Mary Tremblay, Ph.D.:
Today is August the 10th and I am interviewing Dr. Harry Botterell in his home. To begin with, I wanted to go back to when you were training in neurology, neurosurgery and in general surgery as well. What was your experience with spinal cord injury?

E. Harry Botterell, M.D.:
My experience with spinal cord injuries starts with the three severe, partial cases pre World War II, Frank Chalmers, Bill McFarlane, and Joe Sachetti. I looked after them myself in every way, both neurosurgically and urology. And, by chance, they all made dramatic recoveries and went back to work. That was my first really serious experience with spinal cord injuries.

Mary Tremblay, Ph.D.:
When you were training, when you were still a resident, did people discuss spinal cord injuries, other physicians?

E. Harry Botterell, M.D.:
No, not much.

Mary Tremblay, Ph.D.:
And, what would happen to someone with a spinal cord injury before 1935?

E. Harry Botterell, M.D.:
Well there was a pattern that I gradually came to appreciate. The patient would be admitted to whatever hospital, Hamilton General, or Toronto General. They would be intensively cared for by an orthopaedic-led team or a neurosurgical-led team. They would correct the deformities as much as they could and nurse the patients through the acute stage. Then after a period of weeks the neurosurgeon or the orthopaedic surgeon had done everything in their power, and took on other cases; the spinal cord injury patient got pushed to one side. And eventually was discharged to a hospital for the chronically ill, where they died, with a few exceptions.

Mary Tremblay, Ph.D.:
And they would die from what?

E. Harry Botterell, M.D.:
I don't know, I never saw them again. But I presumed they would die from GU sepsis, or pressure sores, or some toxic sepsis, all the things that spinal cord injury patients get who don't have the opportunity to rehabilitate themselves.

Mary Tremblay, Ph.D.:
There was no discussion then that people would go home, go use a wheelchair, go out into the community?

E. Harry Botterell, M.D.:
There was one great advance that I forgot to mention to you before. K. G. Mckenzie, in the 1930s, developed skull-tongs, independently of Crutchfield down in Virginia, who published his skull-tongs paper in a local Virginia journal. McKenzie didn't get much credit for this at all until later on, really after the war, I think. But this changed the whole complexion of the treatment of fracture-dislocations of the cervical spine with spinal cord injury, because skull traction was painless. And as a nurse, you will remember how difficult it was to maintain traction on a dislocated unstable cervical spine. They had those halters, leather halters, that provided traction on your chin and the back of your head--unbelievably uncomfortable, patients couldn't maintain uninterrupted traction. But McKenzie's tongs, his invention, independent, original, pre-World War II, was a great advance. Crutchfield's tongs were quite different than McKenzie's. Of course, we (a whole series of chiefs of service, and young neurosurgeons at the Toronto General) kept on modifying McKenzie's tongs. The same thing happened to Crutchfield's tongs. And so finally they were much the same. Originally Crutchfield's were small tongs that fitted into the top of the skull, the tong didn't go into the skull at right angle to the line of traction. It wasn't as secure as McKenzie's tongs, which stuck out laterally. We cut down McKenzie's tongs, and Crutchfield's successors enlarged his so they were finally much the same.

Mary Tremblay, Ph.D.:
So that was a new piece of technology.

E. Harry Botterell, M.D.:
That was an original work by McKenzie. He didn't know about Crutchfield's tongs, and he wrote a paper on spinal cord injuries too, which you will find back about 1935 or somewhere in there.(Bulletin of the Academy of Medicine of Toronto) After World War II there was a neurosurgeon in Cleveland, James Gardner who was reviewing skull-tongs, and he didn't even know about McKenzie's skull-tongs. Gardner was the Cleveland neurosurgeon at the Cleveland Clinic. He was reviewing some of the various skull tongs.

Mary Tremblay, Ph.D.:
And it had been lost in the Canadian literature?

E. Harry Botterell, M.D.:
That's exactly what happened.

Mary Tremblay, Ph.D.:
Between 1935 and 1939, when you were in Toronto, you were working with McKenzie, there were the two of you as neurosurgeons, were there any others?

E. Harry Botterell, M.D.:
Yes, Dr. William Keith at the Hospital for Sick Children and the Toronto Western Hospital.

Mary Tremblay, Ph.D.:
And would orthopaedic surgeons have treated spinal cord injury. Or not?

E. Harry Botterell, M.D.:
Some did but my memory is most did not. We consulted the orthopaedic surgeon about the stability of the spine. Dr. F.P. Dewar and I worked easily together, and Dr. R.I. Harris, he was the other senior orthopaedic surgeon. We worked easily together.

Mary Tremblay, Ph.D.:
And in that time you talked about the three spinal cord injured individuals you treated. Were there other people with spinal cord injuries that you treated?

E. Harry Botterell, M.D.:
Oh yes sure, there were, but they were either complete and perished, or disappeared as far as I was concerned. I was a neurosurgeon, I wasn't a rehabilitation specialist., in theory.

Mary Tremblay, Ph.D.:
Right. And you were one of a very small number of people too.

E. Harry Botterell, M.D.:
Yes, McKenzie, Keith and I, pre-World War II were the three fully active neurosurgeons in Toronto.

Mary Tremblay, Ph.D.:
How did you end up treating these three people? Was it just a chance?

E. Harry Botterell, M.D.:
Well partly, yes, partly chance. Dr. Gallie asked me to go and see one of these three people out at St. Joseph's Hospital. He'd been asked to see the patient, and he sent me instead. Typically generous Gallie. The other two patients came into the General Hospital emergency.

Mary Tremblay, Ph.D.:
They were lucky if they came there.

E. Harry Botterell, M.D.:
And I was consulted, as a young neurosurgeon, I represented the neurosurgical service. But the difference was that I treated these patients totally, their bladder, .... R.I.Harris turned over to me Munro's tidal irrigator. I got that going -- it had been a failure. I just nursed them and looked after them.

Mary Tremblay, Ph.D.:
In that period, did you have any correspondence with Munro? Did you meet him at all?

E. Harry Botterell, M.D.:
No. Not till after the war.

Mary Tremblay, Ph.D.:
Was anybody else writing about spinal cord injuries, this idea of taking care of the whole person?

E. Harry Botterell, M.D.:
Oh, sure. But I don't know who they were. Guttman, of course, became the great authority on spinal cord injuries, an Englishman.

Mary Tremblay, Ph.D.:
Yes. But I didn't find anything from him in 1935 to 1939.

E. Harry Botterell, M.D.:
No, no.

Mary Tremblay, Ph.D.:
And would Bill Cone in Montreal have been doing anything?

E. Harry Botterell, M.D.:
He was doing exactly the same thing in Montreal, and he had a couple of patients the same way I did, that he acquired and followed. One or two of them, one made a dramatic rehabilitation. Bill McFarlane was my first dramatic rehabilitation. And this guy in Montreal was Bill Cone's. Bill's was earlier than mine, I think.

Mary Tremblay, Ph.D.:
And you would discuss this back and forth?

E. Harry Botterell, M.D.:
Not pre-war.

Mary Tremblay, Ph.D.:
Not pre-war. This was more in the war.

E. Harry Botterell, M.D.:
Yes, and after.

Mary Tremblay, Ph.D.:
O.K. And during this 1935 to 1939 were there any centres in the world that were working on spinal cord injuries?

E. Harry Botterell, M.D.:
them.

Mary Tremblay, Ph.D.:
Well, I wasn't especially interested in spinal cord injuries then. I wasn't looking into The only person I've been able to find who was writing about them, it seems to me, was Munro.

E. Harry Botterell, M.D.:
Yes, and McKenzie wrote a paper in the 1930s.

Mary Tremblay, Ph.D.:
Now I'll look that up. I don't have that. But I couldn't find anyone else.

E. Harry Botterell, M.D.:
Munro was, I regard Munro as a, well, we became quite friends, Munro and I. And he regarded himself as the father and maybe I was the mother of treatment of spinal cord injuries.

Mary Tremblay, Ph.D.:
Yes, he says that in his book.

E. Harry Botterell, M.D.:
Yes. Where did you see that?

Mary Tremblay, Ph.D.:
In the preface of his book.

E. Harry Botterell, M.D.:
Did you really? I didn't know it was there.

Mary Tremblay, Ph.D.:
Yes, it's there in the preface, in the book he wrote in the 1950s. It's right there, yes. But you didn't know Munro, really, until...

E. Harry Botterell, M.D.:
No I didn't know him.

Mary Tremblay, Ph.D.:
You'd have his article tidal irrigators?, but that would be it.

E. Harry Botterell, M.D.:
That's right.

Mary Tremblay, Ph.D.:
O.K. Now, in the war, you enlisted on January 4, 1940.

