmed.utoronto.ca/About_Us/ not under “New Appointments,” information on Enhorning, see history_of_Obstetric_Medicine.htm]. his obituary in The Toronto Star (16 abortions defended,” Toronto Star, 28 indicating that she was already a October 1979.] Shime, in Interview, member of the OBGYN department. February 2013); [http://www.legacy. 462 Walter Hannah, interview com/obituaries/thestar/obituary. gave an account of Cowell’s promotion August 2016 with Christopher Geary. 429 See President’s Report (1947), aspx?pid=163063813]; and the tribute to full professor. In 1968, Jean Flatt pp.106-7; and her publication on to him in The Globe and Mail (6 August Davey and F. Marguerite Hill, 463 Walter Hannah, interview vaginal cytology listed in President’s 2013) [http://www.theglobeandmail. both WCH physicians, became full August 2016 with Christopher Geary. professors in the Faculty of Medicine. Report (1951), p.171. Maloney com/life/facts-and-arguments/goran- 464 Walter Hannah, interview was assisted by Shier from 1949, enhorning/article13611942/]. See also 451 Allen. Interview. Allen recalled August 2016 with Christopher Geary. 95 but Shier took the lead on this “About the Dr. Goran Enhorning that Cowell retired after Allen’s research (at TGH) in 1950. Foundation for Pulmonary Research,” 465 Walter Hannah, interview 489 Interview with Doug Gare 510 http://www.torontopubliclibrary. August 2016 with Christopher Geary. April 2017 with Kristen Gane. ca/search.jsp?Ntt=Toronto+(Ont.)-- Directories&Ntk=Subject_Search_ 466 Walter Hannah, interview 490 McCargar 2 June 2014 Interface&view=grid&Erp=20. August 2016 with Christopher Geary. Toronto Star article. 511 Conversation with Ted 467 Walter Hannah, interview 491 ht t p://doczz.net/ Brown and Lee Adamson / August 2016 with Christopher Geary. doc/5629438/this-pdf-file--- Kristen Gane April 2017. canadian-bulletin-of-medical- 468 Shorter, 535. history - accessed 14 May 2017. 512 Shorter, 533. 469 Knox Ritchie, August 2016 492 McCargar 2 June 2014 513 President’s Report, 1955. Interview with Christopher Geary. Toronto Star article. 514 Chatham-Kent 470 Knox Ritchie, August 2016 493 McCargar 2 June 2014 Heritage Resources. Interview with Christopher Geary. Toronto Star article.

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: 515 Shorter, Partnership 471 Shorter, 536. 494 C. Backhouse, Canadian Bulletin for Excellence, p.530. 472 Shorter, 536. of Medical History, The celebrated abortion trial of Dr. Stowe. 516 Shorter, p.530. See also 473 Knox Ritchie, August 2016 McArthur’s obituaries in The Interview with Christopher Geary. 495 McCargar 2 June 2014 Globe and Mail (16 November Toronto Star article. 1964), in The Toronto Daily Star (17 474 January 2017, interview November 1964) and in CMAJ with Christopher Geary. 496 http://www.cpha. 92.2 (9 January 1965): 97. ca/en/programs/history/ 475 Report of the Chair, achievements/04-fp/history.aspx 517 The First Fifty Years, Department Self-Study. 2012. accessed 14 May 2017 (CPHA). 1936-1985: The Canadian Gynaecological Society, 80. 476 Interviewed by Kristen 497 http://www.cpha. Gane, April 2017. ca/en/programs/history/ achievements/04-fp/history.aspx 477 Interview with Ted accessed 14 May 2017 (CPHA). Brown and Lee Adamson with Kristen Gane April 2017. 498 McCargar 2 June 2014 Toronto Star article. 478 Report of the Chair, Department Self-Study, 2012. 499 Shulman, Morton. Coroner, pp 58-61 Fitzhenry & Whiteside, 1975. 479 Report of the Chair, Department Self-Study, 2012. 500 McCargar 2 June 2014 Toronto Star article. 480 Kaufman, History of Ontario Midwifery, JOGC 1998;20(10):976-81. 501 Toronto Star 1 November 1967. 481 Kaufman, History of Ontario 502 Toronto Star 1 November 1967. Midwifery, JOGC 1998;20(10):976-81. | MAVERICKS, COLLABORATORS VISIONARIES, AND 503 The Globe and Mail 24 482 Taken from www.cmo.ca February 1975; page 5. (College of Midwives of Ontario). 504 Interview with P Bernstein 483 Gare, Home or Hospital 25 May 2017 with Kristen Gane. Births? 1980 JAMA. 505 Interview with P Bernstein 484 Interview with Ray Osborne 25 May 2017 with Kristen Gane. April 2017 with Kristen Gane. 506 Abortion rights: significant 485 Interview with P Bernstein moments in Canadian history 25 May 2017 with Kristen Gane. access 14 May 2017, http://www. cbc.ca/news/canada/abortion- 486 Personal communication 12 rights-significant-moments-in- April 2017 with Kristen Gane. canadian-history-1.787212. 487 College of Physicians and 507 Interview with P Bernstein Surgeons of Ontario, “out of 25 May 2017 with Kristen Gane. hospital births”, the College Notes, March 1983. 508 Interview with P Bernstein 25 May 2017 with Kristen Gane. 488 Personal email between 96 Vicki Van Wagner and Kristen 509 Interview with P Bernstein Gane, 14 April 2017. 25 May 2017 with Kristen Gane.

Dr. Abheha Satkunaratnam prepares to dock for Robotic Surgery at St. Michael’s Hospital, 2018 UNIVERSITY OF TORONTO TORONTO OF UNIVERSITY OBSTETRICS & GYNAECOLOGY OBSTETRICS

99 175 Years: A History of the Department About the Authors

of Obstetrics & Gynaecology Kristen Gane is a Toronto writer, editor and psychotherapist. She joined the Visionaries, Mavericks, and Collaborators Department of Obstetrics and Gynaecology in 2015 and thoroughly enjoyed the From the first student lecture on Front Street in privilege of exploring its history. 1843 to the advanced clinical work of the present

175 YEARS: A HISTORY OF THE DEPARTMENT OF OBSTETRICS & GYNAECOLOGY & GYNAECOLOGY OBSTETRICS OF DEPARTMENT THE OF A HISTORY 175 YEARS: Christopher Geary initiated the project as day, this rich 175-year history of Canada’s largest a research assistant under the direction Department of Obstetrics & Gynaecology offers of John Kingdom in 2015; he is currently a compelling glimpse into the challenges and a doctoral student in English at the University of California at Berkeley. successes experienced by the decades of dedicated men and women who have strived to advance John Kingdom has been a high-risk women’s health. There is much to honour and pregnancy specialist at Mount Sinai Hospital since 1998. He was appointed celebrate, as the Department moves forward Chair of the Department of Obstetrics with renewed determination and expertise in and Gynaecology in 2013 and continues support of clinical and educational progress. to lead with vision and vigor. | MAVERICKS, COLLABORATORS VISIONARIES, AND

102