Life Near The Bone

Glen E. Edwards

Douglas B. Harkness THE UNIVERSllY OF CALGARY

LIBRARY

Life Near The Bone

Life Near The Bone

A History of Orthopaedic Surgery in Alberta

Dedicated to

The Medical Students

and

Residents in Orthopaedic Surgery

at the

University of Alberta

and

University of Calgary

Past, Present and Future

"It is life near the bone where it is sweetest."

Henry David Thoreau Walden, 1854 Copyright © 1991 by Glen E. Edwards & Douglas B. Harkness All rights reserved.

Credits

Photography: Glenbow Alberta Institute Photo Archives; pages 19,21,22,25,26,29,31,35,82,87 ,88 University of Alberta Hospitals; pages 34, 106,107,111,119,120 Alberta Children's Hospital; pages 49,86,91,94,101,102,ll3 Canadian Orthopaedic Association; page 141 Many Private Individuals

Printing and Binding by Ronalds Printing, May 1991 Printed in Canada

Cover design from Nicolas Andry L'Orthopedie (First Edition 1741) CONTENTS

Foreword 11

Chapter:

One. Between The Wars: The Origins of Orthopaedic Surgery in Alberta 15 Two. Learning Orthopaedics 36 Three. Orthopaedics by Non-Orthopods 54 Four. Economic Aspects of Orthopaedics in Alberta 67 Five. Practicing Orthopaedics in Alberta 78 Six. Orthopaedic Care of Crippled Children 85 Seven. Poliomyelitis 105 Eight. Skeletal Tuberculosis 118 Nine. Orthopaedics for Adults 125 Ten. Orthopaedic Associations and Other Activities 135 Eleven. Post-Graduate Medicine Comes to Calgary 145 Twelve. Basic Orthopaedic Research 151

Endnotes 155 Biographies 163 Bibliography 172 Resident Training: University of Alberta 177 University of Calgary 178 Alberta Children's Hospital 179 Alberta Orthopaedic Surgery 1991 -- A.M.A. Register 180

11

FOREWORD

The concept for this book originated in the 1980s, when it became apparent that a history of orthopaedic surgery in Alberta would provide a valuable reference, particularly for young and future orthopaedists. The decision to undertake such a history was also spurred by the Canadian Orthopaedic Association's interest in recording orthopaedic history in Canada. We decided to review the profession's relatively brief history, not only to assess the impact orthopaedic surgeons have had on the development of modern society in Alberta, but also to determine how the times and events have shaped orthopaedic surgery in this province. The history begins after World War I, with Drs. Frank and Hank Mewburn, Reginald B. Deane and Graham Huckell, who pioneered orthopaedics in the province. It then follows the work of the group of orthopaedic surgeons who formed the Alberta Orthopaedic Society in 1948 and of the young orthopaedists who received their academic training in Alberta, then went elsewhere to acquire the skills necessary to train a new generation of surgeons. Finally, it explores the work of the recent graduates who have become involved in basic bench orthopaedic research. The sources of information have been varied and numerous - periodicals, journals, textbooks, obituaries, lectures, hospital reports, and especially the excellent oral histories that researcher Douglas B. Harkness obtained from most of the senior orthopaedic surgeons surviving in the 1980s. 12

While it is recognized that several orthopaedic surgeons have made major contributions in outlying centres such as Red Deer, Camrose, Grande Prairie, Medicine Hat, and Lethbridge, most of this story relates to the development of academic orthopaedics in Edmonton at the University of Alberta and in Calgary at the University of Calgary. Many people have provided information and documents for this story; they may not agree with what has been written. I apologize to those who may have been treated inadequately and to those who believe that more - or possibly less - should have been told. Special appreciation is due to the Alberta Orthopaedic Society, the Alberta Medical Foundation, and the Alberta Historical Resources Foundation, who provided support and encouragement for this project. I would also like to thank Linda Cameron, Director, University of Calgary Press, Pamela Edwards for desk-top publishing, Beth Duthie for editing, and Roy Jennings for his support. I wish to express a very special "thank-you" to my wife Jane, not only for the many ways in which she has been of assistance, but for her understanding and unqualified support.

