Manitoba’s first family of medicine□ Legendary Stewart clan had significant impact on medical practices around the worldHeadstone marks the grave of David Stewart and his wife IdaTo even casual observers of the medical profession it makes sense that the highest profile doctors and nurses live and practice in large centres. While that suggestion no doubt has merit generally, it has no application to members of a legendary Manitoba family, one of whom lived in the village of Ninette, and the other in the nearby town of Killamey.David Alexander Stewart was born in 1874 in Ontario, the eldest son of Scottish immigrants, and moved with his family to Morden 17 years later. It is perhaps a little ironic that for the man whose name became synonymous with western Canada’s first sanatorium and the fight against tuberculosis, medicine was a third career choice.A year after arriving in Manitoba, Stewart entered teachers’ college and taught briefly in his home town. Two years later he gave up pedagogy for theology. A throat ailment limited his ability to speak publieally, however, and thwarted his desire to follow his father into the Presbyterian ministry. With few appealing options open to him, he entered Manitoba Medical College.In medical school Stewart was intrigued by the effect typhoid fever and tuberculosis (TB) had on the human body, an interest which grew after he contracted TB in 1909. While a patient in a famous New York tuberculosis hospital, or sanatorium, he was introduced to the only known method of fighting the disease - the ‘rest cure’, a regimen of bed rest, good food and fresh air.In its pulmonary form, TB causes bleeding and sores in the lungs, and treatment was invariably much more invasive than bed rest and healthy eating. Typically, an infected lung was temporarily collapsed through the induction of air into the space between the lung and the chest wall; less often a lung was permanently collapsed by removing as many as seven or eight ribs.About the time Stewart entered medical school it was discovered that tuberculosis was a communicable rather than hereditary disease, and pressure to find a prevention and cure were increased. Towards that end, the Manitoba government established a sanatorium board in 1904 and the Manitoba Tuberculosis Society started raising funds to build a provincial hospital.In May 1910, a 65-bed facility on the north shore of Pelican Lake near the village of Ninette was opened. Within 13 years its capacity quadrupled. Fresh from his own experience with the rest cure, Stewart was appointed the sanatorium’s superintendent.In his early years atUntold TalesCharles Dale BrawnNinette, Stewart had only enough money to treat those already infected with the tuberculosis bacterium. Most victims came from the stinking, overcrowded slums of Winnipeg, or from Aboriginal communities where poverty, poor nutrition and a lack of proper sanitation were facts of everyday life.Before antibiotics, the most common way to treat tuberculosis was to allow patients to build their natural resistance to the disease through prolonged bed rest. By the second decade of the 20th century, however, the Ninette sanatorium had become an important tubercular teaching hospital, and doctors under Stewart’s leadership were developing new methods for detecting and treating the disease.When it became apparent that thousands of Manitobans were undiagnosed carriers of tuberculosis, hospital officials designed their own traveling clinics, and in 1929 an x-ray machine, generator and portable dark room were built into a van to facilitate testing people living in remote areas.Under Stewart’s guidance, the Pelican Lake sanatorium made a number of significant contributions to the treatment of tuberculosis. Ninette, for instance, offered the first in-hospital training program for medical students, and dozens of journal papers were written by Stewart and members of his staff.Ironically, their success signalled the death-knell of the hospital. By the 1960s, tuberculosis patients were treated either with drugs or the surgical removal of damaged lung tissue, and the rest cure offered by sanatoria became obsolete. In 1972 the facility closed its doors.Both Stewart and his wife Ida Kate Bradshaw were in poor health in the last years of their lives. Like his wife, the doctor contracted a serious case of tuberculosis, but unlike her, was not an invalid until shortly before his death. Although confined to a wheelchair, Mrs. Stewart carried on an aggressive correspondence campaign for peace. She died just weeks before her husband. His last glimpse of her was a brief glance from the doorway as he was wheeled into an operating room.David Alexander Stewart died on Feb. 16, 1937 and is buried beside his wife in Winnipeg’s St. John’s Cathedral cemetery. The two had only one child, but what a child he was.David Bradshaw StewartDavid Bradshaw Stewart was born in Ninette in June 1916. He graduated from the University of Manitoba’s medical school at 25, and the following year joined the Royal Canadian Air Force as a medical officer. While overseas, he learned of the work of a remarkable doctor who ran a department of obstetrics and gynecology in Aberdeen, Scotland.After the war, he returned to Scotland to complete a clinical residency at the hospital and stayed on as a consultant and lecturer. Stewart was only 37 when he was appointed founding professor and head of the Department of Obstetrics and Gynecology at the University College of