Harry Botterell, John Counsell, & Al Jousse
Revolutionaries in Spinal Cord Injury Management

Before World War II, few individuals survived a spinal cord injury and physicians generally believed that there were no effective treatments. During the 1930s a small number of physicians began to question this belief In Canada, Dr. Harry Botterell, a neurosurgeon at the Toronto General Hospital, chose to treat three men with incomplete lesions of the spinal cord. Despite his colleagues' arguments that treatment was fruitless, Botterell developed a team approach that emphasized active medical and nursing care and physical retraining. All three patients survived and - amazingly - returned to live and work in their communities.

In 1939 Botterell joined the Royal Canadian Army Medical Corps and became the chief neurosurgical officer at the Canadian Military Hospital in Basingstoke, England, where he developed a specialized unit for soldiers with spinal cord injury. This unit demonstrated that bed sores, respiratory and urinary infections (the common causes of death following spinal cord injury) could be prevented. During this period Botterell argued that a veteran with spinal cord injury should return "to the main stream of life rather than be set aside as a hermit."

At Basingstoke, Botterell treated Lieutenant-Colonel John Counsell who had received a spinal cord injury during the ill-fated Dieppe landing in 1942. Botterell urged Counsell to consider returning to Canada to argue for treatment in Canada for veterans with spinal cord injury.

In January 1945, Botterell was appointed director of neurosurgical services at the Christie Street Military Hospital in Toronto. On his arrival, he found veterans confined to their beds with little hope of leaving the hospital. Once again he developed a specialized unit for spinal cord injury and established the first rehabilitation unit for spinal cord injury in Canada at the newly acquired Lyndhurst Lodge in Toronto. In March 1945 he appointed Dr. Al Jousse as Lyndhurst Lodge's medical director responsible for the coordination of all aspects of treatment. Jousse was well aware of the impact of a physical disability since he himself used canes for walking. 

1. An injured veteran, Andy Clarke returned to an independent life beyond the confines of "paraplegic colonies" as this 1946 Toronto view demonstrates. Mr. Clarke prepares to get out of his wheelchair and into a car equipped with special hand controls and standing in a designated parking zone for disabled veterans. 2. Canada's first rehabilitation centre for spinal cord injury is Lyndhurst Lodge, established by Dr. Botterell in 1945 in Toronto. This Lyndhurst Lodge view depicts a retraining class, circa 1946. [Canadian Paraplegic Association Archives]

In a landmark article in 1946, Botterell and Jousse wrote that "the primary purpose of treatment at every stage from bed to brace walking is, to return the patient to independent life beyond the confines of hospital or paraplegic colonies." They went on to argue that depression was not always a direct result of paraplegia but often the result of the loss of independence and meaningful participation in community life. Not everyone agreed. Jousse later described the common response from medical colleagues: “We were told we would fall flat on our faces; it was a futile endeavour. But Harry Botterell ... didn’t allow anything to discourage him. He would say: ‘Let’s get going, get these people up and going,’ which we did!”

By May 1945 John Counsell had drawn together a coalition of veterans with spinal cord injury, physicians, and prominent Canadian civilian and military figures to establish the Canadian Paraplegic Association, the first association in the world for individuals with spinal cord injury. The central philosophy of the Association was the belief that “paraplegics could lead useful, reasonably normal lives.” Under Counsell’s leadership the Association helped veterans establish their place in society and business and then, unlike many other veterans’ organizations, provided assistance to civilian paraplegics.

Over half of the 200 Canadian veterans with spinal cord injury went to Lyndhurst. They took part in physical retraining programs, learned to manage activities of daily living, and to maneuvre the new collapsible, self-propelled wheelchairs that Counsell had convinced the Department of Veterans Affairs to provide. By 1946 many of the veterans had cars with newly designed hand controls that gave them the mobility to travel independently in the community. Veterans were encouraged to use the stores of the neighbouring community and encouraged to attend the same university and vocational training programs as their non-disabled peers. They were able to go out in the evening and go home on weekends. One veteran described the benefits of this experience: “Once you get out into the community, you learn more on the weekends out or weeks at home, than in hospital.” 

By 1946, survival rates had changed from below ten percent during World War I to over 92 percent. Most veterans were also living in the community and over half were employed or attending university or training programs. These veterans were among the first Canadians to demonstrate that it was possible to live and work in the community using a wheelchair.

Other physicians around the world also developed programs for spinal cord injury during the post World War II period. However, the Canadian programs were the first to argue for and demonstrate that full, meaningful participation in all aspects of community life was possible.

After discharge from the army, Botterell developed a special unit at the Toronto General Hospital for civilians with spinal cord injury. During the 1960s and 1970s, he served first as Dean of Medicine at Queen’s University and later Vice Principal, Health Sciences. Counsell continued to lead the Canadian Paraplegic Association and saw it established as a national association serving all Canadians with spinal cord injuries. He retired from the position of president in 1967 and died in Toronto in 1977 at the age of 66. Jousse was one of the first Canadians to propose the integration of individuals with disabilities into all aspects of society. A pioneer in the development of rehabilitation in Canada, he was a professor of Rehabilitation Medicine and Director of the School of Rehabilitation Medicine at the University of Toronto until 1972. Jousse continued as the medical director of Lyndhurst until his retirement in 1975. He died in Toronto in 1993.

The Canadian revolution in spinal cord injury was the result of a unique partnership between Dr. Harry Botterell, an articulate, visionary neurosurgeon; Lieutenant-Colonel John Counsell, a quiet, effective political leader; and Dr. Al Jousse, a compassionate, dedicated physician. Together these three men provided the leadership that resulted in a revolution in Canada in the management of spinal cord injuries and the life experience of individuals with spinal cord injury.