A doctor in the house: The architecture of home-offices for physicians in Toronto, 1885-1930

Medical History

Volumn 52, Issue 2, 2008, Pages 163-194

  Adams, Annmarie ^a   Burke, Stacie ^b  

^a MCGILL UNIVERSITY   (Canada)

^b UNIVERSITY OF MANITOBA   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ARCHITECTURE; ARTICLE; CANADA; HEALTH CARE FACILITY; HISTORY;

ARCHITECTURE AS TOPIC; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; ONTARIO; PHYSICIANS' OFFICES;

EID: 48849103115     PISSN: 00257273     EISSN: 09505571     Source Type: Journal    
DOI: 10.1017/S0025727300002349     Document Type: Review

References (78)

1. Born in Cobourg, Ontario, in 1848, Dumble matriculated from the University of Queen's College, Kingston, Faculty of Medicine, in 1870 and practised in Owen Sound, Ontario, and New York City before his death in Toronto on 21 Nov. 1928 aged eighty-one. William Charles Durable, Register of Students, Volume 1, n 1-796, coll. 1161, Queen's University Archives.
2. Jan Jennings, Cheap and tasteful dwellings: design competitions and the convenient interior, 1879-1909, Knoxville, University of Tennessee Press, 2005, p. 120.
3. In British English the house-office is more accurately the "surgery" or "consulting room".
4. For a survey of other contemporary approaches to medical history, see Peter L Twohig, 'Recent writing on health care history in Canada', Scientia Canadensis, 2002, 26: 7-28.
5. For a similar geographical inquiry, see J E Turnbridge, 'Separation of residence from workplace: a Kingston example', Urban Hist. Rev., 1978, 3: 23-32;
6. Jennifer J Connor and Jean Harris touch on the overlap of doctors' private and professional lives in, 'Estate Records of Health Practitioners in Ontario, 1793-1900', Can. Bull. med. Hist., 1993, 10: 115-43.
7. For rural examples, see the Colby house in Stanstead, Quebec; the Hillary House Koffler Museum of Medicine in Aurora, Ontario; the Hutchison House Museum in Peterborough, Ontario; the Banting House in London, Ontario; and the Shipman house in Glendale, California. See Lewis Thomas' autobiographical essays in The youngest science: notes of a medicine-watcher, New York, Oxford University Press, 1985, where he discusses his father's practice in rural New York and describes the layout of the house.
8. Edward Shorter, "The history of the doctor-patient relationship', in W F Bynum and R Porter (eds), Companion encyclopedia of the history of medicine, vol. 2, London, Routledge, 1993, pp. 783-800, esp. pp. 787-92.
9. George Bernard Shaw, The doctor's dilemma: Getting married, & The shewing-up of Blanco Posner, London, Constable, 1930.
10. The play was first performed in 1906, but first published in Britain in 1911 as The doctor's dilemma: a tragedy (Harmondsworth, Penguin). The preface thus dates from 1911. Shorter used the 1957 edition, the quotation appears on p. 797, op. cit., note 7 above.
11. Neil Larry Shumsky, James Bohland, and Paul Knox, 'Separating doctors' homes and doctors' offices: San Francisco, .1881-1941', Soc. Sci. Med., 1986, 23: 1051-7, on p. 1054.
12. Paul Starr, The social transformation of American medicine, New York, Basic Books, 1982, p. 76.
13. Paul Knox, James Bohland, and Neil Larry Shumsky, 'The urban transition and the evolution of the medical care delivery system in America', Soc. Sci. Med., 1983, 17: 37-43, on p. 41.
14. http://www.toronto.ca/ttc/history.htm#looking; abstracted from Mike Filey, The TTC story: the first seventy-five years, Toronto, Dundurn Press, 1997.
15. Knox, Bohland, and Shumsky, op. cit., note 11 above, p. 41.
16. Hamilton was born in Peel County, the son of a well-known farmer and local politician, and educated at Brampton High School and Trinity College, from which he graduated in medicine in 1885. He moved to Toronto in 1894 (house plans dated 1906) and joined in practice with Dr W P Caven and was a physician at the St Andrew's Hospital. In addition to becoming a senator of the University of Toronto, Hamilton served as secretary of the Academy of Medicine. 'Leading medico dies of pneumonia', World, 6 February 1920, Herbert J Hamilton, Scrapbook A73-0028/136(07), University of Toronto Archives.
