Dr. Gustave Gingras on Caliper Walking

Presenters at a 1954 World Congress on “cripples” and rehabilitation said wounded veterans wanted to walk to prove their manhood. The specialists at Toronto’s Lyndhurst Lodge taught walking with crutches and body braces to paralysis patients, but the patients preferred the less exhausting mobility of a lightweight wheelchair. Eventually the doctors agreed that imitating walking with braces was achieving nothing and wheelchairs did not have to equate with failure.

Dr. Gustave Gingras

Neurosurgeon. Intern at Basingstoke Military Hospital England, Rehabilitation Director DVA Hospital, St. Anne de Bellevue, Founded the Rehabilitation Institute of Montreal 1949 and served as Executive Directive to 1977.

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

Mary Tremblay (MT): But if we go back when you were in medical training, whenever you encountered spinal cord injury you were told that patients would not survive past 3 months. And that was what you were generally taught.

Dr. Gustave Gingras (GG): Yes. That's what books said.

MT: And what would happen to patients with spinal cord injury? Would they just stay in hospital and then gradually develop pressure sores and die?

GG: Not gradually develop pressure sores. They would develop pressure sores almost immediately. It is difficult to put yourself in the skin of a paraplegic where you realize there is no sensation whatsoever below a certain level. Below the level of injury in the spine. For instance dorsal five, which is approximately the level of the nipple, when you have the destruction of your spinal cord at the D-5 to speak or to speak our language Dorsal-five, you have no sensation whatsoever from the nipple down. Not only to light touch, but to pin prick, to an ice cube, to boiling water in a test-tube, and a most extraordinary thing, in space sensation. I can tell you where my hand is, and it's space sensation. And there is also position sense. I know that my thumb is flexed. Now, I know that it is extended. …
[describing his arrival at the Ste. Anne de Bellevue DVA hospital] I went to St. Anne’s and I went to the ward, and I looked at the patients that were still weaving baskets. Do you know about that? I didn’t like it. From then on they had to wake up at a certain time. I’m a disciplinarian, in the bottom of my soul. Pills to sleep – kaput – no more. You will sleep well John if you worked hard during the day. Everybody had to be turned every two hours. Those with pressure sores were taken great care of and one nurse did nothing [except dressing] …

MT: What was the atmosphere like? Can you remember when you came to St. Anne's at the beginning? They were doing weaving, and what were the soldier's expecting to happen to them?

GG: The others, except for the men in the infirmary, who had nothing to do were not difficult cases. Mine were very complicated, because of urinary problems, bowel problems, and the fact that they couldn't feel, they couldn't walk. And when I arrived there was a couple of [antique wooden] wheel chairs in the ward [dating from the first war] exchange the wheel chairs to have some mobility. And then, with the interest of the superintendent of the hospital, we started to have modern light metal wheel chair. …

MT: … you mentioned recognizing that it wasn’t a good idea to try to train paraplegics to walk with crutches and braces if they had a complete lesion. I wonder how that recognition came about?

GG: It was found by people like myself and Dr. Jousse and other people who like us in this place and other countries, Germany and elsewhere. They took some time, twelve months, for a patient to learn to put on his braces, stand up and hesitantly to do a few steps. It was also, and it is well noted, that a paraplegic suffers from osteoporosis, lack of calcium. We tried and tried to augment their calcium, nothing works. Consequently, because of the fragility of their bones, there were several fractures of people, complete lesions, trying to walk and falling.

MT: So you recognized fairly early on, with the veterans, that walking wasn't going to be useful.

GG: Let us say that it took two years in order to come to a final decision. When I started, with not a rule for everybody, I started by talking to Jean let us say and tell Jean You have seen in the gym, people trying to walk and you see their great difficulty. It's dangerous and it's not practical. You don't want to waste your life and time trying to get up and downstairs, using your arms only, to get you up or down. And you are going to get older and you might have less strength. Then I might say, "Well, you could go to school for learning, or watchmaking or something. Anyway, slowly and gradually, we didn't even talk about it, and the rehabilitation in the wheel chair became the rule, except for those who had fairly good [residual voluntary] motion [below the spinal lesion.]

MT: How do you feel today, because it is still a big issue in spinal cord rehab, this concern of many, many, people to walk. With electrical stimulation and those types of approaches, how do you view that?

GG: You notice that you don't hear about it much. There was quite a lot of advertising concerning stimulation of muscle and that invention was started by a psychologist somewhere in the States and that didn't work. Theoretically, there are all very nice, but there is something I said many times, "The body doesn't like to be robotized."