GENERAL ARTICLES

They Walk Though Paralyzed

In World War I they were bedridden and died. Now, even with shattered spinal cords, they walk again

GEOFFREY HEWELCKE February 1 1946
GENERAL ARTICLES

They Walk Though Paralyzed

In World War I they were bedridden and died. Now, even with shattered spinal cords, they walk again

GEOFFREY HEWELCKE February 1 1946

They Walk Though Paralyzed

In World War I they were bedridden and died. Now, even with shattered spinal cords, they walk again

GEOFFREY HEWELCKE

ANDY fighter CLARKE bomber of to Edmonton a landing on was an bringing English his air field. It was a formation landing, split-second timing, aircraft coming in abreast. Then he’d had it. The Typhoon flipped over. They took Andy Clarke out of the wreckage with a broken neck. He was paralyzed from the neck down, yet miraculously he was alive ...

Doug Quirt of Peterborough was needling his Mosquito through thick clouds over Scotland, homeward bound after taking photographs of Nazi installations in Norway. The mountain peak loomed out of the mist too fast for him to avoid it, and Doug woke up 10 weeks later in a hospital. They told him he’d been thrown through the plexiglas canopy; that searchers found him with a broken back, two broken ankles and a concussion that had kept him unconscious until then. He, too, was paralyzed. He couldn’t move arms or legs.

Both these men are now going to the University of Toronto. Both are taking courses in political science

and economics, which, they hope, eventually will qualify them for jobs in Canada’s diplomatic service.

They’re studying, looking forward to graduation, planning careers for later life. They’re having fun, too . . . Andy Clarke and his wheel chair are already famous on the University campus. So is his smile.

Doug Quirt no longer needs a wheel chair. He can walk with a cane and with the aid of leg braces. He can and does drive a car. Usually the passenger in the front seat is Andy Clarke, who has learned to swing himself from the wheel chair into the car with smooth ease. Passers-by fold the collapsible chair and tuck it through the back door of the sedan.

The backs of both men are healed. But their spinal cords have suffered—Doug’s not as much as Andy’s. Both realize they have made about as much recovery as they ever will make. Yet they face life with confidence, with smiles.

“We can make a go of it,” says Doug Quirt. “It’s easy to sit around and say it’s too hard. But you don’t know what you can do until you try.”

Andy Clarke and Doug Quirt are the living symbols of a remarkable success in healing through teamwork; success of a kind which never before has been achieved in Canada or in any other country. And this is the story of why they—and close on 200 other Canadian servicemen paralyzed by injury to the spinal cord— can plan civilian careers.

Veterans of the First World War who had similar injuries were brought back with the best of care from across the Atlantic. They were nursed with devotion in Canadian hospitals. They got all the medical and surgical services available . . . And almost invariably they died six or seven years later. 1

But things are different now; and this is the story of why they are different. It’s primarily the story of Lyndhurst Lodge, first of the Dominion’s four hospitals designed to retain and re-establish paralytics of this type as useful citizens,

Andy Clarke and Doug Quirt are paraplegics. This medical term is derived from Greek roots meaning “to strike at the side.” But now it has come to mean individuals whose legs and lower part of the body are paralyzed due to injury or disease of the spinal cord.

Full paraplegics feel no sensation in their lower limbs or body. They can burn themselves without knowing it. They can freeze the same way. The nerves which warn the ordinary person of heat and cold, pain and pressure still exist. They still carry these warnings to the spinal cord, the trunk line through which the body’s nervous system transmits its messages to the brain. But the trunk line itself is broken or so badly bruised and pinched at the point of injury that the messages do not pass on to the brain.

Similarly, messages from the brain cannot go to the muscles and limbs below the point of injury. A paraplegic cannot even control his bodily excretions, for these controls, automatic as they appear to most people, are learned in infancy, are directed by the will and the mind. Also there is no sex function.

Other bodily activities, the pulsations of the heart and the processes of digestion, continue because they are able to function without the control of nerves from the spinal cord.

Many of the individual medical and surgical steps necessary to keep the paralyzed veteran alive were known after the last war. But there have been additions to the scope of medical science since then. Great advances have been made in urology, in plastic surgery—sometimes it is necessary to graft skin over bed sores—and in surgery of the nerves. In addition the wonder drugs have been discovered— the sulfonamides, penicillin and now streptomycin, which aid enormously in keeping down the infections of the bladder and kidneys which caused the eventual death of last war’s paraplegics. But never before were the medical, surgical, psychological, orthopedic appliance and physical training fields organized so specifically to care for these men. That has been a development of this war.

Hope For Civilians

AND, quite apart from the new hope . which it gives the paralyzed exserviceman, it means that a technique has been developed which sooner or later will be applied to civilian sufferers from automobile and industrial accidents. Civilian paraplegics also will benefit, will again become useful members of society.