Glen E. Edwards Calgary, April 1991 Life Near The Bone

15

CHAPTER ONE

BETWEEN THE WARS: THE ORIGINS OF ORTHOPAEDIC SURGERY IN ALBERTA

In August 1914, when reports of the outbreak of war reached the recently created Province of Alberta, the news was received by a population largely made up of immigrants from Great Britain, continental Europe, and the United States. Some of these new arrivals may have been unsure of their military allegiances, but the men of Anglo-Saxon ancestry were quick to enlist in the Canadian military forces . The British-born and the British-bred had seen themselves as the elite, the true Albertans, since the great ranching years of the 1880s, and they had not lost their loyalty to their homeland. Indeed, imperial sentiment was so strong throughout the nation that one-sixth of Canada's working population went to soldier. Among those who enlisted in 1914 was Alberta's first and foremost pioneer surgeon, fifty-six-year-old Dr. Frank Hamilton Mewburn, who closed the general surgical practice he had opened in Calgary the year before and went overseas as a major in the Canadian Army Medical Corps. He was followed later that year by his son, Frank Hastings (Hank) Hamilton Mewburn, a new graduate of the medical school at McGill University, who enlisted in the regular army. The Mewburns entered a war that proved to be both a training ground and the turning point for orthopaedic surgery. British and American orthopaedic surgeons of the late nineteenth century had made such progress in the specialty that orthopaedic surgeons were considered 16 to be "uniquely qualified to care for the fractures and extremity wounds of soldiers on the Western Front." 1 During the war the British Army developed seventeen orthopaedic hospitals with a capacity of 30,000 patients, and the wartime success of orthopaedic medicine such as Robert Jones' treatment for compound femur fractures, which previously had an 80 percent wartime mortality rate, did much to interest physicians in the growing specialty. This growth, in turn, created postgraduate educational possibilities for potential specialists in the United States and Britain. Brief as they were by today's standards, these postgraduate sessions and special internships were more accessible and concentrated routes to specialization than had existed before the war. With such a great demand for orthopaedic surgery -- and a good deal of the attention being directed at restoring movement and function to disabled limbs -- medical officers like the Mewburns could not help but be impressed. They would have seen, as well, that the inherently gratifying nature of orthopaedic surgery made an attractive basis for a career. Postwar surgeons could claim that orthopaedics was the most rewarding part of surgery, and justifiably so. Young soldiers who were in perfect health before the war, but who had been immobilized by the weaponry and incapacitated by pain, could be treated with some success. Civilian patients could also be treated, with similarly satisfying results for the surgeon. The possibility of restoring function to young but damaged bodies and extremities may also have aroused the curiosity of surgeons such as Dr. Reginald Deane, who had been frustrated by his inability to treat musculo-skeletal problems adequately. According to Dr. Gordon Townsend, who succeeded him in his practice, Dr. Deane was "a restless and inquisitive soul, interested in congenital deformities in children and unhappy about the results he saw in the treatment of trauma, so he decided he must do something in an attempt to better the situation. '12 A long-time friend of the Mewburn family and a colleague of Colonel Mewburn's, Dr. Deane decided to close the general surgical practice he had operated in Calgary from 1911 to 1920 and, at the age of fifty, began orthopaedic training in England. Although it was not keeping pace with what was happening in Britain and the United States, orthopaedic surgery was developing in Canada before World War I. Dr. B.E. McKenzie was practicing orthopaedics in Toronto as early as 1887, and the first orthopaedic ward was founded there in 1895. On the prairies, H.P.H. Galloway was 17 teaching orthopaedic surgery at the University of Manitoba by 1907. But orthopaedics was not perceived as a specialty, even in the larger cities of eastern Canada. According to Dr. H.H. Hepburn, Alberta's first neurosurgeon, during his years at McGill before the war there were only general practitioners and "specialists" -- meaning eye, ear, nose and throat specialists.3 If Canada's leading medical school had no other specialists prior to the first world war, it is not surprising that the sparsely populated prairie region could lay claim to few of any sort. Even if orthopaedics had been well-established in Canada before the war, not until the 1920s did the size of Alberta's population make it either practical or economically viable to practice the specialty. In 1901, two years after Deane became the 173rd general practitioner registered in the Northwest Territories, only 73,022 people lived in the area which was to become Alberta. Calgary and Edmonton had populations of only 4,392 and 4,176 respectively. Two decades later, in 1921, the populations of the two cities had increased fourteen-fold to 63,305 and 58,821. The development of orthopaedics in the province had its roots in this dramatic population growth and in the Canadian regionalism that comes from the geographical size and diversity of the country, as well as from constitutional arrangements that make matters such as health care provincial responsibilities. Alberta's size and railway history encouraged a pair of major cities to develop, each with a steadily growing supply of medical people. Yet the population was increasing more quickly than the number of physicians, partly because the first medical class to complete the full program at the University of Alberta graduated as late as 1925. The decreasing physician to population ratio meant additional work for the province's doctors and may have discouraged some from pursuing further studies. Specialization did occur, however, and Reginald Deane became the province's first orthopaedic surgeon when he returned to Calgary in late 1921 from his studies in England. By 1930 the Calgary Associate Clinic included a paediatrician, an obstetrician, and E. P. Scarlett, a specialist in internal medicine. By the end of 1923, the University of Alberta Hospital had specialists in urology, obstetrics and gynaecology, eye, ear, nose and throat, as well as Hank Mewburn, the Chief of the Department of Orthopaedics. The development of orthopaedic surgery in Edmonton occurred at the Strathcona Military Hospital, which was built by the dominion 18 government to meet the demands created by the war. By 1922 the caseload was declining, and the university took over the hospital. A press bulletin issued by the university in 1923 described the medical school's new policy on specialization: With the granting of a Grade A standing to the Medical Faculty of the University it became imperative that the University should have a free hand in building up an institution whose standards would be equal to those of a Grade A Medical School giving a full six years' course in Medicine. In other words, it became necessary to have a group of specialists each carrying on his own work in a teaching hospital, where the student would be privileged to attend clinics and observe operations and the treatment of a wide variety of cases under the practical tutelage of the ablest men in their own line in the province.4 Colonel Frank Mewburn was the first surgeon to be appointed Professor of Surgery in the Faculty of Medicine and Director of Surgical Services at the hospital. He was said to have "achieved considerable recognition for his work in nerve repair and nerve grafting in WWI. "5 Before the war, in the pioneer era of Listerian surgery, Dr . Mewburn had attempted various procedures which had seldom been done. His godfather, Frank Hamilton, had written a "classic" work on fractures and dislocations, and Mewburn himself had done much fracture work in his three decades of practice prior to the war. Following his interest in musculo-skeletal medicine, He bought at his own expense, and installed in the Galt Hospital, one of the early X-Ray machines, a cumbersome affair for which power was produced by turning a crank by hand. Marvellous to relate, when we look at the present machines, it took pictures and was capable of fluoroscopy of bones. 6 Dr. Frank H. Mewbum First Professor of Surgery in Medical Faculty University of Alberta