E. Harry Botterell, M.D.:
8 That's right. I enlisted as soon as the establishment for a neurosurgeon was available. There was great controversy. The Fifteenth General Hospital, a 1200 bed hospital, was recruited into the Toronto General Hospital and I didn't join it because there was no place in the establishment for a neurosurgeon. And as you may or may not know, in the army the establishment is everything. If you haven't got the establishment for a neurosurgeon, you can't provide what a neurosurgeon needs to function.

Mary Tremblay, Ph.D.:
Right.

E. Harry Botterell, M.D.:
The establishment is the key word. I visited headquarters in Ottawa and talked to the Director General of the Medical Corps. and volunteered my services, as soon as _ he had a place for me. I came back to Toronto and went on working and they created the Number One Neurological Hospital largely based on the concept developed at the Montreal, Neurological Institute with the chief neurologist, and chief neurosurgeon, and chief x-ray man, all from the Montreal Neuro.[Institute] They were the number one's. The number two's were from Toronto.

Mary Tremblay, Ph.D.:
O.K. So this was Dr. Bill Cone and Dr. Colin Russell?

E. Harry Botterell, M.D.:
Bill Cone, Colin Russell, and Dr. Arthur Child. Child was a superb radiologist, radiologist.

Mary Tremblay, Ph.D.:
9 And then you went along as number two?

E. Harry Botterell, M.D.:
That's right, in neurosurgery.

Mary Tremblay, Ph.D.:
And you went then to England in the spring of 1940?

E. Harry Botterell, M.D.:
Yes, as the advance party of Colin Russell, Cone and myself. That's when I was going , around as a Lieutenant. They were Lieutenant-Colonels, because my promotion to Major hadn't come through.

Mary Tremblay, Ph.D.:
So you were a junior rank.

E. Harry Botterell, M.D.:
I certainly was [laughter]. Colin said, "Don't be so narrow, put up your rank it is just delayed in the system." I said, "No, no fear." He was a great comrade, Colin Russell. He was the chief neurologist in the Canadian army in World War 1. Never should have been in World War II because of his age and health. But he was bound and determined. He loved Bill Cone, in the nicest way. He was always courteous and a great comrade.

Mary Tremblay, Ph.D.:
And when you were there then, you were setting up the precursor then, you were setting up Basingstoke?

E. Harry Botterell, M.D.:
10 We were looking for a place to locate the hospital that was supposed to be following us. And of course at that time that the hospital got there Dunkirk had occurred. So we were fated to sit in England four and a half years.

Mary Tremblay, Ph.D.:
Now when I looked in the [war] diaries [from Basingstoke] in 1942 Bill Cone seems to have gone by then. Did he go back?

E. Harry Botterell, M.D.:
He was recalled by McGill.

Mary Tremblay, Ph.D.:
O.K. Why was that?

E. Harry Botterell, M.D.:
They needed him. He wasn't doing anything, and ... They also recalled Child, and Colin Russell. I don't know how we got Colin Russell home but he was such a fine man, and his health was terrible. I remember once watching him sit, doze after dinner in the mess with Cheyne-Stokes respirations.

Mary Tremblay, Ph.D.:
Yes. So he was determined to be there, but he really shouldn't have been there.

E. Harry Botterell, M.D.:
That's right, yes.

Mary Tremblay, Ph.D.:
Yes. But this was war, and this was a stressful time.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
What was Bill Cone like to work with?

E. Harry Botterell, M.D.:
Bill Cone was a devoted neurosurgeon, absolutely devoted. And he had a number of interesting characteristics. He loved to work in the middle of the night and he didn't conform to the ordinary pattern of neurosurgery. For instance, he thought I was lacking because I didn't use moist dressings the way he did. So he would dress his patient in the operating room with a saline compress and another dressing, and then he would go around that night and change it in the middle of the night. He was a very good neurosurgeon, and a very good man, and kind physician. He was a perfectionist, conscientious, all the good things, his patients loved him.

Mary Tremblay, Ph.D.:
Right. One of the people I interviewed, Marilyn Noell, the woman who wrote the book [we discussed], talked about him being a very compassionate physician.

E. Harry Botterell, M.D.:
Yes, that's right. His patients adored him.

Mary Tremblay, Ph.D.:
Yes, I got that feeling. Would you have talked to him about spinal cord injuries?

E. Harry Botterell, M.D.:
Oh, all the time.

Mary Tremblay, Ph.D.:
And what would you talk about? What would the issues be?

E. Harry Botterell, M.D.:
Oh, which was the best tidal irrigator, and how we could prevent pressure sores, or heal them. How we could ever get a patient back to Canada without getting a pressure sore on the way. It was very difficult in a hospital- ship or a hospital-train to turn a spinal cord injury every hour, and prevent the development of pressure sores.

Mary Tremblay, Ph.D.:
Yes. Especially when you had so many other casualties.

E. Harry Botterell, M.D.:
Yes, that's right.

Mary Tremblay, Ph.D.:
You also, I noticed, did supra-pubic ...

E. Harry Botterell, M.D.:
Yes, that was a major issue. That was my recommendation to the overall consulting surgeon because by the time we got a patient at Basingstoke, he might have been to half a dozen hospitals, and a hospital ship or an aircraft, and how can you run a tidal-drainage?

Mary Tremblay, Ph.D.:
Right.

E. Harry Botterell, M.D.:
It was a measure of war. And then we closed all the supra-pubics at Christie Street, Aberhart did. He was a courageous surgeon in Europe, but he was very unwilling to close these supra-pubics. He said you're the chief of the service, "if you want to share the responsibility, I'll do it."

Mary Tremblay, Ph.D.:
Why was he unwilling?

E. Harry Botterell, M.D.:
I don't know why? I have no experience with urology. In fact Dr. Aber hart closed one case after another a great success. The surgical officers put great pressure on him [laughter].

Mary Tremblay, Ph.D.:
Do you think he thought maybe if they closed them up then they might run into infection problems?

E. Harry Botterell, M.D.:
I thought of that, yes, or infections would spread up to the kidney's or something, but all supra-pubics were infected.

Mary Tremblay, Ph.D.:
So it didn't make difference then?

E. Harry Botterell, M.D.:
Well, I don't know. Anyway he did them all, one after the other with success.

Mary Tremblay, Ph.D.:
Yes. But pressure from you.

E. Harry Botterell, M.D.:
14 But persuasion from the younger fellows, surgical officers and backing from me.

Mary Tremblay, Ph.D.:
O.K. When Cone went back, [to Canada] you became the chief neurosurgeon?

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
And that was a fairly small operation, I guess, in 1942, but it expands by '44. You had quite a large staff by then. I saw a picture in 1944 of the whole unit. it's a very very large unit.

E. Harry Botterell, M.D.:
Yes. It was a 600-bed hospital, but it included plastic surgery. Neurosurgery, neurology, and plastic surgery.

Mary Tremblay, Ph.D.:
And in the picture there were a lot of men who weren't officers. Were they orderlies, or nurses and there were a number of ...

E. Harry Botterell, M.D.:
Nursing orderlies, and nurses, and quarter-master stores.

Mary Tremblay, Ph.D.:
So all the general day-to-day running of the unit.

E. Harry Botterell, M.D.:
The whole unit.

Mary Tremblay, Ph.D.:
O.K. And I noticed in the diaries that Mcfarlane often visited and Van Nostrand.

E. Harry Botterell, M.D.:
Who?

Mary Tremblay, Ph.D.:
McFarlane, was he visiting?

E. Harry Botterell, M.D.:
Colonel McFarlane, J.A. McFarlane, was the consulting surgeon of the whole Canadian army overseas.

Mary Tremblay, Ph.D.:
He was also the Dean of U of T?

E. Harry Botterell, M.D.:
Later when he returned to Toronto, post-war, he became the Dean of the Faculty of Medicine at the University of Toronto.

Mary Tremblay, Ph.D.:
And before he went to war, was he in Toronto then?

E. Harry Botterell, M.D.:
He was a general surgeon at the Toronto General.

Mary Tremblay, Ph.D.:
So you knew him then.

E. Harry Botterell, M.D.:
16 Yes, I did.

Mary Tremblay, Ph.D.:
What was he like to work with?

E. Harry Botterell, M.D.:
Oh, well I knew him very well. We'd been friends for years. He was an honest and very direct individual, a Scot.

Mary Tremblay, Ph.D.:
If you had some ideas to try out, you could expect support from him?

E. Harry Botterell, M.D.:
Yes, that's right. If you got into trouble he was a loyal colleague.

Mary Tremblay, Ph.D.:
And Van Nostrand?