17. See Charlotte Humphrey, 'Place, space and reputation: the changing role of Harley Street in English health care', Social Theory & Health, 2004, 2: 153-69.
18. On the importance of studying medical buildings, see J T H Connor, 'Bigger than a bread box: medical buildings as museum artifacts', Caduceus, 1993, 9(2): 119-30.
19. It is difficult to say which came first without a comparative survey of earlier directories and censuses (e.g., the 1881 census).
20. Annmarie Adams, Medicine by design: the architect and the modern hospital, 1893-1943, Minneapolis, University of Minnesota Press, 2008, ch. 4, pp. 89-108.
21. Jennifer Connor notes that the house-office tradition persisted outside geographic centres like Toronto, Montreal, and London. Personal correspondence, 31 Mar. 2005.
22. Montreal Star, 25 Jan. 1922.
23. See 'Medical-Dental Building, Vancouver, B.C.', Journal of the Royal Architectural Institute of Canada, June 1930, 7: 206-11.
24. Sherry Olson points out that notaries' wives functioned as receptionists and book-keepers in Montreal and that in Paris lawyers still today have an office at home and the family's salon doubles as a waiting-room; personal correspondence, 23 Feb. 2005. Jennifer Connor, on the other hand, thinks that many physicians may have carved out even more separate space for patients; personal correspondence 31 Mar. 2005. She cites the rural house-office in Lucknow, Ontario, described by the general practitioner William Johnston in Before the age of miracles: memoirs of a country doctor, Toronto, Fitzhenry and Whiteside, 1972, which was an extension to the house (see pp. 19, 53, 106).
25. Jennings, op. cit., see note 2 above, p. 178.
26. A superb analysis of spatial flow and circulation in typical Victorian homes is found in ibid., pp. 167-81.
27. A Palladian window has a high, round-topped central section and two lower, square-topped side sections.
28. 'Honored dead colleague', Globe, 19 Dec. 1906, James Elliott Graham, Scrapbook A73-0026/ 124(12), University of Toronto Archives.
29. Donald L Madison, 'Preserving individualism in the organizational society: "cooperation" and American medical practice, 1900-1920', Bull. Hist. Med., 1996, 70: 442-83.
30. Henry Thomas Machell died on 9 Nov. 1930, aged eighty-one. He was head of medical services at the Hospital for Sick Children, served on the staff of St John's Hospital and was associate professor of obstetrics and professor of pediatrics (professor emeritus at time of death) at the University of Toronto. See Globe, 10 Nov. 1930;
31. Star, 6 Dec. 1930;
32. Henry Thomas Machell, Scrapbook A73-0026/272(25), University of Toronto Archives.
33. Guelph Mercury, 19 Aug. 1960;
34. Globe, 14 Mar. 1907;
35. Mail, 15 Mar. 1907;
36. Globe, 16 Mar. 1907;
37. George Armstrong Peters, Scrapbook A73-0026/362(34), University of Toronto Archives.
38. Varsity, 9 Feb. 1944;
39. Toronto Telegram, 5 Apr. 1944;
40. St. Thomas Times Journal, 12 Feb. 1944;
41. Pictou Advocate, 10 Feb. 1944;
42. plus many more in Alexander Primrose, Scrapbook A73-0026/368(86), University of Toronto Archives.
43. Globe, 14 Mar. 1907, George Armstrong Peters, Scrapbook A73-0026/362(34), University of Toronto Archives. Peters' importance in the medical community and at the university is reflected by the fact that Maurice Hutton, Esq., acting president of the University of Toronto, also served as pallbearer in a funeral procession that included "21 carriages filled with leading members of the medical profession and professors of the university".
44. Findlay Weaver, 'Highly rated surgeon got great tributes', Guelph Mercury, 19 Aug. 1960, George Armstrong Peters, Scrapbook A73-0026/362(34), University of Toronto Archives.
45. Humphrey (op. cit., note 15 above, p. 155) notes how the construction of hospitals near London's Harley Street "acknowledged and consolidated" its health care focus.
46. J T H Connor, Doing good: the life of Toronto's General Hospital, University of Toronto Press, 2000, p. 187.
47. Sherry Olson and David Hanna, 'Social change in Montreal, 1842-1901', in R Louis Gentilcore, Don Measner and Ronald H Walder (eds), Historical atlas of Canada: volume ii: the land transformed, 1800-1891, University of Toronto Press, 1993, Plate 49.
48. See Mary Beacock Fryer, Emily Stowe: doctor and suffragist, Toronto, Hannah Institute & Dundurn Press, 1990.
