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Hospital Founder Was Surgeon Ana’ lecturer VOL. 93, NO. 48. Shea/dice Hospital In Park-like Setting On City Fringe The new hospital combines the graciousness of the original country estate with the modern decor of the recently completed 88-bed addition. This privately operated hospital has been designed to provide patients with the most up-to-date facilities. Particularly important is the provision of space and ample opportunity for patients to move about and resume regular living patterns. The new Shouldice Hospital is situated in park-like surroundings in Thornhill, a suburban Markham Township community in Southern Ontario’s York County. The hospital has moved from the downtown of Canada’s burgeoning major urban centre, Metropolitan Toronto, to the city’s northern fringe. Shouldice Hospital is a specialty surgery where as many as 20 opera- tions per day are carried out to repair discomforting and potentially dangerous hernias. Patients come mainly from the United States and Canada. dam: because of malnutrition? During his last four years he and hernias. They were heal-:had been beginning to think thy. otherwise. §about expansion He had two Dr. Shouldice. aided by hiSJmeetings with architect Don friend. the late Charles Rathgeleackson to talk over plans. who paid all hospital charges.1 Mrs. William Urquhart, the Then in 1939 Dr. Shouldice joined the army. He was too old to go overseas, but served in the Army Medical Corps in Toronto. He noticed the great number of recruits that were turned dam: because of malnutrition and hernias. They were heal- th): otherwise. DI'. Shouldice thought about this. He remembered the num- ber of pulmonary embolisms suffered by patients lying pros- trate for a long time. even after very good operations. He thought of the pneumonia. phle- bitis and other complications that sometimes followed surg- In 1932 the late Dr. Shouldice noticed an especially good re- covery from an appendix opera- tion by a little girl who manag- ed to elude the usual routine and run around right away after her operation. In 1936 Dr. Shouldice hap- pened to operate on a group of four executives who were used to giving orders and having their own way. They refused to use bed pans. got up against orders. and were fine. Secondly came development of the operation itself. But the elder Shouldice went ahead anyway, developing hernia surgery. First came early ambulation getting up right after the operation. Dr. Edward Earle Shouldice, an innovative surgeon and long time medical lecturer at the University of Toronto, was the founder of Shouldice Hospital. "You hesitate to try anything new. It lays you open to criti- cism,” says his son Dr. Byrnes Sh‘ouldice. ‘ RICHMOND HILL, ONTARIO, THURSDAY. MAY 28, 1970 ME Eihmml He bought the present site in Thornhill and took four months to organize the new surgery. Then he found he had too big a bmklog of patients waiting for operations and would need both the old and new sites. In 1963 there was no room left again. Dr. Shouldice died August 20. 1965, just two months before his 75th birthday. He had a cor- onary in his mm room at the Thornhill division of his hospit- al while talking to Mrs. Martin. Dr. Shouldice continually ran out of space and kept adding houses to his little hospital. But in 1953 he decided he wanted to build his own hospital and get lots of space. One morning Dr. Shouldice was sitting at the breakfast table and started to think about having his own hospital for hernias. He started in July 1945 at Church and Charles Streets in Toronto with a little house. a nurse, a cook, and a housekeeper. 'The army could not take these men for four months after the operation. While they were waiting to enlist. they told others what they had done. The result was that by war’s end Dr. Shouldice had a list of over 200 men waiting'for hernia operations. But there was no hospital space. and a hernia was an elec- tive operation that could be al- lowed to wait. offered to provide these men with hernia operations if they would go into the army. He did about 80 such operations. D§PITAL OPENS 3-." {Health Minister Wells To Cut Ribbon 7‘In Essentials Unity; in Non-Essentials Liberty; in all things Charity" Born at Chesley. Ontario, in the Bruce Penninsula. Dr. Shouldice moved to Calgary with his family at the age of 10. He finished high school there. and came back to Ontario to at- tend the University of Toronto. He went overseas in World War I as a medical ofiicer. After the war he taught ana- tomy and surgery at the UnjVer- sity of Toronto until the out- break of World War II. His wife was the former HJlda Marie Byrnes of Halifax. They were both Irish. She died about two months before him. He liked golf and curled ar- dently with his son and son-in- law. He liked curling, for the team spirit involved. He was very competitive and hated to 10:3. In his early years he played football. Some men won’t admit that they have the condition for