The Halifax Explosion and the unofficial birth of pediatric surgery

Pediatric surgery approaches a 100-year milestone in 2017. December 6 marks the centennial of the maritime disaster off the coast of Nova Scotia known as the Halifax Explosion. On that date in 1917, the French munitions ship Mont-Blanc, carrying wartime explosives, collided with the Imo, a Dutch relief vessel, in Halifax harbor. Within a half hour the Mont-Blanc detonated, with a blast that leveled buildings within a two-square-mile area. So powerful was the explosion that the six-ton anchor of the Imo was found in a ruined building nearly two miles from the harbor.¹ Historians estimated that it was the most powerful man-made explosion in recorded history until the Trinity atomic bomb test of 1945.²

Many locals watched the conflagration from their windows, their morning routines interrupted by the spectacle. Thousands of bystanders, including hundreds of children, were killed or maimed by the explosion. Glass shattered into the faces of onlookers in their homes, leaving approximately 200 completely blind and another 500 with serious eye injuries. A radiologist noted more than 226 fractures in his log. In all, an estimated 2,800 people died as a result of the Halifax Explosion.¹

With local health care facilities destroyed and the surviving physicians and nurses undersupplied and overwhelmed, Canadian authorities struggled to bring relief to the devastated city. A medical convoy of 40 physicians and nurses from Boston, MA, led by 37-year-old William Ladd, MD, FACS, traveled by train through a blizzard, arriving in Halifax two days after the disaster. A damaged but still serviceable building at Saint Mary’s College was converted into an infirmary, where the team treated victims maimed and blinded by shards of wood and glass. The medical convoy remained on-site for nearly a month, through the winter holidays.¹

The “father” of pediatric surgery

Legend has it that the experience inspired Dr. Ladd to devote his surgical career to the care of children. Robert E. Gross, MD, FACS, Dr. Ladd’s successor as surgeon-in-chief at The Children’s Hospital (now called Boston Children’s Hospital) in Boston, was among those who believed the origin of the specialty began in Halifax. In fact, Richard Goldbloom, MD, FACS, a pediatric surgeon in Halifax, had a chance encounter with Dr. Gross in 1976, where the latter reportedly said, “I suppose you know that Halifax was the birth place of pediatric surgery as a specialty.”² The folklore surrounding the origin of pediatric surgery was so pervasive that it continued to be retold even by the leading authorities in the field.^3-5

However, Dr. Ladd had set the record straight some 13 years earlier in 1963 in a letter to Gerald Zwiren, MD, FACS, a pediatric surgeon in Atlanta, GA, who had asked him to verify the story. “I fear I will have to make many alterations [to the story],” Dr. Ladd wrote. He had made the decision to focus on pediatric surgery nearly a decade earlier, when he completed his training at the Boston City Hospital in 1908 before joining the visiting staffs at The Children’s Hospital and the Infant’s Hospital in Boston. (The two hospitals merged officially in 1961.) “The Children’s was [my] very first and most permanent love,” Dr. Ladd wrote. “As soon as it became feasible after the first World War, I devoted myself exclusively to pediatric surgery and have never regretted it.”⁶

Dr. Ladd’s place as the father of pediatric surgery is secure, even though the historical narrative linking the Halifax disaster and the origin of pediatric surgery turned out to be false. Dr. Ladd ascended to the position of surgeon-in-chief of Boston Children’s Hospital in 1927. His clinical work defined the specialty and inspired a generation of trainees who came under his mentorship. In 1997, 80 years after the Halifax Explosion, nearly three-fourths of pediatric surgery program directors and two-thirds of all practicing pediatric surgeons in the U.S. and Canada could trace their training lineage to Dr. Ladd.⁷ In the decades that followed the Halifax Explosion, thousands of surgeons have continued his devotion to the surgical care of children.

Acknowledgment

The author acknowledges the diligent support and invaluable assistance of Amy M. Duncan, librarian, Sacred Heart Hospital, Pensacola, FL, in the preparation of this article.

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References

1. Nance ML. The Halifax disaster of 1917 and the birth of North American pediatric surgery. J Pediatr Surg. 2001;36(3):405-408.
2. Goldbloom RB. Halifax and the precipitate birth of pediatric surgery. Pediatrics. 1986;77:764.
3. Gillis DA, Lewis SD, Little DC. The Halifax explosion and the birth of a surgical specialty—myth or reality. J Pediatr Surg. 2010;45(5):855-858.
4. Randolph J. The first of the best. J Pediatr Surg. 1985;20(6):580-591.
5. Hendren WH. From an acorn to an oak. J Pediatr Surg. 1999;34(suppl):46-58.
6. Zwiren GT. Correspondence. J Pediatr Surg. 2001;36(10):1606.
7. Glick PL, Azizkhan RG. A Genealogy of North American Pediatric Surgery: From Ladd until Now. St. Louis, MO: Quality Medical Publishing, 1997.