There are four teams of experts working together in Canada now under the Department of Veterans’ Affairs. They are in Toronto, Winnipeg, Vancouver and Montreal. Senior in date of establishment is that at Lyndhurst Lodge, in Toronto. It has been operating for only a year, but its results already have shown that the effort is worth while. Andy Clarke, Doug Quirt, a dozen others are in its first graduating class. They are the first group of paraplegics in Canada to go out into this bustling, competitive world, confident that they can hold their own among men and women who have full command of their bodies.

Lyndhurst Lodge is a sprawling mansion once the home of Canada’s motion picture theatre mogul, the late Nathan L. Nathanson. Its nine acres of maples dive down the side of the Russell Hill Ravine, half a mile, airline, from Toronto’s Christie Street Veterans’ Hospital. At the Lodge 28 paralyzed veterans of the war are learning how to live again.

There are, in most cases, four beds to a room. The rooms are large and there is plenty of space for manoeuvring wheel chairs, some of which bear names, like “Yukon Sal,” lettered on their canvas backs. There is a library stocked with current fiction—no books of 1890 vintage—and nearly all the men eat in the dining room, coming to

it in their wheel chairs. When I visited the hospital there were only two men still considered bed cases, to whom food had to be brought on trays.

For here they learn how to care for themselves, eventually without assistance. Here they learn how to dress themselves. Here they train in a regular gymnasium—once the Nathanson ballroom — until they become superb athletes as far as shoulders and arms are concerned.

In the gym you hear the drum of a punching bag as an earnest paraplegic sits in a wheel chair and socks it; a heavy drumming—I’d hâte to be hit by one of these paralytics. Behind him is a rope fastened to the ceiling of the gymnasium. Another paraplegic is climbing it, hand over hand, his legs hanging limply. By the time they are graduated from Lyndhurst Lodge every one of the patients has enough strength in shoulders and arms to make that climb to the ceiling.

Off to one side are two stationary bicycles to exercise the leg muscles of those patients who, like Doug Quirt, have had some recovery of movement in the lower limbs.

They See Their Mistakes

IN ANOTHER section of the gym are the parallel bars along which paraplegics inch their way, their weight lifted by stiffened arms and rigid shoulders. At the end of these bars is a mirror in which they can watch their progress, catch any mistakes they are making.

All these exercises, supervised by a staff of trained physiotherapists—some are good-looking girls, others are young men — are designed to strengthen muscles so that the paralyzed men actually will be able to walk!

True, it is not walking as you and I would walk. But it is locomotion on crutches. It is moving from place to place, according to desire, and not in a wheel chair or on a stretcher—something that must have been beyond all hope for the men when they first learned that they were paralyzed.

For it is at Lyndhurst Lodge that they are fitted with the braces, made by the Orthopedic Appliance Department at Christie Street Hospital, that keep body and legs stiff enough to let them swing about on crutches; to let them walk with their shoulders, their body and legs a pendulum swinging between the rubber tips of their crutches.

It is impossible to exaggerate the psychological effect of this achievement for men who otherwise would be bed-bound or restricted to wheel chairs. It gives them a feeling of confidence in themselves. They can go out on the street—and not be the subjects of pitying glances. They can go to work, they can get jobs. It makes a difference to many employers whether the man coming to see them is on crutches or in a wheel chair. Above all it is a sign to the men who have graduated on crutches that they have licked the disabilities of their own bodies; that they have won a fight against odds that must have seemed terrible when they lay motionless in a hospital bed; that they will be able to make their way again in civilian life.

The braces, which make it possible for them to walk by holding their bodies rigid, may, in some cases, be belted about the hips with padded bands, in other cases the bands are not necessary. The steel framework runs down their legs and fastens under the insteps of their shoes. Its total weight is a little over 10 pounds. There are hinges at the knees, which can be locked or unlocked at the will of the wearer. Continued on page 37

They Walk Though Paralyzed

Continued from page 22

This means that he can sit down.

The men are reminded that one Franklin Delano Roosevelt wore similar braces—though they weighed twice as much—during his four terms as President of the United States.

It is not easy to don the braces, but the men learn to do so under the eyes of the physiotherapists. The gym is the appropriate place for this at first,

because it is an athletic feat for a man with neither feeling nor motion in his lower body and legs to wriggle and wrestle his way into them. Yet they learn. They must. For they know that they must be prepared to don them, to dress themselves over the braces once they are on their own.

. Some of the early graduates of Lyndhurst Lodge are still unable to walk. Andy Clarke comes back twice a week from his Trinity College residence for special exercises to strengthen his shoulders and arms which were affected, though not paralyzed, by his spinal injury. Continued on page 38

Continued from page 37

They lead a clubby, informal life at Lyndhurst. Bull sessions are encouraged among the men. They gain confidence in talking over their problems, hopes, aspirations. Visits to movies, week-end visits home, leaves of two weeks or 30 days are granted liberally to make them feel accustomed to living at home again. Several men are attending vocational training school, learning crafts such as cabinetmaking and radio repairing while they are learning anew to manage their bodies; those cumbersome, insensitive trunks and legs which anchored veterans of the previous war to bed or wheel chair. They learn, too, how to cope successfully with their own very special sanitary problems.