E. Harry Botterell, M.D.:
Fred Van Nostrand was a very interesting man. He was a veteran of World War 1. First, he was in the infantry, then transferred to the air force in World War 1. And he crashed, and his leg was broken and various things. So then he was discharged. After the war he studied medicine. And then he went to work in DV A. In DV A he got into psychiatry, and in psychiatry came under a man, a famous character, called Bill Baillie. Dr. William Baillie who was at Christie Street, and later on at Sunnybrook. And Baillie had forgotten more about the psychiatric quirks of veterans than most people ever learned. And he transferred this to Van Nostrand, very generously. So when Van Nostrand came to be our commanding officer, he was like breath of fresh air in terms of army operation.

Mary Tremblay, Ph.D.:
So you could get things done, get through red tape, or ...

E. Harry Botterell, M.D.:
Oh, sure.

Mary Tremblay, Ph.D.:
When Van Nostrand went back to study medicine, would he have been funded by the government.

E. Harry Botterell, M.D.:
I don't know.

Mary Tremblay, Ph.D.:
But he was one of the veterans, though, he was wounded.

E. Harry Botterell, M.D.:
This was World War I'm talking about. I don't know.

Mary Tremblay, Ph.D.:
Yes, in World War 1. There were a few veterans who were disabled, I found, who went back to university with some funding. But it seemed very very difficult to get funding after World War 1. They were more interested in training you in a trade or sending you out to be a farmer.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
But there were a few who went back.

E. Harry Botterell, M.D.:
Yes. Dominion soldiers, Department of Civil Re-establishment, several were rehabilitated.

Mary Tremblay, Ph.D.:
Now then, Van Nostrand was he in charge at Basingstoke, or was he in charge overall?

E. Harry Botterell, M.D.:
He left the neurological as commanding officer to become the consulting psychiatrist to the Canadian Army overseas.

Mary Tremblay, Ph.D.:
Of the hospital?

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
O.K. And Mcfarlane though was the commanding ...

E. Harry Botterell, M.D.:
He was the consulting surgeon overall, the consulting surgeon for the whole army overseas. All branches of surgery.

Mary Tremblay, Ph.D.:
Now, when you were there in the beginning, you had Dieppe, you had Dunkirk before, but you wouldn't be involved in that, were there any spinal cord injuries before Dieppe?

E. Harry Botterell, M.D.:
I can't remember.

Mary Tremblay, Ph.D.:
And in Dieppe, that's when John Counsell was wounded.

E. Harry Botterell, M.D.:
Yes, that's right.

Mary Tremblay, Ph.D.:
Now, did he come straight to Basingstoke?

E. Harry Botterell, M.D.:
Oh, God! John was hauled into a boat by one of his fellow members of the Royal Hamilton Light Infantry. Then he was disembarked at port from this landing craft, and then he went through three or four hospitals, British hospitals, before he got to us. By that time he had a supra-pubic done by somebody else, but not under our say-so at all. And he'd had a hard time going from landing craft to temporary hospitalization in Southampton, or Portsmouth, or somewhere. Then into a hospital train and then into a British hospital, and then transferred to a Canadian General Hospital. The Canadian General Hospital transferred him to us, at Basingstoke. So we learned a huge amount from him, starting right then. And obviously who is going to look after a tidal irrigator in that succession of moves. And that's how I learned that we would probably save lives because surgeons can do supra-pubics, general surgeons. You know that.

Mary Tremblay, Ph.D.:
Yes.

E. Harry Botterell, M.D.:
But they can't fool with a tidal irrigator in the midst of that kind of evacuation and pressure of casualties. So I recommended to Mcfarlane that Canadian soldiers should have a supra-pubic done, high supra-pubic. They never did them high. So that caused a lot of controversy amongst the perfectionists, of whom Bill Cone was one, I'm sure. Though by that time he'd gone back to Canada.

Mary Tremblay, Ph.D.:
What was the controversy?

E. Harry Botterell, M.D.:
Doing supra-pubics, instead of tidal drainage.

Mary Tremblay, Ph.D.:
You were trying to deal with the realities of the war, and they were trying to deal with ideal case management.

E. Harry Botterell, M.D.:
Exactly. That is a very good description. So John landed up in Basingstoke eventually. He had just got married before he came overseas.

Mary Tremblay, Ph.D.:
Yes. He was in Montreal at that time?

E. Harry Botterell, M.D.:
21 I don't know. His mother was the famous Mrs. Counsell of Hamilton.

Mary Tremblay, Ph.D.:
Why was she famous?

E. Harry Botterell, M.D.:
I don't know but she certainly was.

Mary Tremblay, Ph.D.:
Because everyone had told me that, she was famous and she knew McKenzie King. But I went through all the Hamilton archives and I can not find out anything about why she was famous.

E. Harry Botterell, M.D.:
Why don't you ask them. I think John's sister is still alive. Mrs. Walter Gordon. Anyway, he didn't want to come home. He had all the neurological sequelae of a complete conus and cauda equina lesion at the level of T-12 - L-1.

Mary Tremblay, Ph.D.:
And spinal cord injury by the general public was seen as quite a tragedy, I would imagine.

E. Harry Botterell, M.D.:
Well this is a tragedy in his case anyway because there was a cauda equina and a conus lesion. A lower motor neurone lesion to the bladder. And he didn't want to go home. We kept him as long as we could and the nurses liked him and he liked the nurses. We saw the opportunity of indoctrinating him regarding what should be done for spinal cord injuries in the way of hospital care and rehab on the basis of the three patients I'd rehabilitated personally, World War II. Also on what was happening in England and what we had read about and discussed and talked with the English and ourselves. He was the key person in this whole operation. John was, the patient and became the leader and Canadian pioneer patient.

Mary Tremblay, Ph.D.:
Why was he key?

E. Harry Botterell, M.D.:
Well he was key because he was a highly motivated man and at No. Neurological Hospital we educated him about spinal cord injuries, and the nurses educated him. He learned about pressure sores and deformities and pain, he had lots of pain. I got the British consulting neurosurgeon to come over and see him, Brigadier Cairns of Oxford. He was a political hot I potato, the first Canadian enemy action, gunshot wound of the spinal cord injury of World War II.

Mary Tremblay, Ph.D.:
Had you known Counsell before?

E. Harry Botterell, M.D.:
No.

Mary Tremblay, Ph.D.:
Because he went to Ridley, I think, and you went to Ridley.

E. Harry Botterell, M.D.:
Yes I did.

Mary Tremblay, Ph.D.:
But you didn't know him from there.

E. Harry Botterell, M.D.:
Well I'm years older than he.

Mary Tremblay, Ph.D.:
O.K. So you might have gone to the same school, but there was no ...

E. Harry Botterell, M.D.:
I knew his cousins in Winnipeg also.

Mary Tremblay, Ph.D.:
You did. Didn't one of them die in the war too?

E. Harry Botterell, M.D.:
Pardon?

Mary Tremblay, Ph.D.:
The cousins, I had seen there was cousins in Winnipeg. You knew them though?

E. Harry Botterell, M.D.:
I knew one of them.

Mary Tremblay, Ph.D.:
You had Cairns the senior Neurosurgeon in the British Royal Army Medical Corps come over from Oxford to see Counsell.

E. Harry Botterell, M.D.:
Oh yes from Oxford to consult. He said, "Harry you have to operate I did and I didn't do any good and I wished I hadn't. So then he came home.

Mary Tremblay, Ph.D.:
Just before you go .... When you operated, you were saying you had to operate because you had to do something.

E. Harry Botterell, M.D.:
Well, that's right, though in many centres, particularly the U.S.A. centres surgical exploration was routine in cases of gunshot wounds of the spinal cord and cauda equina.

Mary Tremblay, Ph.D.:
But what would you do, what would the surgery be?

E. Harry Botterell, M.D.:
I'd do a laminectomy, and look and see what had happened to the spinal cord and cauda equina, and ensure that the nerve roots had no bone fragments and infringing on them and that sort of thing.

Mary Tremblay, Ph.D.:
So it was really an exploratory.

E. Harry Botterell, M.D.:
That's what it was, yes.

Mary Tremblay, Ph.D.:
There was nothing clinically you could do? I read a paper by Burrell in 1905, and he had talked about people operating to look, but really the operations were doing no good.

E. Harry Botterell, M.D.:
25 No good at all. And that's what I've always thought. But in this case, this was situated in the spinal column where there are nerve roots as well as spinal cord, cauda equina. Anyway, he survived that, and we survived it, and we kept him until the headquarters made us send him home.

Mary Tremblay, Ph.D.:
How long would that have been?

