Discipline of Surgery

MILESTONES IN SURGICAL PRACTICE AND TEACHING IN NEWFOUNDLAND AND LABRADOR'S HISTORY

Written by Jennifer Moran, Discipline of Surgery

September 27, 2021
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The First Surgery Facilities and Operating Room

There is historical evidence of medical facilities existing in Newfoundland and Labrador as early as the late 1600s. However, a main hospital site intended to service the majority of the population was only first established by 1813 under the name of the General Hospital and was situated in St. John’s. The Riverhead Hospital building, built in 1814 on what is now known at the Victoria Park site in downtown St. John’s, was used until 1888 when it was deliberately destroyed after falling into total disrepair. The General Hospital then moved into a structure built in 1851 on King Edward's Place in St. John's known as the Old General Military Hospital. At the time of its use, it underwent several renovations to upgrade the building including a hot air furnace, toilets, a kitchen, pantry and linen rooms. During 1879 came the first request for “separate surgical wards so that doctors could operate in a proper operating room, rather than in a ward with other patients and behind a baize screen (Story, p.5)”. In 1909, a new nursing residence was opened containing a proper operating room, a surgeon’s change room, a sterilizing room, a room for anesthetics, and the surgical patients were on the same floor as the operating room so that clean and septic cases could be separated. This wing contained four wards, each named after prominent figures in medical history: Ms. Agnes Cowan[1], Dr. William Carson[2], Mr. Charles Crowdy[3], and Mr. Henry Shea[4]. Unfortunately, despite all efforts to save the wards as historic structures, they were demolished in 1997.

Archival records reveal that by the late 1920s there were over 50 medical establishments in Newfoundland, most of which were concentrated in the immediate St. John’s area. Many sites came into fruition through charitable groups and private industry that established medical facilities to treat particular diseases, or disorders; or to service a particular population. Examples of such facilities include: the Poor Asylum, St. John’s (1892)[5]; the Fever Hospital, St. John’s (1877)[6]; the IODE Women’s Tuberculosis Camp, St. John’s (1910)[7]; the Sanatorium, St. John’s (1917)[8]; the Grace Maternity Hospital, St. John’s (1923)[9]; and, Bowater’s Corner Brook General Hospital, Corner Brook (1925)[10] (Heritage Newfoundland and Labrador, 2008). Familiar sites still active as hospitals and teaching sites today include St. Clare’s Mercy Hospital[11], Southcott Hall[12], Waterford Hospital[13] and, the Notre Dame Bay Memorial Hospital[14].



Further surgical practice within cottage hospitals in Newfoundland

There are also records that provide evidence that as early as 1911, at least 119 doctors were living in Newfoundland and Labrador (Founder’s Archive, n.d.). The majority of these physicians were practicing in the local St. John’s region with access to well-supported facilities and medical equipment. However, due to the rural distribution of the Newfoundland population, physicians had to travel to and from remote geographical areas to visit patients in need of urgent or emergent care, provide medical advice, and promote health education. Because some areas were extremely remote, there became a need to establish physical sites for doctors and nurses to visit with patients, care for the sick, and to carry out required procedures. Eventually, this need to broaden health care services resulted in the establishment of a cottage hospital system in 1935 by the Commission of Government[15].

These first government-funded cottage hospitals operated on the same principles as the Scottish cottage hospital system. Similar to Scotland, Newfoundland was a country with a large part of its population living in scattered communities, many of which were quite isolated. Scotland’s concept was to strategically locate small hospitals around the coast to provide the best access to medical care for rural populations. Although the Scottish model was a unique system to North America, cottage hospitals were not unique to Canada - or even within Newfoundland. Three hundred and thirty-nine cottage hospitals are recorded to be operating in Canada in 1933 (Lake, 2010), and Sir Wilfred Grenfell had been successfully operating a privately-funded hospital site in Battle Harbour, Labrador since 1893 (Grenfell Historical Society, n.d.). By 1936, there were seven cottage hospitals in operation[16] throughout Newfoundland, with an additional eight sites established by 1946. Each site had a capacity of eight to twenty beds, operating rooms, x-ray facilities, laboratories, and dispensaries, and was staffed by a physician, nurses, nurses’ aides, a secretary-treasurer, a cook, a janitor, and several maids. By 1954, the cottage hospital system expanded to nineteen sites with a total of 543 beds (Lake, 2010).