But the story of their treatment really starts much farther back than Lyndhurst Lodge. In fact it starts with intelligent stretcher-bearers, who can save a paraplegic’s life—or take it, when he is first picked up as a casualty. That’s when the teamwork starts.

It continues with intelligent treatment in hospital overseas, on the hospital ship and, finally, in Canada.

At Christie Street Hospital, to which about half of Canada’s war veteran paraplegics come before moving on to Lyndhurst Lodge, the final medical and surgical work is done and retraining is started, in bed at first. There are at present some 30 men waiting at Christie Street for the doctors’ verdict which will allow them to move on to the first rehabilitation stage.

Treatment varies. Each man offers different problems, for he is likely to have other injuries besides that critical one of the spine. But here neurosurgeons check on earlier measures taken in other hospitals in treatment of the spine. Unfortunately they cannot yet bridge the break in the spinal cord with grafted or transplanted nerve tissue. Sometimes it is necessary to cut nerves, permitting reflex muscular spasms in the legs of the paraplegics.

Other details of medical treatment or surgery connected with wounds are cleaned up and at the same time the rather lengthy business of cleaning the genitourinary system of all infection is carried out. In this connection the use of the new drug streptomycin has been pioneered on cases of stubborn infection of the bladder which would not yield to sulfa drugs and penicillin. Beneficial results have been reported.

Here measures are taken to enable the patients to handle effectively the paralyzed bladder. Infection of the bladder or kidneys is the nemesis of these men, and only with outstanding urological care is long-term survival possible.

Start Training

Sometimes months are necessary to complete the treatment at Christie Street Hospital, but their training there is tremendously important.

Here the importance of avoiding bed sores, as one of the first steps in selfhelp, is driven home to them. First specially trained nurses and orderlies roll them over, turn them in bed at intervals of an hour or two day and night. Then they are encouraged, as strength returns, to turn themselves by gripping a bar that curves down from the head of each bed like a fixed trapeze. Turning must become as habitual as breathing, even at night.

At Christie Street, too, the paraplegic learns to move himself from bed to wheel chair, to attend toilet functions— even to take a bath. All this is part of the first stage of retraining out of bed.

On the ward is a gymnasium and here the paraplegic starts his mat work, learns to balance sitting up and to handle the special collapsible chair which is indispensable.

One paraplegic waiting here for transfer to Lyndhurst Lodge already has his life’s work plotted out—actually has made a fair start on it.

Before the war William J. Johnston was expert at putting copper roofs on buildings. Overseas he served as a motor dispatch rider. He got his injury in a blackout smashup near Aldershot.

Johnston has already worked up a fair business from his bed, selling all forms of insurance except life and as a magazine subscription agent.

How? He had a private telephone installed—you can call him at Lakeside 0880, Toronto—and a typewriter. Then he went to work.

“Sure, I’m making out all right,” he told the writer. “I’m earning money. Only the way I’ve doped it it’ll cost me more to live as a civilian than it would the ordinary Joe. I may need assistance in the house ... I’ll need to spend money on taxis; perhaps a specially fitted car.

“Well, my time schedule is three years. I think I can leave all hospitals then, earn my own living and know that I can lead a comfortable life.”

Started With Dieppe

Lyndhurst Lodge had its beginnings in the Dieppe Raid of 1942. That’s when Captain John Counsell of the Royal Hamilton Light Infantry stepped into the sights of a German sniper. A rifle bullet smashed through his spine, paralyzing him from the waist down.

He was Canada’s first battlewounded paraplegic of World War II.

John Counsell is wealthy. He could obtain private treatment; he could buy appliances for his comfort beyond the financial reach of the average soldier.

Yet when he was at Christie Street Hospital he insisted not only that he should be shown no preferences, but that the other men should get newly designed wheel chairs, new fittings and special treatment before he did.

His courage and cheerfulness were enormous. He maintained that paraplegics could, should, and must be retrained, re-established in civilian life. And now that he is out of hospital he continues to serve them as president of the Canadian Paraplegic Association, going to its offices daily from his hotel.

From his insistence on equality of treatment for all paraplegics, backed by the enthusiastic support overseas of a group of neurosurgeons from Montreal and Toronto, as well as of the medical administrative heads of Christie Street Hospital and what was then, in Ottawa, the Department of Pensions and National Health, Lyndhurst Lodge and the other three centres for the retraining of these casualties in Canada eventually emerged.

Lyndhurst Lodge was opened in January, 1945. Shortly after that Dr. Alben Jousse was installed as medical officer in charge. It is part of the neurosurgical service of Christie Street Hospital, supervised by Dr. Harry Botterell.

There are between 170 and 200 war casualty paraplegics in Canada. John Counsell is trying to get them all to join the Canadian Paraplegic Association, knowing that its voice will be louder than that of any single member in making sure that all of them receive proper treatment, proper retraining, proper appliances.

But Counsell and his board of directors feel this help should not be limited to servicemen only. Civilians who have suffered similar injuries are also in need of aid. Indeed Counsell strongly believes the whole question of treating paralytics should continue to be studied, and hospitals established for the war casualties made available to all who need them.