Dr. Botterell and a new Protocol of Care

In the 1930s the new antibiotics could fight infections caused by bed sores and blocked bladders. Flexible plastic improved catheter technology preventing renal failure. Eventually there was a new medical attitude that called a person with a spinal cord injury a survivor, not a terminal case. Dr. E.H. (Harry) Botterell spoke to Mary Tremblay about his experience in challenging medical orthodoxy in the 1930s and 1940s.

First page of Canadian Medical Association Journal article "Paraplegia Following War".

Canadian Medical Association Journal 55 (September 1946): 249-60. Dr. Botterell told Mary Tremblay he chose to publish his key article in the Canadian Medical Association Journal out of national pride but was afraid this may have led to his contribution not being noticed internationally.

Dr. (later Sir) Ludwig Guttman in Britain and Dr. Botterell in Canada independently worked out the new medical protocol for spinal injuries. It was revolutionary by insisting on on-going medical intervention, but it took time to change old orthodoxies. Care started with active nursing to keep the patient turned to prevent bed sores and bladder cleaning to prevent renal failure. Dr. Botterell wrote about the new protocol as well as demonstrating its value in his war work at Basingstoke, England.

Dr. E.H. (Harry) Botterell (extracts from interview, 8:40 minutes)
Neurosurgeon, Canadian Developer of Modern Protocol for Spinal Injury Care
Interviewed by Mary Tremblay August 10, 1993
Tremblay Fonds, McMaster University, HCM T-002-093
Extracts made with Permission of Medical Services Library Special Collections.

Interview Extracts - Transcript
Transcription extracts from the original transcription by Mary Tremblay.

Mary Tremblay (MT): When you talked the DVA [Department of Veterans Affairs] into buying Lyndhurst and turning it into a rehab centre -

Dr. E.H. Botterell (EHB): Oh, I didn’t talk the DVA into buying Lyndhurst. They bought it. And they were going to make it into a paraplegic service unit, including a kind of club as well. But the concept of promoting active rehabilitation by the patients with a view of going home was not current at that time. Palmer McCormick, have you got him somewhere?

Mary Tremblay (MT): Yes, yes. I wanted to ask you about him.

EHB: He was running the whole neurosurgical service at Christie Street and Sunnybrook and Lyndhurst on a part time basis. Which he obviously couldn’t do. I mean, nobody could do it.

MT: Because there were a lot of patients there, weren’t there, about 100?

EHB: And it was a big hospital full of those requiring neurosurgical services, general neurosurgical services. …

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MT: What was it like [in 1945]? What did you find?

EHB: Well, I’ll tell you, I almost got run out of town. There was one part time neurosurgeon, that was McCormick, and McKenzie was there to back him up, and that was all. The description of the big ward with the paraplegic patients in it is in that paper you’ve got, the reprint. It was a very traumatic experience because here were all these patients receiving inadequate urological care. One orderly going around and seeing them. They were doing their bladder once a day or something. The nurses were, many of them veterans from World War 1 – you know what they thought, they’d all be dead in six months.

MT: Right.

EHB: I’ve forgotten the numbers, but it’s a high mortality rate in the first year. And there was totally inadequate physiotherapy. And I thought the diets were inadequate. Most of them had pressure sores, or many of them, I can’t give you the number, they were losing protein and were infected. All pressure sores were infected, as you know. And, it was a kind of a dismal place.

MT: Would you have known many of these people, because you would have seen them in Basingstoke [in England].

EHB: I knew them almost all. They’d all come through my service there. In fact, when they invited me to come back and take over this job, I said to Colonel R.I. Harris, who was the officer in the army from Canada, visiting in England, “Who’s going to look after my spinal cord injuries?” He said, “Do you want to look after them?” I said, “Yes,” And he said, “What about Lyndhurst Lodge?” Well I didn’t know what Lyndhurst Lodge was. But on general principles, I said, “Yes, sure Lyndhurst Lodge too.” So that’s how it all happened, almost unwittingly. We got more nursing service, more orderly service, a new diet, and new physiotherapy, new everything. We started from scratch.

