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History of the Department of Paediatrics


The Hospital for Sick Children, or "SickKids" as it is affectionately known, and the Department of Paediatrics share an exciting history which began shortly after the birth of our country. In the 1870's, Toronto was a city of approximately 68,000 citizens with Bloor Street as its northern border. Visitors and merchants, upon entering the city, were confronted by a toll-gate situated on Bloor Street which demanded 10 cents for a loaded cart and 1 cent for each goat, sheep, or pig. Downtown Toronto was the slum centre of the city and was comprised of decrepit shanties, lack of plumbing, but plenty of outdoor privies. Approximately 50 percent of all recorded deaths were in children less than 10 years of age and were primarily the result of infectious diseases, diarrhea and malnutrition. There were no medical facilities designed for children and epidemics which killed countless children came with relentless frequency.

SickKids came into being because of the remarkable commitment and vision of a group of women, led by Mrs. Elizabeth McMaster. They managed to pinch together enough money to purchase an old three-story home which stood on Avenue Road, about 50 yards north of the current site. The house had 11 rooms, but the roof leaked and the windows were falling from the frames. The first SickKids opened its doors on March 23, 1875 with certain restrictions including an emphasis on managing outpatients and age limitations for inpatients between two and 10 years of age, i.e., infants were not admitted. Furthermore, it was decreed that children with smallpox or "incurable diseases" could not be admitted or cared for!

In 1875, the world had very few hospitals exclusively for children. The Hospital for Sick Children on Great Ormond Street, London, England, established in 1854, was the only paediatric hospital in the British Empire in existence at the time and in 1855, the Children's Hospital of Philadelphia (CHOP) became the first paediatirc hospital in the USA.

During the next 17 years, SickKids moved no less than four times, primarily because of lack of space due to the increasing patient demands. During the first five years of operation, the hospital had managed 228 inpatients and 1,399 outpatients.

In 1892, the first SickKids, which was specifically designed and built to be a paediatric hospital, opened at the corner of College and Elizabeth Streets (and is now occupied by the Canadian Red Cross). It cost $120,000 to complete and it was advertised at the time as the "newest, biggest, and best children's hospital on the continent". The four-story brilliant red brick building was quite a contrast to those structures in the surrounding slums.

Even at an early stage of its existence, SickKids had an aggressive funding campaign. Pamphlets were distributed to would-be donors with the following remarks: "$5,000 will dedicate a ward, $2,000' will endow a cot, $1,000 will do a lot of good, $100/year will maintain a cot, and $1 will be heartily welcome".

From its earliest days, SickKids and its physicians played a major role in medical education. In the 1903-04 academic calendar of the University of Toronto's Faculty of Medicine, one finds the first mention of a "special course of instruction in Disease of Children" provided by the Department of Obstetrics-Gynaecology-Paediatrics. The course was coordinated by Drs. Henry T. Machell (Associate Professor of Obstetrics and Paediatrics) and he was assisted by Dr. Allen Baines (Associate Professor of Paediatrics) and other members of the faculty who were on staff at SickKids. SickKids was therefore a teaching hospital of the University of Toronto. Medical students received paediatric training in SickKids' clinics and following graduation from medical school, there was also an opportunity for one-year additional training as "Resident Assistants" for "obtaining a practical knowledge of this very important department of medical practice." In 1909, Paediatrics became a separate Department within the Faculty of Medicine.

Dr. Allen Baines was chosen as the first Physician-in-Chief at SickKids, a post he held from 1913-1919. He was followed by Dr. Alan Brown who held this post from 1919-1951. Dr. Brown was one of Canada's first physicians to be well-trained in the diseases of infants and children. He had studied at Babies Hospital in New York City and several paediatric centres in Europe including Munich, Berlin, and Vienna. He transformed SickKids into an outstanding paediatric institution and he trained many young physicians who assumed leadership positions in paediatric hospitals throughout Canada. He was committed to decreasing the high mortality common to infants and children and was eminently successful because of his attention to detail, outstanding clinical skills, particularly in the field of nutrition, and above all his uncanny ability to select and nurture the hospital's future paediatric leaders. Dr. Brown seemed to personally supervise all aspects of patient care and if a Quality Assurance Committee existed at that time, he would surely have been its champion and chairman.

By the mid 1940's, SickKids could no longer meet the increasing patient demands. In 1951, a new hospital was opened on University Avenue less than 100 meters from the site of the original building which had been vacated 76 years earlier. This new SickKids originally consisted of 632 beds which was expanded to 810 beds with the construction of the Gerrard and Elm Street extensions.

As a result of the efforts of Dr. Brown and other leading Canadian paediatricians, The Royal College of Physicians and Surgeons (R.C.P.S.) of Canada recognized Paediatrics as a separate freestanding medical specialty in 1937. However, likely as a result of World War II, the first certifying examination in Paediatrics was not held until 1946. The training programme and certification examinations were, and continue to be, structured for consultant paediatricians.

Dr. Laurence ChuteDr. Laurence Chute was appointed as the Physician-in-Chief following Dr. Brown's retirement. In view of the R.C.P.S.s recognition of Paediatrics as a separate specialty, on September 10 ,1952 Dr. Chute recommended to SickKids' Medical Advisory Committee that the name of his position at SickKids should be changed from Physician-in-Chief to Paediatrician-in-Chief. Throughout his appointment, Dr. Chute also held the position of "Head of the Department of Paediatrics" at the University of Toronto. He carried on the fine tradition of Alan Brown and introduced contemporary paediatrics to the new institution, including more liberal visiting hours and greater interaction with parents. Dr. Chute served during the era of the introduction of antibiotics and helped to pave the way for the creation of subspecialties within the field of paediatrics.