E. Harry Botterell, M.D.:
Well, it started off, in theory days, but I'm sure it was longer than that. And the nurses taught him everything they knew about spinal injuries, and that was considerable, because the sum total of the Montreal Neurological Institute nurses know-how, and our Toronto General, Toronto Western nurses know-how, the neurosurgical nurses was very considerable. The young surgical officers talked to him, and I talked to him. Everybody talked to him all the time so that he understood what he was going to find when he got home that care of paraplegics was nothing like this. And maybe he could help get it going. So when he got home he found all this, and he was transferred from Christie Street to the Montreal Neurological Institute. God knows, I don't know why or how, but he was. And then Bill Cone re-operated on him. Hoping he could maybe do a graft or something, which still hadn't been done.[Pause]

Mary Tremblay, Ph.D.:
We were talking about Bill Cone operating on John Counsell, leaving no stone unturned.

E. Harry Botterell, M.D.:
That's right. And hoping you put a graft in where the nerves were, not to replace the spinal cord, but the cauda equina nerves. Well, that didn't work. Then John came back to Toronto, and got himself out of hospital, using the modern Everest & Jennings wheelchair. One of the first ones in Toronto.

Mary Tremblay, Ph.D.:
Yes.

E. Harry Botterell, M.D.:
Well, then I operated on John Counsell for pain. And we had a disaster, he lost the vision in one eye, even though I was operating on the back of his neck. And that was a disaster, very upsetting.

Mary Tremblay, Ph.D.:
When would that have been? Would that have been after ... ?

E. Harry Botterell, M.D.:
1945.

Mary Tremblay, Ph.D.:
When you came back.

E. Harry Botterell, M.D.:
Yes. So he was the key man in this whole thing because he knew what needed to be done for these people in terms of nursing care and physiotherapy, and so on. And there's a grey eminence, and I use the word in a complimentary sense, in the form of Mr. Lew Wood. Well, he was an invaluable supporter. He knew how to handle these chronic long-term illnesses because he had helped Eddie Baker set up the CNIB. And he helped John Counsell set up the Canadian Paraplegic Association. He did everything in his power materially and personally to support the spinal cord injury patients and the Paraplegic Association. I had great admiration for him. He and John worked together and you checked ... who is the man you checked out of Lyndhurst? You said you talked to some people.

Mary Tremblay, Ph.D.:
Oh, you mean the veterans I talked to?

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
Oh, Ken Langford, yes, because he worked with John.

E. Harry Botterell, M.D.:
Ken Langford, he worked with John, and he became a kind of executive secretary. But he never got the recognition that was his due, Ken Langford. John Counsell's leadership was outstanding.

Mary Tremblay, Ph.D.:
Sort of like a partnership.

E. Harry Botterell, M.D.:
Well, that is a fair statement. John Counsell played this leading role. And then backed up by his sister and his brother-in-law, and his mother. We were in a very fortunate position that (a) he survived the vicissitudes of neurosurgery, and could soon face his disability. [turn that machine off for a minute]. So anyway John understood all of this, and Walter Gordon understood it, and Mrs. Gordon understood it, (that's John's sister). And this was a very powerful group. I was plunging ahead at Christie Street as if I knew what to do all the time when I didn't. I had had the great good fortune to recruit Dr. Jousse, and that's worth recounting now. I went to see Dr. McKenzie and said, "Ken, I need a physician. He said, "You do need a physician who will take on all aspects of the care of spinal cord injury patients. And we the consultants will be called in by this man as necessary." Because urologists do the urology, (that's enduring); orthopaedics have completed the treatment of the acute stage about three weeks after the guy is operated on; same with neurosurgeons. And then what happens to the paraplegic? This was the key of the whole operation. We got a doctor for spinal cord injury patients who was the key man. And he called in the specialists, the neurosurgeons and the orthopaedic surgeons, neurological surgeons, the plastic surgeons as needed. And Dr. Albin T. Jousse was the man we recruited, and he was a perfect man.

Mary Tremblay, Ph.D.:
Why was he perfect?

E. Harry Botterell, M.D.:
He was disabled himself, considerably. He had served during World War II as a neurologist for the neurosurgical service at the General Hospital in Toronto because McKenzie had insufficient staff, a shortage of residents. And Dr. Jousse did the neurology on the neurosurgical service -- not the operating. So he was very well informed about all this stuff. And it is worth recounting, perhaps I told you, Dr. McKenzie said, "Well I think I've got the man for you, but he's ticketed for Sudbury." Did I tell you this story?

Mary Tremblay, Ph.D.:
Yes. It's in the other interview. Right. But you talked him out of it.

E. Harry Botterell, M.D.:
I didn't talk him out of it at all, he talked himself out of it. He said, "Well my war effort hasn't been much, I'll take that job on." He didn't know how much he was going to be paid, or what his rank was going to be, or a damn thing. This was the time I had to start and blast out an establishment for Lyndhurst, and for the medical director at Lyndhurst, and get a proper category for him in the public service, and none of these things had been done. At that time I discovered . . . . Dr. Jousse went down to New York to look at the rehabilitation in the Institute for the Crippled and Disabled in New York for spinal cord injury patients. I discovered that he could only walk two blocks, and that was two New York city blocks. So he was very disabled. When he talked to somebody that was disabled, he had leverage that you and I wouldn't have. Really very important. And his training had included surgical neurology with McKenzie, and he also had worked in the Queen Street Ontario Hospital, psychiatry. He was a very well educated man for this particular job, he was almost ideal. So he went to work and from that time on I was only a consultant, and he was the director of Lyndhurst. And he used me as a consultant and as a backer-upper.

Mary Tremblay, Ph.D.:
Right, of the day-to-day running of Lyndhurst.

E. Harry Botterell, M.D.:
Oh, more than that, the policy.

Mary Tremblay, Ph.D.:
Right. And then you were at Christie Street.

E. Harry Botterell, M.D.:
Well, you see Lyndhurst started as part of the Christie Street Hospital, neurosurgical service, imagine that. And we moved to Sunnybrook and took the paraplegics with us. But (my voice is running out), Dr. Jousse was the director of Lyndhurst. And for a year or two I used to go up there about once a week and make rounds as the ostensible chief of the neurosurgical service. And after that it just petered out.

Mary Tremblay, Ph.D.:
But the link was there as you started?

E. Harry Botterell, M.D.:
The link was there and I was able to protect Dr. Jousse on one or two occasions when there was a political conflagration. One medical group in the city ( who had better remain nameless), decided they should be able to admit their patients to Lyndhurst separate from the Jousse service. But can you imagine as an experienced nurse having half a dozen doctors directing patients' care in a place like Lyndhurst? Just hopeless. I worked on wards in hospitals where there would be that kind of mixture of half a dozen doctors and beds -- awful. But can you imagine the whole tenor at Lyndhurst changing with such an organization.

Mary Tremblay, Ph.D.:
When would that have happened? In the late 1940s, or ... ?

E. Harry Botterell, M.D.:
31 Yes, probably later.

Mary Tremblay, Ph.D.:
Before we go further on into Lyndhurst, can I go back just a bit? When John Counsell came back to Montreal, there is a letter from him to McKenzie King in the Archives.

E. Harry Botterell, M.D.:
Is there?

Mary Tremblay, Ph.D.:
And he's thanking McKenzie King for being concerned about him. And I think he's saying he would consider maybe a job in public service, but he had to feel better first. He wasn't feeling well and he had ...

E. Harry Botterell, M.D.:
That's right, he had pain.

Mary Tremblay, Ph.D.:
Yes, and this was, oh, 1943 in the summer. So he obviously had some connections with McKenzie King.

E. Harry Botterell, M.D.:
Through Walter Gordon.

Mary Tremblay, Ph.D.:
Through Walter Gordon, maybe. Because, you know, and then in 1944 there's some letters from his mother, some telegrams, to McKenzie King, and I gather she was in charge of a Toronto hospital, Women's Hospital Committee. They were looking at Christie Street, and ...

E. Harry Botterell, M.D.:
I don't know.

Mary Tremblay, Ph.D.:
Yes. I wondered if you knew that, because they were complaining about the quality of service at Christie Street in 1944. And trying to get McKenzie King's support that he would start to ...

E. Harry Botterell, M.D.:
There must have been a very big potential upheaval brewing because Dr. Gallie telephoned me one day. He was the sort of big white chief of all of the surgery associated or affiliated with the University of Toronto. And he said, "Harry, the Toronto Star is in my office, around the corner, and they want to break a story about the wickedness of Christie Street, and it's inadequacies and imperfections and so on. What do you think about that?" I said, "Well, I think that would be a mistake because the revolution is occurring. It's too late to make a fuss and upset a whole lot of people whose husband's and son's and so on and daughter's are patients in Christie Street, because it won't improve that. And they've are going to move to Sunnybrook. And since Bill Warner came in things are better anyway."