Mewburn was also an able administrator, and it was under his guidance that the Department of Surgery was organized. He made certain that the surgical specialties each received due recognition; hence, the Department of Orthopaedic Surgery became a self-contained unit with its own director. In an address to Calgary physicians Dr. Reginald Deane gave Colonel Mewburn much credit, both as an innovator and as a teacher from whom he "learnt considerable." My first operation was performed in the unfinished attic of the Galt Hospital in Lethbridge. The patient was a man of unknown age, over 90, with senile gangrene of the right hand due to Atheromatous Arteries, the like of which I have never seen or felt since. The operation was an amputation through the upper arm at about its middle. The anaesthetic was given by the then Lady Superintendent, a lady now living in Edmonton. Dr. Mewburn was the surgeon and I was the Assistant and scrubbed up nurse, my principal duty being of course to hold up the arm--and 20

I must say to the Professor tonight across all the intervening years that I hope I did not get very much in the way. Dr. Mewburn has first, an insatiable appetite for work to the exclusion of all else, second, an infinite capacity for taking pains -- no detail being too small to be neglected, and lastly, though probably this should be the first, and I think he would have it so, his Humanity in that he has ever given of his best to rich and poor alike completely oblivious of reward. When I was invited to visit the Galt Hospital and see the cases as well as the then occasional operations, it was just the opportunity I wanted and I was not long in absorbing some of the Preceptor's professional enthusiasm, as well as on occasion his more forceful mode of expression. 7 Apparently Colonel Mewburn, Dr. Deane and Dr. Hank Mewburn were all notorious for this "forceful mode of expression." Dr. E. P. Scarlett referred to Deane as the most profane man in Alberta next to Colonel Mewburn. And according to Dr. D. Cooper Johnston, who was a resident under Hank Mewburn, the younger Mewburn must have been equally profane. Inserting a bone graft, Hank Mewburn would say, "There she is , tighter than a bull's ass in fly time!" He would also mix with the more vulgar idioms colourful ones that reflected his interest in the cavalry or in railway history. Hank Mewbum and Reginald Deane were both raised in the pioneer west, and the rough edges of frontier companionship no doubt shaped large parts of their characters. But, as E. P. Scarlett wrote of Deane, "bred as he was in this western tradition, he remained an Englishman; outwardly rough in the most approved fashion of the early West but inwardly reserved, stubbornly maintaining certain private allegiances. "8 Dr. Frenk H. Mewbum and Nurses on tour, 1920's MacKenzie River Area, N.W.T.

R.C.M.P. Team and Coach at 104 - 5th Ave. W. Calgary, 1922 Cst. R.J. Threadkell, - Funnell, Inspector J.W. Spalding, Dr. F.H. Mewbum Dr. Reginald B. Deane in Buggy at Maple Creek, Sask. 'On His Doctors Rounds' 1906

Dr. Reginald B. Deane in his office, Calgary, Alta. 'At The Telephone' 1910-1912 23

Deane's father, Captain R. B. Deane, was a career military man and Superintendent in charge of the North West Mounted Police in Regina. The Deanes, Scarlett said, were among the "many adventurous Englishmen ... who in small hamlets and young legislatures brought English justice and love of order to a new land, ... with their disconcerting mixture of the practical and the visionary who settled the plains and with quiet sincerity and industry built the foundations of a new country on the Anglo-Saxon pattern with its traditions of the love of the soil, ideals of sport, patriotism and tolerance." Dr. Deane was raised at the military barracks of the NWMP, and his early interest in medicine probably stemmed from his close friendship with the NWMP veterinarian. Had there been a veterinary school in Western Canada at the time, that might have been Deane's first choice, instead he entered medical school at the University of Manitoba. Dr. E. P. Scarlett wrote the following tribute to Mrs. Deane after her husband's death in 1941. Dr. Deane was a man who achieved the supreme accomplishment in the modern new world -- the first of arming himself. He was an individual and gloriously so. He suffered fools, scorned the standards and cheap ideals of the crowd, made no concessions to the world and went on his own way, somewhat of a solitary way, in observance to his own right and those things which he regarded as being worthwhile. Such a course is not so apt to bring a man the gaudy materials of success, but it insures that he reaches the full stature of a man who is leading the only kind of life that at the last gives one the supreme reward. In this respect he was the complete and perfect Englishman and I am certain that his English ancestors must be proud of him. I was honored by his friendship and I delighted in the splendid demeanour 24 which he had towards life, his irony, his chuckling humour and the deep appreciation which he always had for those things which are more and of good report. I soon penetrated his secret -­ the fact that the rough and seemingly gruff spirit and manner which he displayed to the world was only a blind to cover the really kindly tormented half humorous attitude which was his real self, and the love which he bore towards the things of the spirit. He grew up in a rough shaggy sort of world and while he adopted its conventions, the deeper side of him rooted itself in culture, love of the past and of the fine things which men and women have done and said all down through the centuries. That was the real Reginald B. Deane and it soon broke through when you got to know him at all intimately. He accepted and never wavered in his devotion to the first rule of a physician who is worthy of the name -­ that he should always work incessantly to serve others, remembering at the same time that nowhere it is written that he should save himself. Only a physician or a physician's wife like yourself knows what that means. It is our secret and I think it is a proud one. You may be assured therefore that Dr. Deane's place is secure in the hearts of his colleagues, the privileged ones who were his friends and the many who were his patients. I shall always have the high memory of the evenings which we spent in talk when we ranged over the universe but always 25

