Taking Toronto’s Healthcare History – Abstracts

Medical History in “Otnorot”: Autopsy on a Living Patient

Michael Bliss

Professor Bliss’s keynote address will be a wide-ranging, sometimes anecdotal examination of the condition of medical history in Toronto as it evolved during the twentieth century, and as it stands today. He will touch on organic and functional aspects of the subject, including the role of the faculty of medicine and other silos within the university, the contributions of “amateurs” and “professionals” to the writing of Toronto medical history, the problem of the curriculum, the problem of medical students, the contributions (and limits) of the Toronto Medical Historical Club, the Academy of Medicine and its Museum of the History of Medicine, and Associated Medical Services/Hannah Institute. He will draw on his experiences researching the discovery of insulin to highlight how Toronto’s single greatest contribution to medicine became its single greatest obstacle to writing objective history. For many years no one wanted the history of the discovery of insulin to be written.

In his dissection of the current health of medical history in Toronto, he will reflect upon the deep affinity that health-care workers naturally have for the history of their work and how it can be better understood and furthered by historians. But he will also warn about the peril of diluting disciplined historical work with excessive enthusiasm for fashions in the medical humanities. When we take a patient’s history our main concern is not literary, ethical, or sociological; it has to be deeply professional.

Toronto’s Medical Collections: Past, Present, and Future

Ari Gross and Erich Weidenhammer, IHPST

Since the foundation of the University of Toronto, a number of collections of medical material have come and gone. These have included anatomical collections, collections of historical medical and dental instruments, and a collection of pathological specimens. Although some of these collections still exist, many have been dispersed.

This talk seeks to traces the history and diversity of medical collections relating to the University of Toronto, from the now-defunct Museum of the History of Medicine at Toronto (1907-1993), to the surviving anatomical specimens depicted in Grant’s Atlas of Anatomy (first edition published in 1943). It will also discuss the current locations of historical material once owned by the university.

We will conclude by discussing recent efforts by the University of Toronto Scientific Instrument Collection to preserve and curate some of the older surviving medical instrumentation, and solicit the assistance of the Toronto medical community in building a collection of historically significant objects.

Creating Nursing Identity: The Toronto General Hospital Student Nurse’s Uniform

Christina Bates

The Toronto General Hospital School of nursing (TGH) was founded in 1881, and was to become one of the largest and most prestigious schools in Canada. The TGH nurses were first uniformed like household servants, in a brown checked dress with apron and mob cap. After Nursing Superintendent Agnes Snively took over, the uniform was re-designed more in line with what came to be accepted as “nursing uniform” of striped blue dress, bib, apron and diminutive cap. In the 1940s, TGH led the way with a unique uniform consisting of dress and overall apron; soon to be replaced with a one-piece uniform that set the standard for nursing school uniforms. My presentation will use the TGH example to discuss how the uniform as material culture can illuminate aspects of nursing history that elude written sources.

The nurse’s uniform was an intrinsic part of the culture of the nursing school, residence and hospital ward. The progression of uniform designs at TGH, as an example, underlines significant changes in the nursing profession. In the late-nineteenth century, nursing reform led to the creation of nursing schools and a transition to a young, respectable and skilled nursing workforce. This transition, however, created serious cultural anxieties that nursing reformers had to mediate. Their challenges centred on gendered understandings of the role of women in the workplace: how could they make it acceptable for innocent, respectable women to enter the male-dominated hospital milieu as professionals trained in the handling of bodies, especially male bodies? The uniform was an important strategy for resolving this difficulty. The image of the hygienically starched and proficient modern nurse that persisted throughout much of the twentieth century helped to make the transition acceptable. But the image also militated against nursing’s desire for autonomy and professionalization, eventually leading to the rejection of the uniform close to the end of the twentieth century. But for over a hundred years, the uniform created patterns of behaviour, values and identities that defined generations of nurses.

One Man’s Passion for Anatomy: J.C.B. Grant and the Founding of an Anatomical Museum

Margaret Olszewski

Dr. John Charles Boileau Grant (1886-1973) was Chair of the Department of Anatomy at the University of Toronto between 1930 and 1956. During his tenure, he wrote three anatomical textbooks, the best known of which was Grant’s Atlas of Anatomy (1943). Currently in its twelfth edition and translated into Italian, Japanese, Portuguese, Spanish and Turkish, Grant’s Atlas continues to be one of the most widely used anatomical atlases among medical students.

