McMaster University

McMaster University

The History of Pediatric Surgery in Hamilton

Excerpt from The History of Pediatric Surgery in Canada, by Arlene and Sigmund Ein

Dr.George Lau, Mary Lovas, Dr. Andra Wintrhop, Dr. Jack Langer, Lida Jones, Dr. Gordon Cameron and Dr. Langer's Children
From left: Dr.George Lau, Mary Lovas, Dr. Andra Wintrhop, Dr. Jack Langer, Lida Jones and Dr. Gordon Cameron

Dr. Gordon Cameron finished his pediatric surgical training at The Hospital for Sick Children, Toronto in 1957, having been the first chief surgical resident of both Chief of Surgery, Dr. A.W. Farmer, and Chief of the Division of General Surgery, Dr. Stuart Thomson. Then, after a six month stay at Great Ormond Street Children's Hospital, London, he moved to Hamilton in 1958, where he became the very first pediatric surgeon in that city.

Before Dr. Cameron arrived, whatever pediatric surgery there was in Hamilton was done by adult general surgeons, with pre- and postoperative care assisted by pediatricians in the area. Needless to say, upon Dr. Cameron's arrival to establish his private practice, the benefits of his special interest, knowledge, and skills as a pediatric surgeon were soon recognized by both pediatricians and family doctors. In a few years, pediatric surgery was well established in Hamilton and his practice flourished.

Ten years later (1967), unbeknownst to Dr. Cameron, Dr. C. Barber Muller, then Chairman of the Department of Surgery at Syracuse, contacted Dr. William Kiesewetter (Chief of Surgery, Pittsburgh Children's Hospital) about one of his recent American trainees, Dr. Barry F. Sachs, who had just started a pediatric surgery private practice in Pittsburgh. Dr. Mueller was recruiting salaried, full-time, academic surgeons as faculty for the soon to be opened

Mary Lovas, Dr. Jack Langer, Lida Jones
From left: Mary Lovas, Dr. Jack Langer and Lida Jones

McMaster Medical School in Hamilton, Ontario. He started there as Professor of Surgery in 1969, and these recruited surgeons all arrived before the first class at McMaster Medical School was admitted and before the University Hospital was built. The Department of Surgery was housed in a free-standing wooden shed in the middle of the parking lot. The first Dean of McMaster Medical School was Dr. John Evans and the surgical activity for the newly-recruited full-time faculty involved: Henderson (Maternity) Hospital, Chedoke Rehabilitation Hospital, Hamilton General Hospital, and St. Joseph's Hospital (used as a base for some primary care practices and some pediatric surgery). Although most Hamilton surgeons welcomed the advent of a medical school at McMaster and wanted to cooperate and be involved in the clinical teaching, Dr. Mueller found it difficult to relate to these local surgeons. His introduction of a totally separate and independent group of salaried academic surgeons resulted in misunderstandings, mistrust, and disagreements. It was the classic "Town and Gown" tug of war, which never seems to benefit either side. Adding to the professional tension was the initiations of the Ontario Health Insurance Program and its potential threat to the private practice of medicine. Too much seemed to be happening too quickly!

Lida Jones, Dr. Andrea Winthrop, Mary Lovas
From left: Lida Jones, Dr. Andrea Winthrop and Mary Lovas

In 1968, Dr. Gordon Cameron had recruited Dr. George Lau, who was the chief resident in surgery at HSC in 1964, after which he had been unable to establish a satisfactory pediatric surgery practice in Hong Kong. Dr. Lau was a welcome addition, sharing office space and an increasing clinical load focused primarily at St. Joseph's Hospital. Although the advent of McMaster Medical School le tot modifying their relationship, for 20 years he and Dr. Cameron remained close and friendly collaborators, and Dr. Lau developed a leadership role at St. Joseph's Hospital.

Apparently Dean Evans and Dr. Mueller had recruited Dr. Sachs without ever talking with Dr. Cameron, who never knew of the decision by McMaster Medical School to have a full-time pediatric surgeon. Meanwhile, both D. Lau and Dr. Sachs arrived in Hamilton simultaneously, without knowing about each other's separate hiring. The McMaster plan was that the full-time clinical pediatric surgical activity belonged to Dr. Sachs and was to take place at Henderson Hospital (for newborns and infants), the Hamilton General Hospital (for general pediatric surgical problems), and Chedoke Rehabilitation Hospital (for orthopedics, rehabilitation, and for children with chronic needs).