came back to our companionship in books. Most were hours which make life worth living. 9

Group at opening of Junior Red Cross Hospital Calgary, May 1922; Dr. Deane seated 3rd from left

Although the anglophilic tone of Dr. Scarlett's eulogy may seem dated, there can be no denying Deane's humanitarian spirit. For seventeen years he gave a good portion of his time as the sole and voluntary orthopaedic surgeon to the patients of the Junior Red Cross Crippled Children's Hospital in Calgary, a hospital which was primarily orthopaedic. His "English" service was the single great example of selflessness in Alberta's orthopaedic history. It may be true that in the 1930s many doctors unavoidably gave most of their services without being fully paid, if paid at all. But no other Albertan orthopaedic surgeon appears to have given as much as Dr. Deane. Owing to the population pressures of working in a small medical community, and perhaps later to the economic pressures of the Great Depression, Deane never limited his practice solely to orthopaedics but handled a range of cases until his formal retirement at the end of 1939. The First Trained Orthopaedic Surgeon to Practice in Alberta Dr. Reginald Burton Deane, Calgary, Alberta J930's Photograph: Blank and Stroller Montreal 27

Dr. Gordon Townsend recalled that Deane was "extraordinarily kind" to him when the younger man came to Calgary as Alberta's fourth orthopaedic surgeon. Townsend took charge of Deane's practice with very little in the way of formal arrangements -- he was to pay the older surgeon about $25 every second month for the use of orthopaedic instruments. When I first came here this office had been closed for about six months because of his ill health, but it was still available. Dr. Deane was almost completely confined to bed at home, the victim of pulmonary tuberculosis in his youth and of a combination of pulmonary fibrosis and emphysema and increasing cardiac decompensation. However thanks to his efforts, I occupied his old office in the Grain Exchange Building, was given his old telephone number, and had the backing of his entire household, who had been instructed to inform telephone callers that although Dr. Deane was no longer in his office, Dr. Townsend was there. As a result of this support my gross income went from $80.65 in the first month of practice to $600.00 at the end of the sixth month. Until the day of his death Dr. Deane remained very interested in his practice, in his office, and in the way things were going for me. I dropped into Dr. Deane's home about three times a week usually in the evenings. If he had a good day I would spend about an hour or more with him reviewing the events of the day, asking his advice and simply chatting in general. Dr. Deane was a gentleman of the old school. He was of the era when rounds on Sunday morning were done in 28

morning coats and striped trousers. I believe he was a competent orthopaedic surgeon -- relative to orthopaedic surgery as practised in his day .... Not only was he interested in medicine, but in English literature, in history, and archaeology. He was a prolific reader and had a beautiful command of the English language. He also had better than a casual aptitude in the use of profanity. One evening when I called on him I was depressed. I had operated on a Hutterite child who had an eight weeks' old supercondylar fracture of the humerus, the fragment being displaced and united posteriorly. In the operating room the corrected position looked beautiful. However I neglected to use any internal fixation, and two days later in x-rays the fragment had slipped anteriorly! When the old boy finally sensed my unhappiness and asked me the cause I told him. He looked at me for a moment, shook his head and said "Dear Jesus, doctor, you must learn never to x-ray these things once you have operated on them! Although Deane had never been much interested in the political side of medicine, even on his deathbed he continued to hold a grudge against William Aberhart's Social Credit government, whose monetary policies were said to have cost him ten or twenty thousand dollars. Wainwright, the devoted nurse who cared for him during his last days, could not have had an easy time of it. As Townsend said of him, "He was an old school conservative. He was fine as long as he could do things for people; he didn't want them to do things for himself." Dr. Hank Mewburn, the second Alberta surgeon to limit his practice to orthopaedics, was also an old school conservative, but of a different stripe. He had the tough sort of personality associated with the military, Dr. Reginald Burton Deane's House at Wolfe Street Calgary, Alberta and even his civilian patients would have to "report" and call him "sir," standing at if they were able. Dr. Olav Rostrup, who was a few days late in reporting for his internship, discovered that Mewburn was critical of people who were less respectful than he of military virtues such as punctuality. Mewburn began his military career in 1914, when he enlisted in Lethbridge's Twentieth Battery of the Canadian Field Artillery. He chose not to sign up for the medical corps; however, a letter dated 15 April 1917, four months after his marriage to Colonel Belcher's daughter, Jessie, shows that he applied for transfer to duty as a medical officer. He joined the staff of the Canadian hospital at Tap low, England, where Colonel Mewburn was the chief surgeon, and finished the war there. Arriving in Edmonton in July 1919, Hank Mewburn began working with the Soldiers' Civil Reestablishment Department (SCR). His work with the SCR until 1922 marked the beginning of a long civilian career with numerous military affiliations. From 1923 to 1945, he was Orthopaedic Surgeon to the SCR and the Department of Pensions and National Health. After World War II, he and Dr. Rostrup were consultants to the Department of Veterans' Affairs(DVA). During peacetime Mewburn served as a reserve officer; as a Lieutenant-Colonel he commanded Edmonton's Fourth Field Ambulance unit. Dr. F.H.H. (Hank) Mewburn

