Dr. Albin Jousse on Lyndhurst Lodge Rehabilitation
Dr. Botterell made the case that, after stabilizing the medical trauma, care should immediately shift to a team of rehabilitation and nursing specialists working under the direction of a single medical director. In Canada Dr. Jousse was the first of these medical rehabilitation directors. His work at Veterans Affairs’ Rehabilitation Centre, Lyndhurst Lodge in Toronto, set the standard in Canada for active rehabilitation of patients with spinal injuries.
Interview Extracts - Transcript
Transcription extracts from the original transcription by Mary Tremblay.
From interview of January 17, 1991
Mary Tremblay (MT): … what was the response of people to spinal cord injury, either the individual, or the family?
Dr. Albin Jousse (AJ): Well, the medical profession, first and foremost, were negative about it. They said, "You can't do anything about these people, you let them die." And that was true in the upper echelon at the University of Toronto too. But that was their attitude. As Harry Botterell put it, one of his colleagues who was a very bright man, said "Harry this enterprise of yours is going to fall flat on its face." That was the idea that most senior medical and surgical people looked on this business. And, MacFarlane, the dean, Dean MacFarlane, was a surgeon in the RCAMC (Royal Canadian Army Medical Corps). He became converted and he used to say that Lyndhurst was the brightest jewel in the crown of the DVA [Department of Veterans Affairs], treatment program, and that just reflects his amazement really. Not only was he chief of surgery, he was a world famous surgeon. Even old Duncan Graham, who was as sour as could be. Duncan Graham was a professor of medicine, Professor of medicine until after the war, I guess. And he finally conceded that it was a great advance. Of course it was made possible by the treatment team, the antibiotics, and the "life care style." We trained surgeons and physicians and therapists to look after the spinal cord injured. Many of the neurosurgeons and orthopaedic surgeons, many of them, and therapists moved across the country, and settled from Halifax to Vancouver literally. …
MT: … because it seemed to me in the '60s we tended to institutionalize people more.
AJ: Well, we were always trying to get them [the patients] out because John Counsell was a very very great influence on us. And he wanted to get them out of here and get them into their own homes, and he set the example. And I remember we had a young lad who was a quad, not complete, I mean he was C-7, C-8, around there, and his hands were very weak, and he had a sensory deficit, couldn't walk, but he went to the Edmonton area. And the first weekend, he was at Lyndhurst the first weekend, the first Easter, he said I'd like to go home not for the weekend, but for the holiday. So I gave the go ahead and arranged transportation. So we put him on the train, and away he went. Now he was not independent but there were other people on the train willing to look after his needs, to the extent he needed help. Just after he got launched away, I got a call from Ottawa, you know, what was the idea putting a quadriplegic alone on the train. I said he wasn't alone, there were a lot of other people around. He can instruct people if he had to. And there were a lot of other veterans on the train anyway. I guess it was early after the war. And so they got to Edmonton, and much to his chagrin, they met him there with an ambulance and a stretcher, and they insisted that he get on the stretcher and they conveyed to wherever he was going by ambulance, you see. So that I remember one episode of the bureaucracy having done things since time in memorial in a certain fashion, you see. They thought that was the only way to do it. But the patients themselves really set their own pace and their own goals. And they've really taught the rest of us what you can really do, or really do. And they're the ones who used the hand controls in the car. They don't have very many accidents that were related to paraplegia or quadriplegia. People who were reckless are still reckless.
From interview of March 25, 1991
MT: … So this was the beginning of any rehabilitation [for spinal cord injured persons in Canada.
AJ: Yes, but there had been survivors. We had two or three World War I who had survived. We had a little fellow, MT, a Belgian, who was injured in the Abitibi Canyon [development], which was built about 1932. That was a power development up north. He was a complete paraplegic, and he came down to Toronto and he spent years and years and years at St. Michael's [hospital]. He was interested in the [stock] market. He went to the races as he was interested in horse races. He used to go out in his wheel chair, about half way to Oakville, and then came back to St. Michael's, where he lived. We took him and in due course we refined his self care. He went to live in the community and he got married. …
MT: you said we had several World War 1 veterans, did they come to Lyndhurst?
AJ: Yes. There was one Colonel, a Lieutenant Colonel, who lived in Grimsby, between the wars. He had an incomplete lesion, and he came over [for a period]. There was another chap, a paraplegic, who had multiple sclerosis, a veteran of the first war [who did not come to Lyndhurst.] There were a couple of others whose names elude me. One of them was an airman. … There were some of them who were living in chronic care units, attached to Christie Street Hospital which was then the Veteran's Hospital. …
We tried to prevent the hospital from becoming a permanent home for the veterans. Fortunately we had the support the John Counsel when he got out of the hospital. He encouraged patients, encouraged them to go back to their homes and go into society and practice a vocation.
MT: How did families react to that, when you were trying to have someone go home?
AJ: We educated them. Everybody [in the staff] in the hospital became an advocate of mastery of personal independence. In areas such as elimination and [personal] hygiene of all sorts, self- sufficiency and going out shopping, going out to the barber instead of having the barber come in. There's was one point I remember. Going out to the pub instead of drinking at the hospital. So they did both. But anyway they were encouraged to go out. We arranged, the Red Cross did a lot of worthwhile work there, to get them down to the Royal Alex, and to the Maple Leaf Gardens where Connie Smythe set aside certain blank spaces around the boards for people [who used wheelchairs] from Lyndhurst. They could go down there to see some hockey matches and other events. There a few whose homes were unsuitable for wheelchairs. We had one of our vocational counsellors or placement officers who would search the community for other domiciles [suitable housing] or change the access to make it more readily accessible.
MT: They [their homes] were unsuitable because of the building?
AJ: Yes, the building, yes. A lot of people moved away from their homes if they were up in the snow belt, they came down to Toronto and settled down here because it was easier to get around. They were also encouraged to get their own cars if they wanted them, and hand controls if they needed them to get around [as they did formerly]. Now there weren't many quadriplegics [at that time] who returned from overseas. [The nursing care essential to preserve life was not a component skill of all nurses as it is now.] They mostly died.
MT: They would have died in hospital there, or in the field?
AJ: [In both areas.] In transit maybe some of them might have, but we did receive a few who were returned by hospital ship. That changed of course, because we had indoctrinated the residents [physicians] we had, to the fact that quadriplegics had a contribution to make, and that they could live in the community. And many of them [accepted our teaching.] But still the mortality of the quadriplegic was higher than the paraplegics.
From interview of February, 1992
MT: the woman you were talking to this morning they are having trouble with nursing care.
AJ: They have had trouble with nursing care. She is capable of providing it herself but not twenty four hours at day. But when he gets into hospital he has sores [ulcers] you see and she can't persuade them that sores [ulcers] are a consequence of neglect. They are an act of God still with some people.
MT: I have heard that a lot of times now.
AJ: I am sure you have. But then there is another thing, Harry Botterell is a very forceful man and if he says something should be done well it has to be done or you have to have a good explanation for not doing it. He was very keen on all aspects of support care for paraplegics, for spinal cord injured people, and for all patients as a matter of fact. He used to come around, he used to come after me, he came home a couple of times from overseas to have a look at what was going on here. He, of course, had to persuade the old-timers that this was not a wild goose chase. Van Nostrand, who was a veteran of the First World War I and World War II, was a neuropsychiatrist and he used to mutter in his beard and say, "Harry you are wasting your time and you will fall flat on your face." But he [Botterell] was able to win Gallic over. …