Mary Tremblay, Ph.D.:
It's already started.

E. Harry Botterell, M.D.:
Neurosurgery got everything they asked for.

Mary Tremblay, Ph.D.:
33 Yes. So this would have been in 1944 though, before you ...

E. Harry Botterell, M.D.:
No, this was when I was in Christie Street.

Mary Tremblay, Ph.D.:
Yes, this would be 1945, though.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
But her telegrams were in 1944. That would be before you came back.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
If we go back to England, you had talked about Geoffrey Jefferson, from Manchester and in the interview with U of T that you used to discuss with him philosophies about spinal cord injury.

E. Harry Botterell, M.D.:
All sorts of things.

Mary Tremblay, Ph.D.:
And one of the things that I read was that there was a discussion about paraplegic colonies. How did that discussion go?

E. Harry Botterell, M.D.:
34 Well we were probably having coffee after dinner together in his house. I'd been looking after his service for him, at one stage that was in 1940. I went back often and spent leaves with him. And he came in very often into our hospital. It was a very close relationship between Professor Jefferson and me.

Mary Tremblay, Ph.D.:
Yes I saw that. That's in the war diaries from Basingstoke, you see him coming in, they recorded.

E. Harry Botterell, M.D.:
And we discussed what we were going to do with these people. And Guttman was a moving force in spinal cord injuries in England. And he was doing at Stoke-Mandeville what we were doing at Basingstoke, that is healing pressure sores and mobilizing patients and so on. We were taking a much more .... he was looking at all aspects of what to do with these people when the war was over. And one of the possibilities was a paraplegic colony. Jefferson says I make too much of that in our conversations, he's dead now. His son's turning up in a couple of weeks. Anyway, it just came up in conversation. [end of side 1]

Mary Tremblay, Ph.D.:
So, you both rejected the idea of a paraplegic colony. What about Guttman, did you meet Guttman when you were in England?

E. Harry Botterell, M.D.:
Oh yes, sure and he came out to see us here. Guttman has written a book this thick on spinal cord injury.

Mary Tremblay, Ph.D.:
Yes, I've read that yes.

E. Harry Botterell, M.D.:
There was always a, (how do I put it?) a sense of rivalry between Jousse and me on the one hand, and Guttman on the other.

Mary Tremblay, Ph.D.:
What was the rivalry about?

E. Harry Botterell, M.D.:
Well I don't want to make much of that.

Mary Tremblay, Ph.D.:
O.K. I wondered because in some of his early articles,there were a few that appeared in Caliper, in the paraplegic newsletter.

E. Harry Botterell, M.D.:
That's Jousse.

Mary Tremblay, Ph.D.:
No, Guttman's. He was talking in one of the articles in 1948, I think, that not everybody with a spinal cord injury would be able to go home. And he was talking there about setting up a colony or a place for people to live. I wondered if he talked about that at all with you.

E. Harry Botterell, M.D.:
Yes, he talked about that. We were not very prolific writers from Christie Street and Sunnybrook, and even Lyndhurst, though Dr. Jousse did better than we did. I always had the feeling that Dr. Jousse felt that Guttman sort of picked his brains a bit, and then had gone ahead. I can't prove that. It's a feeling I've had for years.

Mary Tremblay, Ph.D.:
Actually I had a similar wondering because many of the things that you did at Lyndhurst seemed to be revolutionary and often were the first done anywhere in the world. ERB: Yes, that's right.

Mary Tremblay, Ph.D.:
The article in 1946 on paraplegia is as relevant today, I think, as it was when you wrote it.

E. Harry Botterell, M.D.:
Well, that's the key paper.

Mary Tremblay, Ph.D.:
Yes. And you could read that today. I mean it's a very comprehensive approach. But I also wondered if it was because it was a Canadian paper it tended to get lost in ... ERB: It was published in the wrong place. It was published in the Canadian Medical Association Journal. My Canadian loyalties were involved. And it was first given at the Canadian Medical Association meeting at Banff, where they couldn't even darken the room enough to show the movie properly. So it was rather sad. But, that was the key paper. And actually we haven't had to change that much, that whole paper in light of Dr. Jousse's analysis of scores of patients who went through.

Mary Tremblay, Ph.D.:
That was a very visionary paper compared to what other people were writing at the same time.

E. Harry Botterell, M.D.:
Yes, at that time, yes.

Mary Tremblay, Ph.D.:
And I wondered if because you didn't write a lot, or because you also weren't, say, travelling the world and talking about it.

E. Harry Botterell, M.D.:
I was travelling the world.

Mary Tremblay, Ph.D.:
Were you?

E. Harry Botterell, M.D.:
Sure I travelled, and gave this paper in Paris at Professor Petit Dutailles Hospital Clinic in English and it was translated as I went along. I gave it in the Netherlands, I gave it to the British s at the neurosurgical meeting of their Society. It was first reported in Cincinnati, Ohio and published in the cincinnati Academy Medical Bulletin.

Mary Tremblay, Ph.D.:
So you were out travelling with them.

E. Harry Botterell, M.D.:
38 Yes sure. And I was in Australia as a visiting professor at Melbourne University, and gave all the stuff there. And I went to New Zealand to travel with my wife for fun, and I knew McKenzie who was the professor of neurosurgery at the North Island University at Auckland. He arranged university visits and lectures in both the north and south islands.

Mary Tremblay, Ph.D.:
And throughout is the idea of going back to civilian life, going back to employment, going back to your community.

E. Harry Botterell, M.D.:
Yes, that's right.

Mary Tremblay, Ph.D.:
And that's the first reference I've seen where anyone articulated that philosophy so clearly. That's the earliest one I could find. Many people seemed to hedge their bets by saying, "it' could happen for a small number, but it wouldn't happen for most."

E. Harry Botterell, M.D.:
Yes, but nobody else knew how to do it except by guess and by God.

Mary Tremblay, Ph.D.:
Yes, but right from the beginning you did.

E. Harry Botterell, M.D.:
Turn that thing off for a minute.

Mary Tremblay, Ph.D.:
O.K. One last thing when John Counsell came home, did you correspond with him, or were you in touch with him about. ...

E. Harry Botterell, M.D.:
Not till I got home.

Mary Tremblay, Ph.D.:
O.K. And when you talked the DVA into buying Lyndhurst and turning it into a rehab centre ...

E. Harry Botterell, M.D.:
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 a 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, Ph.D.:
Yes, yes, I wanted to ask you about him. 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.

Mary Tremblay, Ph.D.:
Because there were a lot of patients there, weren't there, about 100?

E. Harry Botterell, M.D.:
And it was a big hospital full of those requiring neurosurgical services, general neurosurgical services. The key man was Joe Cluff.

Mary Tremblay, Ph.D.:
Right.

E. Harry Botterell, M.D.:
You've got him? There he is over there.[photograph]

Mary Tremblay, Ph.D.:
Which one?

E. Harry Botterell, M.D.:
The bottom one.

Mary Tremblay, Ph.D.:
O.K.

E. Harry Botterell, M.D.:
He's sick nigh unto death at the moment.

Mary Tremblay, Ph.D.:
And he was there while McCormick was there.

E. Harry Botterell, M.D.:
Yes he was. And he was there with me too.

Mary Tremblay, Ph.D.:
Right after. There's a letter I found at CPA from McCormick, and he was talking about amputations of the paraplegic's legs. I hadn't heard that before. This was about 1944, 1945.

E. Harry Botterell, M.D.:
That's right.

Mary Tremblay, Ph.D.:
Did that ever happen?

E. Harry Botterell, M.D.:
No. Oh, one man I think turned up having had his legs cut off somewhere else.

Mary Tremblay, Ph.D.:
Yes. But that wasn't an accepted procedure or was it talked about?

E. Harry Botterell, M.D.:
Not in our unit.

Mary Tremblay, Ph.D.:
O.K. He seemed to be advocating it in this letter, that some might chose to do that and that seemed a pretty ....

E. Harry Botterell, M.D.:
Yes, well there were these terrible spasms.

Mary Tremblay, Ph.D.:
So that was a way to eliminate the spasm.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
But you would eliminate all the balance issues as well.

E. Harry Botterell, M.D.:
The counter-weight, that's the whole point right there.

Mary Tremblay, Ph.D.:
When you were in England, you had a meeting at Basingstoke of the British Neurosurgical Society?

E. Harry Botterell, M.D.:
This was the British Society of Neurological Surgeons. THE Society. Beyond which there is no whicher. And they'd never had a meeting except at British establishments before that one. And we really bust ourselves to make that a success.