Meanwhile, Dr. Cameron had an excellent, vigorous practice at St. Joseph's Hospital, however, both he and Dr. Sachs sought to establish a professional relationship; Dr. Sachs also brought some research interests with him. It was their hope and expectation that together they could help expand and develop new dimensions for pediatric surgery in Hamilton, both clinically and academically. Therefore, in the  Spring of 1970, they both met with Dean Evans to explain their idea of uniting the clinical, academic, and research activities; this would be a new direction of cooperation between full-time and private practice pediatric surgeons in the Hamilton community. However, they needed permission from Dr. Sachs to work out of Dr. Cameron's office and for both to care for their private patients at St. Joseph's Hospital. The latter site would also be used for clinical teaching of pediatric surgery to surgical residences and medical students. Similarly, Dr. Cameron would have a McMaster faculty appointment and also be involved in teaching and research. Dr. Evans' answer was: "That is not what the university has in mind for the way we want to practice medicine", and his attitude prevented this ambitious scheme from advancing pediatric surgery in the 1970's to where it is today. As a result, Dr. Sachs returned to the United States in August 1970, and Drs. Cameron and Lau carried on with their practice of pediatric surgery in Hamilton. Dr. Cameron was head of the Division of Pediatric Surgery at McMaster from 1972 to 1985.

In 1972, Dr. Cameron joined the full-time university surgical staff. He became heavily involved with the medical school and its innovative policies. The new controversial campus-based hospital also brought new and exciting challenges. Regional centralization of neonatal intensive care, cancer treatment, and management of major trauma followed, with involvement of a small cadre of surgical sub-specialists with special training and interest in children's problems. Postgraduate programs developed, and both pediatric and general surgical residents had regular rotations on the pediatric surgery service and at St. Joseph's Hospital, where the bulk of routine simple cases were still being admitted. By 1988, all inpatient pediatric surgery was concentrated at McMaster, and it was officially designated as a children's hospital. He and Dr. Lau were then joined by Dr. Jack Langer in 1989, six months before Dr. Cameron's retirement. Under Dr. Langer's leadership, the care of more complex cases was possible, the caseload expanded, and the role of pediatric surgery was greatly enhanced. A year later, Dr. Andrea Winthrop, also trained in Toronto, as recruited. Within four years, Drs. Langer and Winthrop both left for St. Louis. During all this time, Drs. Cameron and Lau still shared both clinical and educational duties until Dr. Cameron's retirement in 1989.

In the 1990's, the beginning of the present group of pediatric surgeons started. Dr. Peter Fitzgerald (trained in Halifax) became Head of the Division of Pediatric General Surgery in 1993 and is presently the Chief of Surgery at McMaster Children's Hospital. Within a few years, he was joined by Dr. Mark Walton (trained in Ottawa). Dr. Brian Cameron (trained in Vancouver and son of Dr. Gordon Cameron) joined the division in 1999, the same year Dr. Lau retired. Dr. Khalid Al-Harbi (trained in Vancouver) became the fourth member of the present division in 2002 and Dr. Helene Flageole (trained in Montreal, MCH in 1995) moved from MCH to join the division in 2007. As of October 2008, the pediatric surgery group became the eighth Canadian Pediatric Surgery Training Program to be approved by the Canadian Royal College of Physicians and Surgeons, which graduates one fellow every year. This group now accommodates all pediatric surgery inpatient care in Hamilton, has earned a wide reputation for its Minimal Access Surgery Program, and serves as a tertiary referral centre for a population of more than two million.

As of December, 2009, Dr. Al-Harbi has returned to Saudi Arabia and Dr. Karen Bailey (trained in Toronto, HSC) was recruited to replace him. Dr. Peter Fitzgerald is now President of McMaster Children's Hospital.

Note: Dr. Helene Flageole was appointed the Chief of Pediatric Surgery in 2013.

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