Many of the dissections used for the anatomical drawings contained in this text were preserved in the anatomy museum at the University and are available for study by medical students and anatomical scholars to this very day. However, while there are some writings on the life and work of J.C.B. Grant and his contributions to the study of anatomy, very little published material on the Grant Museum is available – even the exact founding date of the Museum is unknown. A smattering of popular culture references in the media, an even more limited number of academic texts and fragmented oral histories are all that currently capture the history of this seminal collection.

This paper catalogues the history of the anatomical museum at the University of Toronto in the 1930s and 40s. The founding of this museum is described and the role of medical museums in medical education during this period is examined. Using archival holdings at the University of Toronto including University records in the Department and Faculty of Medicine and the Department of Art as Applied to Medicine, and personal collections held at the University, this paper explores: 1) Grant’s goals for the collection and the anatomical museum 2) the collaboration between illustrator, dissector and anatomist and 3) student, administrative, and public uptake of and response to the anatomical museum. Through this research, it becomes clear that this educational initiative was as much a testament to one man’s passion for anatomy, as it was a product of a conflicted and transitioning time period.

Toronto, Toxoid & The Defeat of Diphtheria: “Object” of Immunization Innovation – “Agent” of Public Health Change, 1925-1935

Christopher Rutty

Diphtheria was the childhood scourge of the late 19th and early 20th century. Developing, evaluating and efficiently delivering a means to prevent its spread was the focus of a pioneering public health effort in Toronto that began in 1925. Diphtheria toxoid was that means, and through an unprecedented attack on the disease, within five years incidence was reduced by some 90%. Indeed, within a decade, diphtheria mortality and morbidity rates in Toronto had fallen effectively to zero.

Toronto’s remarkable success in bringing diphtheria under control was the product of a unique collaborative effort between Toronto’s public health department, the Ontario Department of Health, and the University of Toronto’s School of Hygiene and Connaught Laboratories.

While this presentation with highlight the contributions of several key individuals in the Toronto diphtheria story, the primary focus will centre on diphtheria toxoid itself as an “object” of immunization innovation and as an “agent” of significant public health change in Canada.

This presentation will be highly visual, taking advantage of the rich image archive and other primary materials held in the archives of Sanofi Pasteur Limited (formerly Connaught Laboratories), as well as the public health literature of the period.

Inflitrating the Curriculum: Triumphs and Disasters in Bringing History to Future Doctors

Jackie Duffin

For 25 years, Duffin has opted for a “infiltrative” method to integrate history with the other more traditional subjects in the medical curriculum, including both the basic and clinical sciences in all four years of study. She focused on two modest goals: 1. to raise awareness of history as a research discipline relevant to medical practice; and 2. to encourage skepticism about everything else being taught.

Her plan has enjoyed some success, but it also encountered obstacles intrinsic to health professional training; in some situations, it failed completely. Perversely, some of the greatest barriers to success stem from medical attitudes to history and the other humanities and their potential role in clinical life.

Qualified to Practice – The Development of Medical School Accreditation in Canada

Aaron Minster

As medical education developed in North America in a time of rapidly advancing medical science there sprung up a number of schools producing questionable doctors. A standardized system of accreditation was needed to guarantee a uniform quality of graduate; to preserve public trust in the profession and in the larger medical establishment. Throughout that process Canadian medical schools have had a sometimes uneasy relationship with their stakeholders: the profession, governments and the public. This work examines the history of the accreditation of Canadian medical schools from the perspective of the early schools at Toronto to the integrated faculty at the U of T. Through that lens it explores early attempts at standardization and integration with American institutions at the time of Flexner. It tells the story of Canada’s ties with the powerful medical institution south of the 49th, explores developments through Canada’s turn to socialized medicine and the repatriation of the accreditation process with the establishment of the national Committee on Accreditation of Canadian Medical Schools.

Medical History in Canadian Undergraduate Medical Education: Then and Now

Jonathan Fuller* and Margaret M. Olszewski PhD

*presenting author

Many have commented on the merits of an education in the history of medicine (HoM) for medical students and doctors. Recognition of the value of medicine’s history for its practitioners, along with the status of the HoM in undergraduate medical education, has varied considerably across time and institution in Canada. We analyzed this chronological trend using previous surveys of Canadian faculties of medicine. In 2011, we conducted our own survey of the seventeen accredited faculties of medicine to ascertain details about present curricular and extracurricular HoM education initiatives for medical students. Faculty members involved in professionalism curricula or HoM teaching were contacted by email and their responses were individually analyzed and quantitatively summarized. Half of Canada’s medical schools provide core lectures in the HoM, similar to the proportion that did so a little over a decade ago. Interestingly, almost all schools without HoM lectures offered electives in the subject. We closely examined HoM teaching in undergraduate medical education at the University of Toronto as a case study, situating this narrative against the backdrop of the historical and institutional trend we described. Reflecting on medical history’s place within medical pedagogy suggests diverse and changing dispositions toward the discipline.