Mary Tremblay, Ph.D.:
Yes. Because you were fairly busy at that time too. This was '44?

E. Harry Botterell, M.D.:
Yes, but it had settled down.

Mary Tremblay, Ph.D.:
It was settled down. You became, I think, a Fellow in that society?

E. Harry Botterell, M.D.:
Honourary.

Mary Tremblay, Ph.D.:
Honourary Fellow. Yes, that's in the diaries.

E. Harry Botterell, M.D.:
Is that right?

Mary Tremblay, Ph.D.:
Yes. And they talk about, they say you are one of a very small number. Ł

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
... outside of Britain.

E. Harry Botterell, M.D.:
That's right.

Mary Tremblay, Ph.D.:
And did that last, did you become a Fellow for ever?

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
So you are still a Fellow?

E. Harry Botterell, M.D.:
Honourary, yes.

Mary Tremblay, Ph.D.:
Once you are appointed. At that meeting, did you talk at that meeting at all about spinal cord injuries, or was it other issues?

E. Harry Botterell, M.D.:
I can't remember.

Mary Tremblay, Ph.D.:
Yes, it wasn't a central focus? When you came back to Christie Street, in February of 1945, what was it like? What did you find?

E. Harry Botterell, M.D.:
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 -- you know what they thought, they'd all be dead in six months.

Mary Tremblay, Ph.D.:
Right.

E. Harry Botterell, M.D.:
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.

Mary Tremblay, Ph.D.:
Would you have known many of these people, because you would have seen them in Basingstoke.

E. Harry Botterell, M.D.:
45 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.

Mary Tremblay, Ph.D.:
In the war, at Basingstoke, would you have physiotherapists there, or would nurses have done that?

E. Harry Botterell, M.D.:
Sure, we had physiotherapists.

Mary Tremblay, Ph.D.:
You had them there, and you got them at Christie Street then.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
That must have been, actually, as you say traumatic, because you had set one program up, sent these ...

E. Harry Botterell, M.D.:
46 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.

Mary Tremblay, Ph.D.:
Yes.

E. Harry Botterell, M.D.:
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." [laughter] 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.

Mary Tremblay, Ph.D.:
Someone else mentioned to me that in the war all the young dynamic physicians were overseas.

E. Harry Botterell, M.D.:
That's right.

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

E. Harry Botterell, M.D.:
Exactly.

Mary Tremblay, Ph.D.:
And you were upsetting the status quo that had gone on somewhat comfortably?

E. Harry Botterell, M.D.:
Well this was ~n 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.

Mary Tremblay, Ph.D.:
Right.

E. Harry Botterell, M.D.:
And so we set up a new service, in a new setting, and recruited an x-ray man Dr. Cliff Ash ? to do our x-rays, and a urologist Dr. Carl Aberhart to do our urology. All this was backed by Professor Gallie and Professor Gordon Richards. Drs. Ash and Aberhart were already fully occupied.

Mary Tremblay, Ph.D.:
And what was John Counsell's role during this time? Did he have a role in this?

E. Harry Botterell, M.D.:
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.

Mary Tremblay, Ph.D.:
How would he do that?

E. Harry Botterell, M.D.:
Well, through his family connections, and he was identified as being a good man.

Mary Tremblay, Ph.D.:
So you had many different ways to tackle the problem.

E. Harry Botterell, M.D.:
Well, I wouldn't have said that exactly. In June of 1945 I took a holiday with my wife. And I said to Joe Cluff, (I've told you this story haven't I?).

Mary Tremblay, Ph.D.:
Yes, it's in the speech, in the interview, the old one. And they went and renovated the place while you were away. And you came back and ...

E. Harry Botterell, M.D.:
And there was no authority for this. Lew Wood' s contracting firm did it, because he said anytime I could help you just let me know. And I said to Joe Cluff, "You can get this Christie Hospital unit fixed up. And if you need any help get John Counsell and Lew Wood."

Mary Tremblay, Ph.D.:
One comment I heard as well, Dr. Norwich.

E. Harry Botterell, M.D.:
49 Yes, Arthur Norwich.

Mary Tremblay, Ph.D.:
Arthur Norwich. There is a quote in James Burke's book about Lyndhurst. He talks about Norwich, describing Jousse at this time, saying that Jousse had a very good skill of getting the things done he needed doing, sometimes breaking the rules.

E. Harry Botterell, M.D.:
That's right.

Mary Tremblay, Ph.D.:
But then Norwich said, "Well, I just figured out how to look the other way so we could get it done."

E. Harry Botterell, M.D.:
Oh sure. Norwich was a great sport he had vision and courage. He was a man who was running Christie Street when I came back. And he defended me, I'm sure, many times.

Mary Tremblay, Ph.D.:
You talked in your last interview about writing a report about what you found.

E. Harry Botterell, M.D.:
Oh yes.

Mary Tremblay, Ph.D.:
What happened? How did that happen?

E. Harry Botterell, M.D.:
Well, there was a committee in Ottawa, chaired by R.I. Harris, "Doc" Farmer of the Children's Hospital, (A.W. Farmer) was on it and (I can't remember who else). They were responsible for 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." [laughter] So down I went to Ottawa, to defend this report.

Mary Tremblay, Ph.D.:
And this was where Farmer backed you up.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
You were trying to bring about an awful lot of changes.

E. Harry Botterell, M.D.:
Oh, sure.

Mary Tremblay, Ph.D.:
Which couldn't have always been easy.

E. Harry Botterell, M.D.:
Pardon?

Mary Tremblay, Ph.D.:
It sounds now like they just happened, but they must have been very difficult.

E. Harry Botterell, M.D.:
Oh, of course. The nurses all had to change their outlook or change or 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've 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."

Mary Tremblay, Ph.D.:
Yes. Who was that you ran into? That wouldn't be Jack Higman would it?

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
Yes in his interview, when you get the thesis, 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.

E. Harry Botterell, M.D.:
Well these people were being neglected by modern standards.

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

E. Harry Botterell, M.D.:
I Exactly.

Mary Tremblay, Ph.D.:
So that was quite common.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
What about in other spots in Canada, what was happening in other places?

E. Harry Botterell, M.D.:
Well it was happening everywhere. Bill Cone had one of his younger men, Harold Elliot who'd been with us at one stage, he was at the Queen Mary Road Hospital in Montreal, and they did some, the same sort of thing we were doing. And Fritz Strong, a doctor in Vancouver, had a daughter who was a spinal cord injury, and he sponsored the changes out there.

Mary Tremblay, Ph.D.:
There were some other nodes starting. And you would communicate?

E. Harry Botterell, M.D.:
Well, informally. And in the States they were setting up spinal cord injury centres too, weren't they?

Mary Tremblay, Ph.D.:
Well, I read a history of the American Paralysed Veteran's Association. And in that history they are saying that in 1945, 1946 the vet's were pushed off into the corners and just left.

E. Harry Botterell, M.D.:
Yes, they were.

Mary Tremblay, Ph.D.:
And it was only after a number of vet's started to really agitate and they ...

E. Harry Botterell, M.D.:
I didn't know that.

Mary Tremblay, Ph.D.:
Yes. They talked in, one of the individuals talks about knowing about Munro and what he was doing, and why weren't they doing it for the Vets. And then·by 1947, I think, is it Ernest Bors was starting something out in the West Coast.

E. Harry Botterell, M.D.:
Yes, yes, he was a urologist.

Mary Tremblay, Ph.D.:
Yes. But, 1945, 1946 sounded dreadful.

E. Harry Botterell, M.D.:
I had a great friend who was professor of neurosurgery at Cincinnati University. He invited me to come down there and talk about the management of spinal cord injury patients who had been returned from combat. So they were right in on it right from the very beginning, Cincinnati was.

Mary Tremblay, Ph.D.:
54 - ---- ------ Right. So that would be one hub that was ...

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
I guess they're problem was they had so many. They were saying, it seems they had about 2,500 to 3,000.

E. Harry Botterell, M.D.:
Yes, sure, but look at the size of the country.

Mary Tremblay, Ph.D.:
True.

E. Harry Botterell, M.D.:
The ratios.

Mary Tremblay, Ph.D.:
But it sounds like they were much later in starting the special units.

E. Harry Botterell, M.D.:
Yes, they were.

Mary Tremblay, Ph.D.:
I wanted to ask you one thing about your relationship with John Counsell. You had mentioned that he was very important to everything that had happened. But here you were the neurosurgeon, the chief neurosurgeon, and yet you were, in a sense, planning programs with a patient.