MT: In the war, at Basingstoke, would you have physiotherapists there, or would nurses have done that?

EHB: Sure, we had physiotherapists.

MT: You had them there, and you got them at Christie Street then.

EHB: Yes.

MT: That must have been, actually, as you say traumatic, because you had set one program up [at Bastingstoke, England], sent these –

EHB: The reason it was traumatic because I came from a really high-class operation – medical, surgical, x-ray, every other way you could think of. It was sort of the pride of the Canadian army in England. Although they would never admit it. And to come back to a hospital that wasn’t ready, to look after patients where the x-ray department was overwhelmed, the physiotherapy was overwhelmed, everything was overwhelmed, this was pre-Sunnybrook.

MT: Yes.

EHB: It was really a schmozzle. Bill Warner hadn’t got his reorganization through yet, you see. So I had to get reorganization through for neurosurgery. And I remember Arthur Norwich the director of the hospital saying, “Harry, I’ve got the nurse for you, she’ll run you too.” Or she’ll handle you, or some such. I was by this time regarded as a very prickly individual who was upsetting the apple cart.

MT: Someone else mentioned to me that in the war all the young dynamic physicians were overseas.

EHB: That’s right.

MT: And then after the war they came back. Would that have been, in a way, what was happening?

EHB: Exactly.

MT: And you were upsetting the status quo that had gone on somewhat comfortably?

EHB: Well this was an old pension, a quiet pension hospital, being asked to receive, and admit and care for scores of casualties, who had various needs of treatment of medical care, or rehabilitation, or whatever, and they weren’t, it wasn’t geared up for this originally. They'd temporize, for instance they moved the neurosurgical service into the pavilion that's been built for tuberculosis patients, but there weren't any tuberculosis patients.
MT: Right.

EHB: And so we set up a new service, in a new setting, and recruited an x-ray man to do our x-rays, and a urologist to do our urology …

MT: And what was John Counsell's role during this time? Did he have a role in this?

EHB: He was at Lyndhurst, so he was around there a lot. And every time we got in a real big trouble John would get us out.

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MT: You talked in your last interview about writing a report about what you found.

EHB: Oh yes.

MT: What happened?

EHB: Well, there was a committee in Ottawa, chaired by R.I. Harris, "Doc" Farmer of the special units, neurosurgery, orthopaedic surgery, plastic surgery, right across Canada. Farmer was there, of course, and Harris was Army and Webster [of McGill and the Royal Victoria Hospital] was Navy. I wrote my first report, monthly report to this committee. I was so aghast at what I found, it was all there. I took it down to Arthur Norwich and said, "Arthur can I send this off to this committee with your blessing?" And he sat down and read it, and said, "Harry, I've been telling them that for months. It isn't strong enough." "Well," I said, "I can't think of anything any stronger." So down I went to Ottawa, to defend this report.

MT: And this was where Farmer backed you up.

EHB: Yes.

MT: You were trying to bring about an awful lot of changes.

EHB: Oh, sure.

MT: Which couldn't have always been easy.

EHB: Pardon.

MT: It sounds like [the changes] just happened, but they must have been very difficult.

EHB: Of course. The nurses all had to change their outlook or change their job, we had to get new orderlies, a better diet. I ran into one of these guys the other day. “Oh,” he said, “I remember when you came back. We, the patients, decided that something was going to happen because we got our first steak after you came home.

MT: Yes. Who was that you ran into? That wouldn't be Jack Higman would it?

EHB: Yes.

MT: … I quote him, he talks about Christie Street before you came, and it wasn't very nice. And then he talks about after Botterell came, the difference, how the diets improved, and everybody couldn't figure it out why we were being so well taken care of now. But he talks about that quite a bit.

EHB: Well these people were being neglected [by modern standards].

MT: So there still was this belief that they weren't going to survive, and so why spend resources on them.

EHB: Exactly.