The Eugenic Legacy of Psychiatry: A History Lesson

Sarah Colman, Psychiatry, University of Toronto

This paper explores the case of a woman being treated for psychotic illness and substance dependence, who unwittingly became pregnant. An exploration of the history of eugenics within psychiatry follows.

In the early 19th centuries scientific and social theories led to biological determinism throughout Canada, the United States and Germany. Of particular concern were criminals, the impoverished, prostitutes and the mentally ill. The Eugenics movement, which promoted segregation and sterilization of those likely to pass on “defective” genes, was implemented in the United States in 1907. Over 42,000 people were officially sterilized between 1907 and 1944.

Prominent Toronto psychiatrists C.K Clarke and Clarence Hincks were vocal supporters of eugenics. Their work helped to pass The Sexual Sterilization Act in Alberta in 1928, which lead to the sterilization of over 3500 people.

In 1933, Hitler became chancellor of the Third Reich, and Germany’s longtime priority of public health became justification for eugenic sterilization programs. After 1939, eugenic logic went a step further; senior psychiatrists selected mentally disordered patients to be dispersed to medical killing centres. Between 1939 and 1945, 180,000 psychiatric patients were “euthanized” in Nazi Germany.

We must remember that our predecessors were well-intentioned creatures of their time and reflect on our own equivalent practices today. Preventative health should never be prized above treatment of those who are ill. We must be mindful that political and economic pressures can intrude on our decisions about delivery and distribution of resources and be vigilant in preventing a new biological determinism from sweeping our profession.

What Disturbs Our Blood: A Cautionary Tale of a Toronto Medical Family

James FitzGerald

Drawing from his award-winning book, “What Disturbs Our Blood”, journalist James FitzGerald “takes Toronto’s healthcare history” within his own prominent medical family, exploring the fine line between high professional achievement and mental breakdown.

His grandfather, Dr. J.G. FitzGerald, the founder of the Connaught Laboratories and an internationally recognized pioneer in public health, was responsible for saving countless lives in Canada and abroad; yet mysteriously, he killed himself at the height of his success. James’ father was a pioneering Toronto allergist, yet his career was cut short by severe drug addiction and depression. Both men received bio-medical treatments – drugs and shock – at the expense of in-depth talk therapy.

Suicide and addiction endure as highly stigmatized conditions, doubly so when occurring within the medical/psychiatric/helping professions. In his exploration of the history of Toronto psychiatry, James raises several inter-related questions:

• -What happens when the doctor becomes the patient, when the helpers need help?
• -Can the evolving science of the brain work hand in hand with the evolving art of in-depth psychotherapy inside the walls of a bio-medical institution such as CAMH?
• -Are bio-medical and humanistic conceptions of “mental illness” fundamentally incompatible?

With the Ontario government’s formation of The College of Registered Psychotherapists in the spring of 2013, an opportunity arises: the expansion and re-invention of the channels of referral between medical and non-medical models of therapy.

Work in the early 1900s: a form of treatment, an outcome, and the impetus for a new healthcare profession at the University of Toronto

Judith Friedland

In the aftermath of World War I, Canada was forced to consider a definition of health that included social and economic well-being. If injured soldiers were unable to work and become productive citizens, their dependence would create grave consequences for themselves and for the country. During the soldiers’ lengthy convalescence, it fell to “ward aides” to raise the soldiers’ morale, build their self-esteem, and teach them new skills. These women provided occupations, generally in the form of crafts, at the bedside and on the wards in preparation for vocational training. As work with veterans decreased after the war, the ward aides expanded their role to provide service to civilian populations in hospitals and community-based workshops. Dr Alexander Primrose, Dean of the Faculty of Medicine at the University of Toronto, was a staunch supporter of the fledgling profession (now known as occupational therapy), and helped establish its diploma program at the university in 1926. Over the following decades, as the importance of the biomedical model increased, attention to work and productivity as health outcomes decreased, and the nature of occupational therapy adjusted its focus.

Using materials from the University of Toronto Archives and Library and Archives Canada, and the rehabilitation literature for the period, this presentation considers the importance of work and productivity in promoting health in the first part of the last century. A comparison is made with practice in today’s health care environment where work, which is accepted as a key determinant of health, is not adequately addressed.