The Commission of Government created a debt load during its tenure primarily due to the expenses accumulated from the establishment and maintenance of these medical sites. By the 1930s, the number of physicians in the country had decreased by almost 30%[17], so the demand for practicing physicians grew in rural areas. These practitioners often performed common surgical procedures like appendectomies and tonsillectomies, but more complicated patient cases were sent to larger hospitals in the St. John’s area, creating the need (and expense) for medical transportation. Remote areas were mainly serviced by boat[18], and these vessels[19] also served as mobile clinics. In order to recuperate some of the costs of patient transport, the cottage hospital system created a type of “health insurance” where families would pay an annual fee[20] for medical services. The fees covered all medical services, with the exception of childbirth and dental procedures. The cottage hospital system, with its fee-for-service model, was allowing rural doctors to provide reliable primary health care to individuals and families who once did not have access to such continuing and comprehensive medical care services in the communities they called home.   This fee model is often referenced as the example that inspired the Medical Care Plan (MCP) in Canada.

The cottage hospital system is not only historically significant for expanding access to high-quality, reliable medical care services to the rural Newfoundland, but also because it was instrumental in providing public health education to the general population and providing medical knowledge and training to aspiring clinicians and nurses. In fact, the cottage hospital system is often credited for the community health ideals that fueled the establishment of the first medical school in Newfoundland, and has influenced the structure of programs in nursing and medicine we know today at Memorial University. In an article written by Dr. Ian Bowmer in the publication Capturing an Era: History of the Newfoundland Cottage Hospital System, he credits Dr. John Ross for acknowledging that a visit from the legendary Dr. Ian Rusted was not just a consultation but an opportunity to learn. Dr. Ian Rusted, the first Dean of Medicine at Memorial University, conceptualized a medical education program grounded on the principles of community and community health – the principles that defined the cottage hospital system in Newfoundland.
 
 

Surgery as an academic discipline

The history of the academic discipline of surgery dates back to the beginning of the formation of the medical school at Memorial University. On March 31, 1968, Dr. James B. Littlefield of Rhode Island, NY was appointed as professor of surgery, one of two major academic appointments granted at that time, and Littlefield was also named chief of surgery at the St. John’s General Hospital, an announcement made by Health Minister John C. Crosbie. Following in 1970 were several other part-time academic appointments in the discipline – Dr. J.D. Baird, chief of surgery at the General Hospital; Dr. Richard Kennedy, chief of surgery at the Janeway Child Health Care Centre; Dr. John Blackwood, chief of surgery at the Grace Hospital; and, Dr. George Battcock, chief of surgical service at the General Hospital. In 1973, after a review of administrative appointments, Dr. Christopher Heughan was named as a lecturer of surgery. Dr. Littlefield stepped down as chairman in 1974 and was succeeded by Dr. Cecil Couves. Following in 1979 was the appointment of Dr. Earle Wright as professor and chairman of surgery and as chairman of the department of surgery at the General Hospital.

The Discipline of Surgery has also been led by the following chairs:

Dr. F. Maroun     1989  – 1999
Dr. Pollett          1999 – 2009
Dr. D. Boone      2009 – 2017
Dr. C. Stone       2018 – Present
 
Over the last 40 years, there has been a long list of gifted individuals who have contributed their clinical skills and medical knowledge to practice and teaching in the Discipline of Surgery at Memorial University. Many general and orthopedic surgeons have been recognized for individual achievements and some still carry legacies in the discipline. 