E. Harry Botterell, M.D.:
That's right.

Mary Tremblay, Ph.D.:
Why did you do that?

E. Harry Botterell, M.D.:
Because that was the only way to do it. Where else would we get support to spend all this money, and change the establishment, and reorganize -- we had to get help where we could find it. And he was a patient, and he had planned every little thing before we came back. The wheelchair being an example.

Mary Tremblay, Ph.D.:
Right, that's right. You really were working together.

E. Harry Botterell, M.D.:
Oh, very closely. But you have to realize after this first year. When I came home, at the request of DV A, I discovered very quickly that if I went back to the General Hospital in Toronto, I would just be absorbed. As far as the neurosurgeons, McKenzie was very very tired. I decided I had to stay at Christie Street, Sunnybrook for at least long enough to get Dr. Jousse established, be his guardian, protector, and colleague. So that was how I got these things going. I remained and detached from McKenzie, and the General Hospital. Oh, I filled in when he was sick, or away, or that sort of thing. But, it took, as it turned out, it took from about February to the end of 1945 when I went back to civilian life.

Mary Tremblay, Ph.D.:
56 When CPA gets founded in June of 1945, the Paraplegic Association.

E. Harry Botterell, M.D.:
I remember Lew Wood talking to me in the spring saying, "Colonel, this is much too important to be left to doctors, forming the Paraplegic Association." [laughter] He had helped form the Association for the Blind with Eddie Baker.

Mary Tremblay, Ph.D.:
And how did they form that? What were they talking about when this was formed?

E. Harry Botterell, M.D.:
I don't know.

Mary Tremblay, Ph.D.:
You weren't involved in it?

E. Harry Botterell, M.D.:
No.

Mary Tremblay, Ph.D.:
Did you get involved with CPA later?

E. Harry Botterell, M.D.:
No. Al Jousse did.

Mary Tremblay, Ph.D.:
But you did really get involved?

E. Harry Botterell, M.D.:
You see, I gradually eased out of this thing after the reorganiz.ation, and Dr. Jousse took over Lyndhurst. Then what was left, was a quiet veterans 's neurosurgical services at Sunnybrook, that was Christie Street, Sunnybrook, and some of the complications of spinal cord injury. But it was really Dr. Jousse' s show.

Mary Tremblay, Ph.D.:
When you went back to the Toronto General, you were involved in trying to set up that as a very specialized neurosurgical service too?

E. Harry Botterell, M.D.:
Well, not anymore than I had been before World War II.

Mary Tremblay, Ph.D.:
Right. So you continued on?

E. Harry Botterell, M.D.:
I'd had come from a very good, well set up neurosurgical service. What I worked at Toronto was to get the patient's centralized. They were spread out all over the hospital.

Mary Tremblay, Ph.D.:
And there was a centralized unit there for spinal cord injuries as well.

E. Harry Botterell, M.D.:
Yes. The Compensation Board set up the unit. The first spinal cord injury centre in Ontario was set up by the Workman's Compensation Board of Ontario in the Toronto General Hospital. They came to me and said would I take on their acute spinal cord injuries. And I said no I wouldn't but I would with my colleagues, Aberhart, Jousse, and Dewar, the orthopaedic surgeon and that happened.

Mary Tremblay, Ph.D.:
Did that gradually open up to civilians as they had funding?

E. Harry Botterell, M.D.:
I can't remember what happened. I can't remember what happened. I left about that time to come down here.[Queen's University]

Mary Tremblay, Ph.D.:
That's when the hospital insurance starts to come in, in the 1960s.

E. Harry Botterell, M.D.:
Yes. When they built the new building of the time,[Toronto General Hospital] they put a paraplegic unit near where urology was. I can't even remember the name of the building.

Mary Tremblay, Ph.D.:
Urquhart? Was it the Urquhart unit?

E. Harry Botterell, M.D.:
That the first post-war new building.

Mary Tremblay, Ph.D.:
Yes, I think you said in the other interview that it was the Urquhart.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
One other thing, I didn't know if you were involved or not. The programs set up for the veterans were the first rehab programs [for spinal cord injury]. Then the veterans began to argue for access for civilians around 1947, 1948.

E. Harry Botterell, M.D.:
Yes, that was Botterell and Jousse promoting.

Mary Tremblay, Ph.D.:
How did that come about?

E. Harry Botterell, M.D.:
Well, somebody would telephone Dr. Jousse or me, usually me, and say we've got a· spinal cord injury in Thunder Bay, will you take him into your program? Well, I couldn't take him into our program up to that time. And I remember going to see Van Nostrand about it. He said, "I'll tell you what you do Harry. Just tell them to speak to their local member." [laughter] He knew all the practical answers. So eventually we got the veteran's opened for civilians. And Sunnybrook opened for civilians. At first the veteran patients themselves didn't want to do it. They were afraid they would lose what they regarded as a preferred operation. I said, "You would lose this operation if we don't keep bringing in new patients into it to keep it alive." So finally with John's help and Higman, the veteran's supported the idea and we were able to put them into Sunnybrook, and into Lyndhurst. Then the Paraplegic Association bought Lyndhurst for a dollar, but the government retained the right to take it back in case of war.

Mary Tremblay, Ph.D.:
Were you involved at all with the CPA when they were running Lyndhurst? You didn't sit on a Board or anything? Because, I mean, it would have been new at the time.

E. Harry Botterell, M.D.:
60 I think I was on the Board at Lyndhurst for a while, but I didn't have time to go to Board meetings.

Mary Tremblay, Ph.D.:
And you were happy with the way it was running?

E. Harry Botterell, M.D.:
I was happy so long as Dr. Jousse got his way. [laughter]

Mary Tremblay, Ph.D.:
Yes, he said the same thing. [laughter] He said you were always in the background running interference if he needed it.

E. Harry Botterell, M.D.:
Yes, I did.

Mary Tremblay, Ph.D.:
One of the other things I noticed, (and I'm towards the end now), is that you had a lot of very important visitors to Lyndhurst. You had the Governor General, you had George Drew and General Alexander, you seemed to be able to bring through a lot of people.

E. Harry Botterell, M.D.:
As I mentioned to you, after World War it was the amputees they had that kind of treatment. This time it was the spinal cord injury patients who were new and exciting. That appealed to the public imagination. And of course, Walter Gordon, did what he could to promote the VIPs visiting and so did John Counsell.

Mary Tremblay, Ph.D.:
61 That would be his kind of role to keep it in the public eye, to ke~p the concepts there, to do the political kinds of lobbying.

E. Harry Botterell, M.D.:
Yes, that's right.

Mary Tremblay, Ph.D.:
O.K. In your article, in 1946, you talked about a comprehensive program of rehab, medical treatment, but also funding and pensions to help people go back into the community to work, so that they had assistance. The veterans got a very comprehensive package.

E. Harry Botterell, M.D.:
Well the veterans package was quite independent of us. But they got a so-called a helplessness allowance if they were out of hospital, which they didn't get if they were in hospital. That wasn't all that large amount of money I didn't think, but it was significant. It made a big difference. In the United States, they got more in hospital than they got out of the hospital. No, they didn't have the same motivation.

Mary Tremblay, Ph.D.:
When it came to civilians, was there anybody arguing that the civilians should get the same kind of benefits?

E. Harry Botterell, M.D.:
Financial? Well the Canadian Paraplegic Association took on the cause of the civilians.

Mary Tremblay, Ph.D.:
62 Right. But it seems that we never saw that the civilians got the same kinds of pensions or the helplessness allowance.

E. Harry Botterell, M.D.:
Well, this is a terribly complex issue because health in Canada is a provincial responsibility. So that what the government will do for veteran's, which is a national operation, has a great emotional appeal, post-war "our heroes." The only people who had a really positive interest in the spinal cord injury patients was the Workman's Compensation Board. The Ontario Workman's Compensation Board, came to me and said would I run a service, look after their patients. And I said well with my colleagues I could. They stayed with it and they were very far-sighted. There was a man called Cameron at the Compensation Board, Mr. Cameron, he was really terrific. He retired, and I don't know who took it then, and I retired. But they were extremely good. And furthermore, I told you about the cost benefits study that was done by the Workman's Compensation Board. Did you ever get hold of that?

Mary Tremblay, Ph.D.:
No, I never got it, but I've heard about it.

E. Harry Botterell, M.D.:
It was Hastings at the School of Hygiene, University of Toronto. Well I'll conduct a one man's search. Not now. If I can find my copy ... Write to them and ask them for it.

Mary Tremblay, Ph.D.:
I was in touch with them trying to get their early records about rehab, sort of their history, and they don't seem to have it either.