The Rockefeller Foundation’s Nursing Moment and the Toronto hub.

Sioban Nelson, Dean and Professor, Lawrence S Bloomberg Faculty of Nursing, University of Toronto

Following WWI the development of nursing education and training was shaped by an ambitious plan to transform health care and the health of the population across the globe. For over 30 years the Rockefeller Foundation supported the creation of nursing schools in many parts of world. The Rockefeller Foundation invested in the training of directors and staff for these new schools, as well as in the training of public health nursing leaders, through its extensive fellowship program. Estimates vary but records exists for approximately 700 nursing fellows, a substantial proportion of whom visited Toronto for training programs that ranged from weeks to years. This paper discusses the role of the nursing school at the University of Toronto from the 1920s to the 1950s in the creation of this highly particular global nursing elite. It takes as its starting point the story of individual fellows and examines the historiographical challenges and narrative opportunities the records of these internationalist nurses provide. This paper forms part of a digital project entitled: “The Nursing Moment”, developed for the centenary of the Rockefeller Foundation in 2013.

“I think she is just Belgian, also an over-tired Belgian:” Mapping “difference” at the University of Toronto Nursing School.

Karen Flynn, PhD, Department of Gender and Women’s Studies and African-American Studies, University of Illinois, Urbana-Champaign

Since its inception, the University of Toronto School of Nursing (UTSN) has played a formative role in the education of international students. Clearly, a transnational site of activity, designated students from around the globe, often with the support of the Rockefeller Foundation fellowships, pursued post-graduate training. Upon completion of their programs which lasted anywhere from 6-12 months, the students were expected to return to their countries of origin and assume leadership roles in their institutions. Drawing on Rockefeller Foundation archival sources (from 1920-1950) and using an intersectional analysis that considers race, class, gender, language, nation and nationality, this presentation aims to explore how the UTSN under the leadership of Kathleen Russell and RF officers helped international RF students navigate the unique challenges of being a “foreign” student in Toronto. While some scholarly attention has been paid to some of the fellowship nurses who gained international prominence as well as the uniqueness of the UTSN, less is known about how these fellows negotiated the demands of their training and Canadian cultural generally. Paying attention to the challenges of students who occupy particular bodies in a particular geographical space despite a shared educational agenda, adds another dimension to the health care narrative in the city of Toronto.

Historians and Physicians: What They Can Learn From Each Other

Edward Shorter

The history of medicine is essentially interdisciplinary. Historians are trained to identify more the context; physicians are well outfitted to follow the narrative. Each discipline can also, of course, do the work of the other. The context of the history of medicine in Toronto is provided by two world wars that forged a sense of camaraderie among academic physicians, who often identified one another by military rank. This camaraderie played a role in the extraordinary cooperation that went on among hospitals and between lab and lecture room. It had the negative side of excluding women from the jolly common room. But the narrative in Toronto medicine is important too, because it takes us from the achievements of the basic science departments, in the insulin and heparin stories, to the tremendous role of the hospitals in medical discovery after the Second World War, as seen in the rise of cardiovascular surgery and neurosurgery in Toronto – both pediatric and adult – to world renown. Both kinds of contributions, context and narrative, are important in understanding the Toronto story.

History, Medicine and the Power of “Making Strange”

Brian Hodges

Medical education and practice are highly ritualized and contextual. Yet practicing physicians and medical students can easily loose sight of the cultural and contingent nature of our current professional activities. Our ways of teaching, learning and practice appear to be so natural that it is difficult for us to think that they could have been undertaken in any other way. For example, for decades, the assessment of competence consisted of long written tests of knowledge. Then, in the 1960s, a new notion of “performance” appeared. Competence was not what you know, but what you could show. What had been taken for granted and assumed to be “normal” for so long suddenly appeared, if not strange, at the very least worthy of questioning – a rather arbitrary construction, one that perhaps could be re-examined or changed. Another compelling example is the much-recounted history of the (heroic) Flexnerian reforms of medical education in North America. More than one hundred years later these reforms continue to serve as the basis for a particular narrative about modern medical education. And yet various historical accounts position the Flexner reforms in contrasting ways, some of them very critical.

The study of medical history serves as an immediate and potent corrective, illustrating that many, if not most, of the structures of medical education and practice are historical constructions. This realization can provide medical educators and students the freedom to re-imagine what medicine and medical education could be. History then, in helping us to “make strange”, ensures that medicine in its capacity to elicit, tell and retell enchanting narratives, retains at least a modicum of reflectivity about the constructed nature of its stories.