As of October 2021, the Discipline of Surgery has 13 full time faculty members and 40 part time faculty in Newfoundland and Labrador, 9 part time faculty in Prince Edward Island, and 53 part time faculty in New Brunswick. Many of our faculty are general and orthopedic surgeons, but there are many other surgeons who are clinically skilled and academically learned in surgical sub-disciplinies, including: trauma, critical care, surgical oncology, bariatric, pediatric surgery, urology, otolaryngology, plastic surgery, thoracic surgery, ophthalmology, cardiac surgery, intenstive care, cardiovascular surgery,  and vascular surgery. During your residency at Memorial, there are elective opportunities in many of these sub-disciplines.

The Discipline of Surgery at Memorial's Faculty of Medicine offers fully accredited residency programs in General Surgery and Orthopedic Surgery.

For more information on our residency programs, please visit PROGRAMS.
 
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REFERENCES
 
Collier, Keith. 2011. “Cottage Hospitals and Healthcare in Newfoundland”. Heritage Newfoundland and Labrador.
https://www.heritage.nf.ca/articles/society/cottage-hospitals.php

Faculty of Medicine Founders’ Archive. “The Story of the Medical School”.  The Early Days of the Medical School at Memorial University of Newfoundland. https://www.med.mun.ca/earlydays/default.htm

Founder’s Archive. (n.d.). “Timeline”. The Early Days of the Medical School at Memorial University of Newfoundland. http://www.med.mun.ca/earlydays/pages/timeline.html

Higgins, Jenny. 2007. “Social Changes under the Commission of Government”. Heritage Newfoundland and Labrador.
https://www.heritage.nf.ca/articles/politics/social-changes-commission-government.php

Lake, Edward F. J. (2010). Capturing an era: History of the Newfoundland cottage hospital system. Argentia Pilgrim Publishing.

Story, Janet. “Heritage Buildings Report: The General Hospital, St. John’s”. The Trident. January, 1998. Pp. 5-7.
 

FOOTNOTES
[1] A nurse and hospital administrator, died in 1893 of tuberculous at the age of 54.
[2] A physician, but also well known for his political activity.
[3] A political figure and member of legislative council, active from 1831 – 1855.
[4] An Irish Catholic immigrant to Newfoundland, noted as one of the most respectable citizen and merchants active in St. John’s between 1767 and 1830.
[5] Historical references speculate that this facility was established, or refurbished, as a relief effort in relation to the St. John’s fire of 1892, which destroyed almost all of St. John’s, affecting 11,000 people and causing more that $13 million in property damage.
[6] This facility was located on Forest Road, and intended to treat patients with fever, caused by communicable disease (i.e. smallpox).
[7] A summer rest camp for women with tuberculosis operated by the Imperial Order of Daughters of the Empire
[8] The primary location for the treatment of patients suffering from Tuberculosis.
[9] Operated by the Salvation Army as a relief effort for unwed mothers, the hospital also served as a facility to educate and train nurses as midwives. In 1929 it also operated a children’s ward.
[10] Instituted by Bowater Newfoundland Limited, known today as Corner Brook Pulp and Paper Limited, intended to serve its employees and their families
[11] Still operates under this name.
[12] Southcott Maternity and Children’s Hospital established in 1916 is now part of the Leonard A. Miller Center Complex, 100 Forest Road, St. John’s, NL
[13] Originally known as the Lunatic Asylum; established in 1854, and is now operated as the Waterford Hospital at 306 Waterford Bridge Road, St. John’s, NL.
[14] Located in Twillingate, first opened in 1924 with 60 beds; still in operation.
[15] On February 16, 1934 the Commission of Government, consisting of seven persons appointed by the British government, was sworn in. One of the seven commissioners, a Newfoundlander, was responsible for a senior department of government known as Public Health and Welfare.
[16] Old Perlican, Markland, Agentia, Harbour Breton, Burgeo, Come By Chance, Burin.
[17] From 119 in 1911 to 83 in 1930.
[18] The first vessel purchased in 1935 was the MV Lady Anderson, a converted yacht staffed by a doctor and a nurse
[19] Five medical cruisers were in service between 1950 and 1967, mainly to service the Southcoast of the island
[20] $10.00 per family or $5.00 per individual