they feel is reflects on. their masculifimir "The irritating re-’ currence rate discourages many while others cannot afford to take long periods off work. To- day a hernia repair at some centres has a recurrence rate of less than one per cent and patients are often back at their jobs within ten days or less of surgery. The success of this Toronto hospital is due to a combina- tion of factors: 0 except in an emerg- ency, Shouldice doctors ask most of their patients to lose superfluous weight be- fore their operations. Al- most all patients are asked to lose some weight under prescribed diets and some have taken off as much as 100 pounds. This weight reduction gives surgeons more tissue to work with in suturing, reduces the pres- Dr. Shouldice was extremely interested in the Phi Chi medi- cal fraternity and ran the fra- ternity's restaurant for a time. He was a Mason and a great admirer of Sir Winston Church- ill. His reading leisure was mainly confined to medical lit- erature. Churchill's writings and the comics. herniorrhaphy, it is much This hospital has attracted patients to Toronto from all over North America and, on invitation, doctors have dem- onstrated surgery throughout the Americas, Europe and 'Asia. Favourite anecdote of the hos- pital’s IOU-man staff is of the visiting Russian scientist who, having officially observed an operation one morning, reques- ted the doctor to work again that afternoon on the visitor. founder’s daughter, says the late Dr. Shouldice was the kind of man who expected a lot from everyone who worked for him, or was near him. But he never asked anybody to do anything he wouldn‘t do himself. He was a hard man to live with, but you wouldn't find anyone kind- er, she says. There's always a waiting list for hernia operations because, apart from coughs, colds and influenza, hernia may well be the most common affliction of western man. At any one time, perhaps some six million or more North Americans suffer the condition, which is male- predominant by a factor of about twenty-four to one. For a variety of reasons however, not all sufferers have their hernias corrected surgically. It was not unusualgto see Dr. Shouldice giving directions for an operation while in his farm- er's overalls, or to see him driv- ing a tractor in his dinner jack- et. He really enjoyed the farm, and since pigs get hernias read- ily, he had a readyâ€"made op- portunity to improve his operat- ing technique with the animals. The oldest Shouldice hospital in Toronto occupied a group of converted homes on down- town Church Street. Now a major new hospital with its eighty-eight bed capacity and five centrally-monitored oper- ating rooms incorpérate the modern facilities. It began op- eration in 1969 and the official opening ceremonies will be held Saturday, May 30th at 2 pm. Dr. Shouldice had always wanted a farm of his own, and he had it at the new hospital. He raised his own meat and produce for the hospital. The Shouldice Hospital techniques of surgical, pre-operative and post- operative care have evolved over a quarter-century of research, cautious innova- tion and methodical follow-up. Where recurrence was a bugbear of much herniorrhaphy, it is much less of a problem today. This hospital has attractedl sure of the incision. im- lfor ten or twenty years afiei Toronto’s Shouldice Hospital is quite unique. In the past twenty-five years, this specialized medical institution has repaired by surgery the dis- comfortng and potentially dangerous hernias of 60,000 patients. Five days a week in four operating rooms, its totally specialized surgeons perform up to twenty_operations and all the patients walk back to their beds. SUCCESS FACTORS ANNUAL DINNER The annual dinner is only one element in the compre- hensive follow-up plan. Pat- ients are checked at travelling clinics or by their local doctor sure of the incision, im- proves the patient's gener- al health and eases the strain on his heart. 0 the hospital is restrained in its use of anaesthetics. For many years it support- ed a specialized anaesthet- ics researcher and now, in all operations except on young children an severe incisional herniorrhaphy. it relies on a local infiltration anaesthetic. 0 surgical techniques in- clude the exclusive use of stainless steel wire for all sutures (except in young children and for ligatures in the hernial sac and near nerves or the skin sur- face.) Thorough explora- tion and repair of all three layers of abdominal muscle are vitally important. (De- tailed descriptions of the surgery are available in numerous medical journ- als). 