Dr. Harry BainDr. Harry Bain was appointed as the next Paediatrician-in-Chief at SickKids in 1966 and is also the first individual who was designated as the University of Toronto's Department Chairman of Paediatrics. He developed an exemplary training program for consultant paediatricians and attracted scores of bright young paediatricians to join his department. It was during Dr. Bain's term that The Hospital for Sick Children Foundation was established in 1973. The primary purpose of the Foundation was the support of research activities in the field of child health in Canada. The remarkable foresight of the Board of Trustees of SickKids and individuals like Dr. Bain led directly to the establishment of the Research Institute and all the noteworthy scientific discoveries which have subsequently followed.


Dr. Donald CarverDr. David Carver followed Dr. Harry Bain in 1976. He was recruited from Johns Hopkins University where he had established an international reputation as a paediatric virologist, particularly in the field of hepatitis. Dr. Carver recruited many outstanding paediatric subspecialists, reflecting the rapid advances in medical knowledge and increasing ability to successfully treat complex paediatric illnesses. Excellence in clinical care and clinical and basic research flourished, thus greatly enhancing the academic prominence of the hospital and Department of Paediatrics. By this time, SickKids and the University of Toronto had begun a "Canadian" approach to academic leadership. To enhance the process of renewal and a continuous infusion of new ideas, successful candidates for the Chair of Paediatrics and Paediatrician-in-Chief are granted five-year term appointments, renewable one time only. This contrasts with non-time limited appointments in the United Kingdom and the United States of America.

Dr. Robert HaslamDr. Robert Haslam, a Canadian paediatric neurologist and previous Chair of Paediatrics at the University of Calgary, became the Chair of Paediatrics at the University of Toronto and the Paediatrician-in-Chief at SickKids in 1986. Through key appointments and a keen personal interest, he enhanced both undergraduate and postgraduate training in Paediatrics. During the latter part of his second of two five-year terms, significant changes in health care strategies, combined with restricted growth in health care funding, resulted in marked changes for the hospital and department. Under his leadership, the funding for the Department of Paediatrics switched from a fee for service basis to Canada's first Alternative Funding Plan for an academic Department of Paediatrics. During the same period, the number of paediatric residents was significantly reduced. As well, the number of active inpatient beds at SickKids decreased from well over 500 to approximately 300 as there was increased emphasis on the ambulatory outpatient management of paediatric illnesses. Inpatient care developed an increased focus on tertiary and quaternary paediatric illnesses.

In 1992, inpatients at SickKids moved to a magnificent new building, "the Atrium", directly connected to the previously existing hospital. This aesthetically pleasing new facility possesses state-of-the-art technology and was specifically designed for family-centred care. Virtually all patients are cared for in individual single rooms equipped with a separate bed for the parent and self contained fully equipped washrooms. What a difference from the SickKids of the 19th century where children were placed in large multi-bed wards and parents were actively discouraged and even prevented from visiting their children!

Hugh

Dr. Hugh O’Brodovich was appointed as Chair of Paediatrics and Paediatrician-in-Chief in 1996 and he held this post until June 30, 2006. Prior to his appointment, Dr. O’Brodovich was the Division Head of Respiratory Medicine. As a Senior Scientist in the SickKids Research Institute, Dr. O’Brodovich helped develop the Medical Research Council of Canadas Group in Lung Development and was the first Director of the SickKids Lung Gene Therapy Program. Dr. O’Brodovich formed the Paediatric Executive which played and continues to play a critical leadership role in the ongoing evolution and management of the department. The goal of the Paediatric Executive is to enhance the department's and the hospital's mission to be a knowledge-based institution where the generation, evaluation, dissemination, and utilization of knowledge improves the health of infants and children. In a leading paediatric academic health sciences centre, excellence in clinical care cannot be separated from excellence in research and education. To assist the individual faculty member's career development and to more clearly define the role of an individual, physicians now belong to one of six job profiles which are evaluated and valued for their important contributions.

In 1997, SickKids and the department were given an exciting and challenging mission. The Province of Ontario's Health Care Restructuring Commissions recommended that SickKids and the Department of Paediatrics provide leadership for the development of a "Child Health Network" (CHN). The goal was to consolidate inpatient paediatric care that had been provided at many hospitals throughout the Greater Toronto Area, at SickKids and Regional Paediatric Centres (RPCs). All hospitals involved in the CHN will enhance their ability to provide clinical care, education, and research activities so that together with SickKids they can provide care for the urban area of more than four million people. The CHN has also enhanced SickKids' ability to develop satellite ambulatory clinics for patients with more complex diseases. For example, maintenance chemotherapy can now be administered to children with cancer much closer to their homes.

On July 1, 2006, Dr. Denis Daneman took on the leadership role for the Department of Paediatrics, becoming the eighth leader of the Department. Prior to his appointment as Chair of Paediatrics and Paediatrician-in-Chief, Dr. Daneman was the Division Head of Endocrinology at SickKids. Dr. Daneman is also a Senior Associate Scientist in the Research Institute at SickKids and he continues his important contribution to clinical work within the Division of Endocrinology.

Much has changed since the first children came to SickKids. Although it is impossible to predict what will happen in the next 100 years, the strategies to maintain health and treat disease will likely bear little resemblance to what we are doing today. What will not change is the skill and dedication of the physicians in the department who provide care, train the future caregivers, and develop new health strategies for our children’s children. 

See The Hospital for Sick Children for SickKids' history.



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