Edward Archibald: Surgeon of the Royal Vic (review)

Canada has known more than its fair share of brilliant, complicated, and notorious physicians – from William Osler to Frederick Banting to Norman Bethune – and historians have explored the place of many of these doctors in the medical, social, and political context of their times. One leading physician who has not received much attention, however, is Royal Victoria Hospital's one-time surgeon-in-chief, Edward Archibald (1872–1945). Martin A. Entin, md, has redressed this omission in an informative and enjoyable biography.

A native of Montreal, Archibald graduated from McGill Medical School in 1896 and completed his residency training at the newly opened Royal Victoria Hospital. Following one year of surgical specialization in Breslau, Archibald returned to the Royal Victoria with new ideas about the necessity of a scientific approach to surgery. Thus, he insisted on the importance of keeping accurate statistics to evaluate the success of surgical procedures, of using animal models, and of exposing surgeons to a broad education in the basic sciences. Archibald's personal experience with tuberculosis, for which he was treated at the famous Trudeau Sanatorium at Saranac Lake in the Adirondacks, inspired a great interest in this debilitating and, at the time, common illness. He was the first Canadian surgeon to perform a thoracoplasty – a surgical procedure that consists in the removal of several ribs in order to collapse the lung and thereby control the threat of advanced tuberculosis. Although his first few patients died within days of the operation, Archibald's technique improved, and he was able to save many who would have otherwise succumbed to the illness. Apart from thoracic surgery, Archibald showed considerable skill in operating on head injuries, and he published an important monograph on the topic.

This biography is highly readable, and although Entin often describes in detail the mechanism of a particular disease or the technical aspects of a surgical procedure, he does so in an admirably clear manner. The book's organization into chapters that deal with distinct topics – 'Tuberculosis before wwi,' 'Adventures in Neurosurgery,' 'Raising the Standards of the Profession' – rather than in a more strictly chronological fashion is very useful for readers interested primarily in the history of medicine. However, this structure detracts a little from the overall flow of the narrative, since it leads to occasional repetition. Some readers may also wish that the book provided a clearer sense of who Archibald's patients were, and not merely what they suffered from, as well as a broader reflection of the rich secondary literature on the history of medicine at the end of the nineteenth century and beginning of the twentieth. The rise of specialization, for instance, is a well-researched topic that would have provided a helpful theoretical lens through which to focus some parts of Archibald's story.

Nevertheless, Entin weaves a vivid narrative based on a wealth of primary sources and several interviews with individuals who knew Archibald, including three of his daughters. The chapters on the two World Wars are especially captivating, as they describe in detail the challenges faced by the surgeons and the importance of technological innovations such as the X-ray machine. From Entin's biography, Archibald emerges as a serious, devoted, and methodical doctor, but also as a kind, endearingly absent-minded, and incurably unpunctual man. His legendary inability to be on time may have cost him the position of surgeon-in-chief the first time it became available, although he did assume the helm of the Department of Surgery two years later, after his professional rival, Sir Henry Gray, resigned.

Archibald's biography fills a gap in Canadian medical history. By telling Archibald's story, Entin engages with one of the most eventful periods in the history of Canadian medicine, and it is not surprising, therefore, that the usual medical suspects also make an appearance – Bethune, John McCrae, Wilder Penfield, and others add further flavour to the narrative. Professional historians will find the book rich in historical detail, if somewhat lacking...