49. See Emily Stowe, Dictionary of Canadian Biography Online, Library and Archives, Government of Canada, http://www.biographi.ca/EN/ShowBio. asp?BioId = 40926.
50. In 1901, the majority of "one parent" families were created through the death of a spouse and not divorce or separation.
51. See Eric W Sager, Douglas K Thompson, and Marc Trottier, The national sample of the 1901 Census of Canada: user's guide, revised edition, http://web.uvic.ca/hrd/cfp/data/1901%20Census%20User% 20Guide.pdf
52. See Stacie Burke, 'Transitions in household and family structure: Canada in 1901 and 1991', in Eric W Sager and Peter Baskerville (eds), Household counts: Canadian households and families in 1901, University of Toronto Press, 2007.
53. Primrose's first wife (enumerated in the 1901 census), Mrs Clara Ewart Primrose, died in 1919. Elizabeth Britton Primrose, his second wife, died two months after her husband in 1944. See Globe and Mail, 13 Apr. 1944, Alexander Primrose, Scrapbook A73-0026/368(86), University of Toronto Archives.
54. Family member participation in the house-office is also of interest since a survey of physicians practising in Ontario in the early 1960s found that a number of male doctors who had been in practice since the 1940s or 1950s routinely depended on their wives to be present at physical (gynaecological) examinations of women patients and to provide occasional secretarial and nursing assistance. See Kenneth Clute, The general practitioner: a study of medical education and practice in Ontario and Nova Scotia, University of Toronto Press, 1963, pp. 65-6.
55. Medical journals after the First World War featured many articles on how to arrange ideal offices. See, for example, Charles M Harpster, 'Some practical offices for the surgeon with illustrations', The Ohio State Medical Journal, Aug. 1919, 15: 478-82;
56. Faber Birren, 'The psychological value of color', Modern Hospital, Dec. 1928, 31: 85-8.
57. The subject seems to have been particularly popular in the journal Medical Economics (ME). See 'Can an office express its owner's individuality', ME, Feb. 1929, 6 (5): 31-2, 34-5, 37;
58. W F McCulloch, 'Laying out the office', ME, April 1929, 6 (7): 41-7;
59. Milton Tucker, 'Making the most of a suburban office', ME, June 1929, 6 (9): 20-1, 57-61;
60. Robert S Staples, 'Re-decorating in modern style', ME, Jan. 1931, 8(4): 14-16, 113;
61. 'A suggested plan for the medical suite',ME, Mar. 1928, 5(6): 12-13, 40-1;
62. Frederick C Smith, 'Our clinic - and how it operates', ME, Sept. 1928, 5 (12): 15-17, 71.
63. On non-medical technologies in the hospital, see Joel Howell, Technology in the hospital: transforming patient care in the early twentieth century, Baltimore, Johns Hopkins University Press, 1995, pp, 30-68.
64. 'The Medical Arts Building, Toronto', Journal of the Royal Architectural Institute of Canada, Feb. 1930, 7: 59.
65. Olson pointed out the need for specialized equipment to us, citing the example of surgery. Procedures such as bone-setting and lancing boils could be done in the doctor's office, but the expansion of surgery to a range of more complex interventions required more specialized equipment; personal correspondence, 23 Feb. 2005. The house-office still thrives today in psychiatry and psychotherapy, where there is no need for specialized equipment or technical platforms.
66. Shumsky, Bohland, and Knox, op. cit., note 9 above, pp. 1055-6.
67. 'A miniature hospital is a feature of the Medical Arts Building, Toronto', Canadian Hospital, June 1930, 7: 22.
68. Shumsky, Bohland, and Knox, op. cit., note 9 above, p. 1057.
69. Globe, 18 May [1928], Alexander Primrose, Scrapbook A73-0026/368(86), University of Toronto Archives.
70. Shumsky, Bohland, and Knox, op. cit., note 9 above.
71. Ibid., p. 1052.
72. Ibid.
73. See Starr, op. cit., note 10 above, pp. 210-11.
74. Madison, op. cit., note 27 above, p. 477.
75. Ibid., p. 459.
76. Ibid., p. 483.
77. See http://www.newsandevents.utoronto.ca/ bios/02/history6.htm.
78. On architecture for tuberculosis at Muskoka, see Annmarie Adams and Stacie Burke, ' "Not a shack in the woods": architecture for tuberculosis in Muskoka and Toronto', Can. Bull. med. Hist., 2006, 23 (2): 429-55.