Hank Mewburn is said to have been an honest, forthright man with a rather blunt manner. Despite his outwardly rough personality, he is remembered as a kind man who was always busy with patients. One eulogy referred to him as a respected professional, a well-organized teacher, and an excellent surgeon. Dr. D. Cooper Johnston recalled Hank Mewburn as follows: He would have his instruments made by a local blacksmith, the osteotomes, which are now all finely chrome-plated and so on.... He would go down, and he would design it himself and have it hammered out of cold, rolled steel; and they were always blacker than hell. Those days we would take a tibia, and we would have to cut it out with an osteotome. There was no such thing as an oscillating saw or things like that; and, you'd pound away with this osteotome in order to cut out the size of bone graft you'd want. And Hank certainly was not a delicate surgeon. He was more of the buckle and brace sort 31

of orthopaedic surgeon. And, I can well remember one day, him talcing out the bone graft, as he was taking out the tibia (he was pounding down here) the tibia split all the way down. And his comment was, "Holy Jesus, Cooper, we've shivered her from stem to gudgeon!" But, it didn't make a hell of a lot of difference, the guy was off his legs for a while. Such was the surgical style of Hank Mewburn. The third man to practice orthopaedics in Alberta, Graham Huckell, had a lighter touch. A graduate of McGill, Huckell returned to Alberta to intern at the University Hospital. But in the midst of his second year of surgical internship, he was discharged from the Hospital, having broken hospital regulations by marrying a nurse, Jean, without permission. Huckell became the general surgeon -- responsible for taking out tonsils and such -- on a travelling clinic in the outlying districts of the province. Along with the general surgeon, these teams typically included an examining physician, a dentist or two, and several nurses. They operated during the summer and charged nominal fees, but they were considered by many medical men to be an encroachment by public health authorities on the practices of private physicians.

Dr. Robert Graham Huckell Rounds with Dr. Hank Mewbum (centre) Dr. Graham Huckell (left of centre)

After a season of travelling, Dr. Huckell went into general practice at Waskatenau, a newly-created village not far from Edmonton, and worked out of the small but active cottage hospital at nearby Smoky Lake. Evidently he was not far from Hank Mewburn's thoughts. During the infantile paralysis epidemic of 1926-27, Dr. Mewburn sent for Huckell, and by the summer of 1928 he was back at University Hospital. Drs. Huckell and Mewburn were associated for about three years after the epidemic, with the younger man learning orthopaedic surgery by a form of apprenticeship. Huckell also acted as Demonstrator in Anatomy at the medical school and was a Lecturer on Orthopaedic Surgery. As Huckell's son, Dr. John Huckell, tells it, one day in 1930 it was decided that Graham Huckell was sufficiently qualified to be called an orthopaedic surgeon. The University Senate was contacted, and Huckell was appointed to the University Hospital staff. That same year he opened his office for the practice of orthopaedic surgery in Edmonton. Graham Huckell is frequently described as a remarkable anatomist, as well as an efficient, inventive, and precise surgeon. From 1950 onwards speedy surgery was essential for him, because he suffered from lower limb paralysis with troubles in mobility and balance, complications following a lumbar discectomy. He therefore devised surgical methods and procedures which allowed him to function well Smoky Lake Hospital, 1920 despite his disability. An energetic and determined man, he discovered that he could do virtually all of his major surgery sitting down. He had stools made to various heights and would move the stools around the operating table as required. During the early 1950s performing orthopaedic surgery while seated was almost unheard of; however, it enabled Huckell to carry on his large active orthopaedic practice. He was also known for the instrument he developed, the "Huckell wedge," which was used to remove a piece of bone of certain dimensions during a sacro-iliac fusion, in those days a very common operation for persistent low back pain, buttock and late pain. Dr. Huckell had a wide reputation for his proficiency with spinal manipulation and caudal injections for chronic low back pain, these manipulations being done under a general anaesthetic. Late in his professional career he estimated that he had done well over 3,000 such manipulations. Dr. Olav Rostrup portrayed Graham Huckell as a "stout and generous man," adding: As busy as Doctor Huckell was he never forgot the patients at the University Hospital on Christmas. He always took Santa on his rounds on that day. He was not only looked on as a doctor by his patients, but also as a friend . He had a great memory for 34

names and faces and could call a patient by name even though not having seen them for years. He was loved by the children and on occasion was heard to be referred to as "like my Grandpa." A reminder of the high regard and esteem held for Doctor Huckell by his patients was the planting of two trees in Jerusalem, in his memory, in 1967. Dr. Huckell, whenever possible, would visit medical centres while away on holidays. He was continually seeking medical knowledge, upgrading his level of confidence in orthopaedic surgery and was vitally interested in visiting as many medical centres throughout the world as possible. 10 These, then, were the men who pioneered the practice of orthopaedic surgery in Alberta -- Colonel Frank Mewburn, Dr. Hank Mew burn, Dr. Reginald Deane and Dr. Graham Huckell . Their experience during and following the First World War allowed them to develop the specialty in the province, and the polio epidemic of the late 1920s made the need for orthopaedic specialists abundantly clear. The pattern of development established in these years was to continue with World War II and the polio epidemic of the early 1950s.