0 early ambulation speeds recovery, improves morale and reduces post-operative complications. Patients walk back to their beds from the operating table and the next day are em- barked on a gentle exercise programme under the di- rection of the staff Physio- therapist. . the hospital cultivates a club-like informal atmos- phere. Patients are dis- couraged from regarding themselves as “sick” and they move about freely, play cards, sing around the pian’o in the evenings. Most enjoy their stay: so much so that a group once got together and asked Earle Shouldice to sponsor an annual reunion. The doc- tor agreed providing that all those who came to the dinner used the occasion for a medical check-up. That’s how it came about that every year now the Crystal Ballroom at Toronto‘s Royal York is subdivided into temporary cubicles where twenty doctors examine as many as 1,400 former Shouldice patients before they all stroll next door to enjoy a banquet. a speech and a floor show. Wide Smiles From First Graduates Of New Hospital “We’re the first,” this group of hernia operation graduates seems to be saying as the members exhibit wide smiles. Shown are the first seven people to have operations at the new 88-bed Shouldice Hospital addition in July 1969. Personally engraved tankards were presented to each member of the group. Handing out the mementos were the son and daughter of the hospitlalf’s) founder, Dr. Byrnes Shouldice (third from left) and Mrs. William Urquhart (fifth- mm 9 t . HOME PAPER OF THE DISTRICT SINCE 1878 Women‘s abdomens in the groin area are much stronger than men’s and Earle Shouldice used to suggest that this is why women in primitive cultures often tackled the heavy work: they wanted to save their men from the risk of rupture. Some men seem to inherit a tendency to hernia. Other primary causes include: heavy lifting or pushing with legs apart, especially with one be- hind the other; chronic cough~ ing; continuous standing â€" by a barber. for example â€" with- out exercising the abdomen. Perhaps the most common cause of all is “middle age spread" which can weaken the vulnerable groin area. A man who does heavy man- ual work then graduates into a softer supervisory job is :1 (Continued on Page 22) - A basic reason for the high incidence of hernia in men is that, at birth, a male baby’s testicles descend into his scrot- um through an aperture in the wall of his abdomen at the groin. In later years, and sometimes even when the baby is young, that aperture will fre- quently tear or stretch and sometimes let some abdominal contents protrude. That con- dition is a hernia. There are other places in the. abdomen where a break can commonly occur and each is regarded as a different type of hernia: inguinal, femoral: umbilical, epigastric. Another common type is incisional â€" the breaking open of an old surgical wound. But wherever located and whatever the cause, the principle remains the same: something from inside the ab- domen protrudes through a tear in the muscle wall. Some- times the protrusion is as small as a thumb: sometimes larger than a football. Many people, often with the aid of a truss 01' other mechan- ical device, learn to tolerate the condition. But as well'as be- ing uncomfortable, a hernia can also be dangerous. When. for example, a portion of bowel protrudesiand cannot be push- ed back, its blood circulation may be cut off. Then it's “strangulated”. a condition which can become deadly with- in a day or two if medical at- tention is not provided. for ten or twenty years after their operations. This proced- ure lets the staff analyze the results of any minor variations in‘ procedure. 3 MAY 3| Public' Is Invited To Open House Health Minister Wells was born'in Toronto and was. first elected to the Legislature in 1963. He became a minister without portfolio in 1966 and minister of health in 1969. He represents Scarboro North. His previous connections in the health field in- cluded a period as advertising“ manager for the Canadian Medical Association and membership on the Scarboro General Hospital Board. He was also a Scarboro school trustee for six years. and a mem- ber of the Metro Toronto School Board. He attended Victoria College and Toronto University. , Local officials and dignitaries have been invited for the opening ceremony. Platform guests at the half hour opening cere- mony will include: Health Minister Wells; Reverend Irvine Perkins, minister at Donlands United Church. Toronto; Dr. Byrnes Shouldice, the hospital’s first vice~president and surgeon; Reeve Stewart Rumble, bringing greetings from Markham Township; and Councillor Albert Laidlaw, representing Warden Gordon Cook, and bringing greetings from York County. The official opening of the Shouldice Hospital May 30 includes a six-hour open house. The public is invited to attend and tour the new hospital. Former patients have been issued special invitations. The hospital is located at 7750 Bayview Avenue, Thornhill. The Honorable Thomas Wells, Minister of Health for the Province of Ontario, at 2 pm will cut a ribbon and declare the hospital in service. The hospital open house begins at 10:30 am and will continue until 4:30 pm. The building and the spacious landscaped grounds will be open for the public to inspect and enjoy. Members of the hospital staff will be avail- able to point out highlights of the building and the services provided. PER COPY 10c