E. Harry Botterell, M.D.:
Well, this came from the School of Hygiene, John Hastings.

Mary Tremblay, Ph.D.:
Right. Oh, who did the Hastings reports later?

E. Harry Botterell, M.D.:
Yes. I don't think he's got a reprint left, and I'm not sure where mine is. I may have sent mine to Dr. Jousse.

Mary Tremblay, Ph.D.:
Let me, I could try another way.

E. Harry Botterell, M.D.:
But he did a cost-benefits study showing that the program we had going for their patients at the General Hospital saved them money. Imagine that, a doctor saving money.

Mary Tremblay, Ph.D.:
The same program would save the civilian government money as well. But that never seems to have been implemented, that same program. When you were in the war did you run into Robert England at all?

E. Harry Botterell, M.D.:
Robert England. Why should I run into him?

Mary Tremblay, Ph.D.:
He was the secretary to McDonald's Committee. There was a committee called the General Advisory Committee on Demobilization and Rehabilitation. That was chaired by a Brigadier H.F. MacDonald, Harold MacDonald.

E. Harry Botterell, M.D.:
I don't remember.

Mary Tremblay, Ph.D.:
MacDonald died in '43. And then the Committee was taken over by Walter Woods, Walter S. Woods. Did you run into him?

E. Harry Botterell, M.D.:
Yes, that name is familiar. But I didn't get back from England to functioning until February 1945.

Mary Tremblay, Ph.D.:
Right, yes. And I most of your dealings would be through Dr. Warner, through Treatment Services?

E. Harry Botterell, M.D.:
Yes, but I dealt mostly with Norwich, or Van Nostrand.

Mary Tremblay, Ph.D.:
Right. And at the political level, in terms of DVA. Why I asked is England wrote a book in 1943 called Discharged, where he laid out a philosophy of the services. You never saw that?

E. Harry Botterell, M.D.:
No.

Mary Tremblay, Ph.D.:
65 Woods wrote a book in '52 called Rehab; A Combined Operation, where he talked about what the government of Canada had done [for veterans]. But you didn't run into them?

E. Harry Botterell, M.D.:
No. You see, I wasn't a rehab specialist. I was supposed to be a neurosurgeon.

Mary Tremblay, Ph.D.:
But you got into all of that.

E. Harry Botterell, M.D.:
Well, what happened was that I had these three patients, pre-World War II. I did everything for them, I ran their tidal irrigation and I got them home, and did this and did that, and fortunately they all recovered independence.

Mary Tremblay, Ph.D.:
So you knew it could happen.

E. Harry Botterell, M.D.:
Sure. And that's what got me started. And then Bill Cone had had the same experience in Montreal. He had one or two patients that made dramatic recoveries, who were not quite complete at the from outset. None of us had any patients who were really complete, at the time of the acute injury, who recovered at all.

Mary Tremblay, Ph.D.:
And it's the complete lesions that you start to deal with in the war and after the war.

E. Harry Botterell, M.D.:
And the incomplete.

Mary Tremblay, Ph.D.:
And the incomplete's as well, right. Is there anything I haven't asked you that I should have?

E. Harry Botterell, M.D.:
Well, have you got the role of the nurses to your satisfaction?

Mary Tremblay, Ph.D.:
I think so. You talk a lot about that in the last interview. You talked a lot about running a neurosurgical teaching for nurses in the General in the 1950s.

E. Harry Botterell, M.D.:
Yes, but I'm thinking now of the nurses at Basingstoke and Christie Street Hospital.

Mary Tremblay, Ph.D.:
Yes, there's a lot about that in there.

E. Harry Botterell, M.D.:
And the physical training instructor at Lyndhurst Lodge, George White.

Mary Tremblay, Ph.D.:
No you didn't talk about him.

E. Harry Botterell, M.D.:
Oh, well, everybody at Lyndhurst Lodge got up and went down for the morning mat class. The gymnasium mat class on the floor. We had this superb physical training instructor, ex-army, George White. He had a magnificent voice of command, he never ran out. He was one of the features of Lyndhurst Lodge Hospital. Dr. Jousse and I appreciated him. Dr. Jousse appreciated him, and I admired them both. If you were going to stay at Lyndhurst Lodge and do your stuff in Dr. Jousse's day, you got up for mat class. Did I tell you about my sister's child, my niece. Well, at the age of about two or three or four years or somewhere in there, she became paralysed. They thought she had polio, I guess she was a bit bigger than that, and down in Atlanta, Georgia. And because he [her father] was high up in the Coca-Cola Company they said, "they'd diagnosed polio, they would send her to where President Roosevelt went.

Mary Tremblay, Ph.D.:
To a Warm Springs.

E. Harry Botterell, M.D.:
Yes. So down she went, no improvement. Back she came, and finally a neurosurgeon saw her a contemporary mine, of Ken McKenzie. He discovered that she had a block, you know what I mean by a block? No rise in cerebrospinal fluid pressure when he squeezed the jugulars. And he said she has got a spinal cord tumour. I dashed down to Atlanta for the operation. And it was a haemorrhagic cyst, outside the dura. God, I had never seen one in my whole life! And they plucked it out without but she never recovered. They opened the dura and looked at the spinal cord and it looked all right. When she was five or six or seven, somewhere in there; she got too heavy for her mother to sling around. And nowhere in the States were they taking civilians into veterans spinal cord injury rehab centres. We brought her to Lyndhurst and here she was a seven year old girl in the midst of Lyndhurst, mostly men, some women. She got down to mat class and George White [laughter] pushed her along like everybody else. She learned to handle a wheelchair life, and transfers and all this kind of stuff. Then Dr. Jousse sent her out onto Lakeshore Road in Toronto, where there were a couple of girls with paraplegia who ran a telephone answering service. She was learning to live outside the hospital there, and she was incontinent. One day they said, "Listen Margie, you can't stay here and be incontinent. That's just nonsense." So she stopped, she learned to take precautions and she's been living independently ever since. She went back to Atlanta. She never married. Yes she did, I can't remember. Anyway, if she married it broke up. I know she had a boyfriend, serious. Anyway, she's still alive. She's having her troubles now, at this stage of her life, fortyish. I don't relate that to biochemistry, but I related to her seeing the end of her life coming up. Anyway, she did a lot for rehab down there, went to university and lived independently. So our family has a personal stake in Lyndhurst.

Mary Tremblay, Ph.D.:
Yes, yes. It's a small world, hey. You never know what's going to happen.

E. Harry Botterell, M.D.:
Yes.

Mary Tremblay, Ph.D.:
I think I'm just about finished though.

E. Harry Botterell, M.D.:
Good. [pause]

Mary Tremblay, Ph.D.:
There was in the war diaries in 1944 discussion about how to evacuate soldiers from the battle front, there was some discussion that you were involved in terms of how to get people off of planes. They were flying them out from Europe. This was when they were in France and in Holland after D-Day. There was some discussion about evacuating, or getting people to Basingstoke with the least possible trauma. How did that evolve?

E. Harry Botterell, M.D.:
I'm not quite clear what your question is? All we were trying to do was get the various levels of evacuation by air, by a combination of ambulance, train, ship, and the same thing in England. And, some people were saying that everything should come by air. Well, you couldn't always come by air, because you got held up by the weather, for two or three days at a time, or longer sometimes. That's all I remember about that.

Mary Tremblay, Ph.D.:
O.K. And in there it mentioned you went to Holland one time.

E. Harry Botterell, M.D.:
Oh, Frank Turnbull was the neurosurgeon in Vancouver, now retired. He was Dr. McKenzie's first resident. He came over to do a tour by some political manoeuvre he had been successful at. I said to Joe Mcfarlane, "You are going to send Frank Turnbull on tour around Europe and leave me sitting here in Basingstoke for five years." He saw the light and I was delegated to take Dr. Turnbull to see the installations in Europe. We flew over to Holland and Belgium, and we went to Paris by air to see the American installation there. The U.S. army was late with the order concerning the arrangements for us to get around. Dr. Edgar Kuhn from Ann Arbour was the neurosurgeon for the States in Paris, he had a big service. So we had a good visit anyway.

Mary Tremblay, Ph.D.:
There were a lot of connections that you made through the war.

E. Harry Botterell, M.D.:
Oh sure.

Mary Tremblay, Ph.D.:
That probably became a network that you used after the war.

E. Harry Botterell, M.D.:
I did. But the only way that I ever used it was to send residents to see these various people around Europe. The Edinburgh, London, Manchester, Oxford network, sure that came out of my time in England. But I also cultivated communications with the Swiss neurosurgeons, and the a Swedish neurosurgeon, Professor Herbert Olive Krona in Stockholm and Professor Petit Dutailles and Dr. Griot of Paris.