Public Ward , University of Alberta Hospital, 1923 FRANK HAMILTON MEWBURN 1858-1929

PROFESSOR OF SURGERY IN THE UNIVERSITY OF ALBERTA 1921 -1929 HONORARY SURGEON ROY AL NORTH WEST MOUNTED POLICE LIEUTENANT COLONEL ARMY MEDICAL CORPS CANADIAN EXPEDITION FORCE 1914-1918 ASSOCIATED FOR MORE THAN FORTY YEARS WITH THE PRACTICE AND TEACHING OF MEDICINE IN WESTERN CANADA

A LIFE SECURELY BUILT INTO THE FOUNDATIONS OF THIS PROVINCE

Plaque honoring Frank H. Mewburn, July 1930 36

CHAPTER TWO

LEARNING ORTHOPAEDICS

In the period before formal residencies there were numerous routes to specialization, and Alberta's early orthopaedic surgeons probably travelled most of them. Indeed, a young surgeon wishing to take formal postgraduate training in orthopaedic surgery had to go abroad, since there were no orthopaedic residencies as such in Canada between the wars. The large hospitals in eastern Canada had a few residents in the 1920s, but the general surgery residency lasted just one year and offered little opportunity for specialization. So a general surgeon might develop an interest in a specialty and then gradually restrict his practice to that specialty. Or he could train as a specialist's assistant. There were also a few brief postgraduate sessions and a very small number of special internships in orthopaedic surgery. North American physicians wanting to pursue a career in orthopaedics most often went to London or Edinburgh for a fellowship. These brief postgraduate sessions at medical centres abroad gave Alberta's first orthopaedic surgeons much of their initial exposure to orthopaedic surgery. Dr. Reginald Deane, for example, had perhaps only a year of orthopaedic education; from 1919-22 he spent brief periods in London, Bristol and Liverpool. One of today's highly trained Fellows might express some embarrassment at such a lack of training, but Dr. Deane acquitted himself by keeping abreast of the literature. He 37 was, as E.P. Scarlett described him, a perennial student. Dr. Gordon Townsend, Deane's successor, did his orthopaedics in Cardiff, Wales, spending two and one-half years with Dr. O.A. Parker, a giant of British orthopaedics who was well-known for his triple arthrodesis of the hind foot. With so few specialists in the province between the wars, and with the specialties being as little recognized as they were, there were few moves towards certification. In the 1920s there were no generally accepted standards for specialists, although in eastern Canada, a British fellowship was more recognized than an American one, according to Harvey Agnew's history of Canadian hospitals. The Royal College began to recognize specialties in 1929, and while this recognition was not a legal formality, it did simplify the granting of hospital privileges in the east. As early as January 1938, the University of Alberta had regulations in place for becoming a specialist. Certificates were granted in seven surgical specialties, including orthopaedics, and these required at least one year in a postgraduate rotating internship or three years in general practice. In fact, by the end of World War II, Alberta seems to have been the only province which required certification of specialists. The Alberta Medical Professions Act of 1942, section 72, required certification of specialists. Hank Mewburn, for one, was registered as a "Specialist in Orthopaedic Surgery (Alberta)" and was a member of both the Canadian and American colleges of surgeons. For their part, the other provinces seemed to be expecting the Royal College to deal with the issue in good time. The College began to recognize orthopaedics as a specialty after the Second World War. The first physician to complete an orthopaedic residency in Alberta was Dr. Olav Rostrup. After graduating in medicine from the U of A in 1937, he began a year of rotating internship at the University Hospital in Edmonton, the first two months of which he spent in orthopaedic surgery under the direction of Drs. Hank Mewburn and Graham Huckell. Mewburn's department at the University Hospital had come into being in July 1923, when a number of orthopaedic cases were taken over and grouped together. The majority were crippled children who were being treated under the surgical division and, for the most part, were nearing the completion of that treatment. 1 These patients became the basis of study for the twelve sixth-year medical students. The students were expected to write histories and take bedside notes as 38 well as scrub for operations and assist the interns. There were ward rounds, and Hank Mewburn gave Wednesday morning lectures in orthopaedics to the fifth and sixth year students in the fall of 1923. Mewburn left no record of what he thought of teaching undergraduates, but he expressed dissatisfaction with the program of his first rotating intern, Dr. Rostrup. As soon as it is possible, some provision should be made for detailing one intern permanently to the orthopaedic service. With the number of patients in the house, and the number attending the Out Patient department, the amount of detail left to an intern is more than he can handle, particularly when he has work to do for other services. At present the man detailed to this department gets little more than a slim smattering of important details, and has not time to get his hand in. I am sure that such an arrangement would tend to be more satisfactory to the orthopaedic service, and would make the man's house service in the hospital a more attractive one. 2 Things improved over the years. In the late 1930s, Dr. Rostrup was helped by the interns, once they were "not too green." When Cooper Johnston began his residency after the war, they tried to teach the rotating interns and residents to be less afraid of broken bones and to recognize emergencies. Much the same goes on today, but perhaps with more organization than the house staff at the university had in the prewar period. Mewburn and Huckell were described, however, as "pretty confident in their business and as interns we were made conversant with everything modern, but in the thirties, the U of A was g.p. oriented -- you had to go elsewhere for residency." 3 Dr. A. E. Wilson, obstetrician, said that the undergraduate course was pretty comprehensive, with many lectures in orthopaedics. Faculty historian John W. Scott wrote that Mewburn was a well-organized teacher and that he and Huckell had a heavy teaching load in the early years. 39