the West Indies, an affiliate of the University of London.One of the first examiners sent to the school from England spoke of concerns he and his British colleagues had about the quality of teaching at the new school. “On the plane coming out, we had agreed that we would have to pass one or two candidates so that the faculty would not be too much discouraged. In fact, we found the students to be quite up to London standard, and the percentage of passes more than normally expected in any of the London teaching hospitals.”Aside from teaching, Stewart’s most pressing task was to create a modem obstetrics unit, a responsibility that did not end when the department was physically up and running. Stewart expected his new ward to be over-run with patients, but for weeks, row after row of beds, each with a new red blanket neatly folded at its foot and a baby cot by its side, sat empty. Desperate, his hospital administrator asked a reporter to write a story about the clinic.On the way to see the hospital first hand, the newsman picked up a woman rushing to her home in the hills.Along the way she had a precipitate delivery in the back of his car. After the much shaken journalist turned over care of his passenger to Stewart’s staff he wrote an amusing and informative account of the new facility, and from that time onwards they were seldom empty.After 17 years in the West Indies, the now 54-year-old Stewart gave up medicine and moved to Killamey, MB. He soon became a part-time lecturer in zoology at Brandon University, and eventually head of the department and member of the school’s board of governors.Stewart was also a prolific author. Among his books was a definitive study of obstetrics and gynecology in the tropics, an edited re-issue of a leading examination of Jamaican birds, and on his return to Canada, a history of the Ninette sanatorium.Among the honours bestowed on him were a military MBE, the Jamaican Independence medal, the Canadian Silver Jubilee medal, and an honourary doctorate of laws from Brandon University.David Bradshaw Stewart died on Nov. 21, 2006, five months after his 90th birthday.Isabel Maitland StewartThe third member of the Stewart medical team was more famous than her brother and nephew, and she was not even a doctor.Isabel Maitland Stewart was born in 1878, the fourth of nine children. After graduating from high school in Morden, she attended normal school and taught for three years before entering the Winnipeg General Hospital Training School for Nurses.The decision was not an easy one to make. When she told a friend of her intention to leave teaching, the response was: “Why are you going into nursing? Are you disappointed in love, or did you get religion?”It turned out the choice was propitious. By the time Stewart retired, she wrote or co-authored 20 books and 123articles, including three critically acclaimed studies of the nursing profession, and earned an international reputation as a nurse educator and historian.Like many of her closest friends, Stewart was deeply disturbed by the inadequate facilities she encountered during her time in training. Doctors gave lectures in the dining room of the nurses’ residence, and clinical instruction was provided at patient bedsides only when a physician had the time or motivation to do so. Stewart was determined to change things, and played an important role in establishing professional standards for nurse practice and education.Her particular interest was training teachers for nursing schools. She worked closely with nursing organizations throughout the United States, and for a time chaired the education committee of the group which published the profession’s leading journal, Standard Curriculum.Shortly before she retired, Stewart wrote a highly regarded book about nursing. In it she warned of the dangers associated with a multitiered health system consisting of staff nurses, nurse managers and nurse educators. She argued that instructors must be highly skilled in clinical practice, and for the good of the profession it was essential to leave the best and brightest nurses in direct control of patient care.Towards the end of her brilliant career, Stewart predicted there was no prospect of unemployment in the nursing field. “No gadgets have been invented to replace the human hand and no universal panaceas or preventives have been discovered that will keep the human machine from creaking and wearing out.”In a much quoted comment, Stewart summed up what she believed her profession was all about. “The real essence of nursing, as of any fine art, lies not in the mechanical details of execution, nor yet in the dexterity of the performer, but in the creative imagination, the sensitive spirit, and the intelligent understanding lying back of these techniques and skills”.Stewart received dozens of national and international awards for her work. Among them were three honourary doctorates, Finland’s Medal for Humanitarian Work, an award and medallion from the American Red Cross, and the international Florence Nightingale Medal. She was also the first nurse to earn a master’s degree from New York’s prestigious Columbia University.Isabel Maitland Stewart was 85 when on Oct. 5, 1963 she died at the New Jersey home of her nephew.■Dale Brawn practiced law in Shoal Lake in the 1980s before entering graduate school, and is now teaching in the Department of Law and Justice at Laurentian University in Sudbury, ON. 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