Dr. Olav Rostrup Miss. Jean Lees Dr. Graham Huckell, 1938

In any event, during Rostrup's two-month rotation they worked him "like a dog," and he soon began to enjoy orthopaedics. He particularly liked working with the children with polio, since paediatrics was his goal at that time. Rostrup had moved on to his next rotation in surgery when Dr. Huckell approached him about studying orthopaedic surgery. It was not an opportunity that he could turn down, since few doctors had the chance to specialize in prewar Canada. Rostrup finished off his year of internship and in July 1938 became "the resident" in orthopaedic surgery at the University Hospital. Rostrup's training was extremely informal but required a lot of work in the service area. Since he did his residency in all four of Edmonton's hospitals, he was seldom off call. Drs. Mewburn and Huckell took turns having him assist them at surgery, and he had the help of rotating interns on the orthopaedic service. There were no formal seminars, no reading courses, no journal club, no pursuit of basic bench research, and very few formal textbooks in orthopaedics. Only an industrious, strongly motivated individual such as Dr. Rostrup could obtain adequate training in this unstructured environment. The Royal College informed him that three years of residency was sufficient for him 40 to qualify for his specialty in orthopaedic surgery. Dr. Rostrup practiced in 1940-41 and joined the Canadian Army Medical Corps in 1941. Although Olav Rostrup went off to war as a more or less qualified orthopaedic surgeon who had practiced the specialty for at least a year, many medical officers enlisted with little practical experience. Indeed, some of the officers enlisted with as little as eight months of rotating internship, and their formative clinical experience was obtained during the war. Only five orthopaedic surgeons were practicing in Alberta before World War II, but a dozen more of the province's postwar orthopaedic surgeons had graduated from medical school by the end of 1945. Of these, at least half had war experience. For some, if not most, of these men their interest in orthopaedic surgery was a result of this wartime experience. Dr. Thomas Richardson saw orthopaedics during his two years in the naval medical corps and thought it would be an interesting specialty to practice following his release. Gordon Wilson also had a lot of experience with musculo-skeletal problems in the navy. Moss Albert, Lethbridge's first orthopaedic surgeon, had not studied the specialty before the war but found himself practicing it during the conflict. Calgary's third orthopaedic surgeon, Edward H.J. Smyth, also learned his skills during the war, serving as a surgeon in the British Army from 1939-45. Many of Alberta's general surgeons, such as Dr. J. Smith ("Smitty") Gardiner, also learned a good deal about musculo­ skeletal surgery during the war years. At the war's end, the large number of discharged medical officers presented what Dr. R.H. Hepburn called "an acute problem." Dr. Hepburn, who was professor of surgery and a world-renowned surgeon with extensive formal education in neurosurgery, described the postwar period as a time of great expansion in the surgical specialties. Canadian medical officers were not very busy during the war, he said, so they spent time doing postgraduate work at excellent centres in Britain. As a result, very few of them were interested in going out to country practice when they returned -- most wanted to specialize in Edmonton, some chose Calgary, and a few of the broad minded ones considered other places. 4 For those who wanted to pursue a specialty, this large number of returning medical officers became a bit of an obstacle. Thomas Richardson, for example, returned to Calgary in 1945 and did general practice with his father for a year. With so many other medical officers as competition, residency positions were extremely scarce. He applied 41 to thirty-two medical centres and was accepted in Iowa City, thanks to a last-minute cancellation in their formal orthopaedic program. He was then able to attend the Campbell Clinic in Memphis, Tennessee. In 1950 he became the fifth orthopaedic surgeon to practice in Calgary. Cyril Walsh began practicing orthopaedic surgery in Calgary two years before Richardson, having returned from rigorous postgraduate studies in the United States. He graduated from the University of Manitoba medical school in 1939, interned at Calgary's Holy Cross Hospital, and married in 1940. He was shipped overseas as a Lieutenant in the Royal Canadian Army Medical Corps in 1941 but was discharged in June of the same year because of an ongoing health problem, bronchiectasis. On Walsh's return to Calgary he joined the Associate Clinic, staying until 1945, when he went to study orthopaedics at the Mayo Clinic for two and one-half years. The last six months were spent at St. Paul's Children's Hospital in Minneapolis. Two other Calgary surgeons who trained in the United States in this postwar period were Drs. Donald Sturdy and William Kindrachuk. Don Sturdy graduated in 1944 from McGill University, having done two years of residency at St. Boniface Hospital in Winnipeg, and worked for two years as a general practitioner in Climax, Saskatchewan, before he was able to start postgraduate orthopaedic studies. After one year at Johns Hopkins University, he went on to Stanford Hospital, where his chief was Dr. Don King and Dr. Sterling Bunnell was the head of the hand surgery service. Sturdy learned that Calgary had only three orthopaedic surgeons and so joined Cyril Walsh at the Associate Clinic in 1952. Four years later, he went to California to practice orthopaedic surgery, but he returned to Calgary in 1962 and practiced there until 1977. Dr. William Kindrachuk graduated from Queen's University in 1943 and joined the Canadian Army Medical Corps. After being discharged in 1945, he did general practice in Drumheller and studied orthopaedics in Cleveland and Miami from 1951-54. He set up a private orthopaedic practice in Calgary in 1954 and practiced there until his death in 1985. Of the surgeons who came to practice orthopaedics in Edmonton in the decade after World War II, most were trained out of the province, if not out of the country. Dr. Joseph Moreau did his residency in orthopaedics at Du Sacre Coeur in Montreal. Drs. Gordon Wilson and Gordon Gray studied in Montreal and Toronto, respectively, while Fred Day and Robert Henderson had British credentials. Day had trained in 42

Liverpool and Henderson in London, England. Dr. Erwin Bako did his medical training in Berlin before the war and probably did not have any formal orthopaedic qualifications. Clearly there was a demand for surgical postgraduate opportunities in the province. To respond to it the University of Alberta Hospital developed what came to be known as the Marshall Plan, initiated by Dr. Mark Marshall, an ophthalmologist at the hospital. Marshall started the plan in his own department, and it was largely through his organizational efforts that residencies developed in the other surgical specialties immediately following the war. It provided for one resident per year in each of the specialties, including orthopaedic surgery. The plan began in 1946, when the University did not have an accredited residency program, and continued for six years, until the University became affiliated with the Royal College of Physicians and Surgeons of Canada. The first orthopaedic resident on the Marshall Plan was Dr. D. Cooper Johnston. Immediately after World War II he and the nine other medical officers in his charge were working at Calgary's Mewata Armoury, discharging men from the Canadian army. He had so little to do that he only worked every sixth day. On one of those days, Dr. Rostrup came through the demobilization centre, and it was Cooper Johnston who discharged him from the army. According to Cooper Johnston, when Rostrup asked him what he thought about orthopaedics, Cooper Johnston replied that he would do anything to get out of Mewata Armoury. With the help of Dr. Hank Mewburn's DVA connection, Dr. Rostrup was able to have Cooper Johnston sent to the University Hospital to start his orthopaedic program. As a full captain who had not been overseas, Cooper Johnston was paid $410 per month plus allowances, rather than the $90 which the other discharged officers in the Marshall Plan received. This pay carried on for some eighteen months, until the federal government caught wind of it. Dr. Tom Otto was the second man trained in orthopaedics on the Marshall Plan. Although the majority of the plan's graduates remained in Alberta, Otto went to the United States to practice orthopaedics. Dr. Doug Wallace also started out on the plan, but after a year of the program switched into hospital administration, eventually becoming Superintendent of the University Hospital. Dr. Gordon Cameron, the third Marshall graduate, had worked for four years as a general practitioner in Saskatchewan and knew that residencies were in short 43 supply. After an interview with Dr. Walter Mackenzie, then Head of Surgical Services, he was accepted on to the Marshall Plan in orthopaedic surgery. The residents on the Marshall Plan were a close-knit group, most of them without cars, money, or wives. Cameron and Cooper Johnston both complained of the treatment they sometimes were expected to take from the hospital bureaucracy. They were worldly ex-soldiers who were not about to be treated like children -- or like inexperienced interns -- so there were frequent quarrels with the administration about liquor and women in the living quarters. The hospital clung to the old rules for a while, but the residents stuck together; the rules were gradually changed. Cooper Johnston was on the service with Mewburn, Huckell, Rostrup, and the occasional rotating intern or surgical resident. The residents learned on the job and by precept. There was very little teaching per se, other than the occasional undergraduate lecture, and few orthopaedic books. But with so few residents, they had a tremendous amount of hands-on surgical experience. They operated almost every morning and then would spend the rest of the day putting on what Cooper Johnston said was an extraordinary number of plaster of Paris casts. Mewburn and Huckell were tremendous sticklers for proper casts, insisting that the residents learn to do them properly even if there were plaster room orderlies available to do the same work. Glen Edwards, another Marshall Plan participant, said that Huckell made him do his first cast three times, claiming that it still didn't look like a cast. Cooper Johnston taught the general practitioners how to recognize the emergencies such as osteomyelitis and septic joints. Gordon Cameron recalled that although he was on constant call he did receive some help from the interns. The residents also ran two DVA outpatient clinics a week, which supplemented the DV A surgery. But polio was the foremost teacher of orthopaedics in those years. From polio, residents learned the general principles of tendon transplants, fusions, straightening joints and limb bracing. While not above reproach, the orthopaedic teaching staff was good as a whole. By Cameron's time, Huckell and Rostrup were doing much of the work, Hank Mewburn was not yet fully retired, and Dr. Gordon Wilson had joined the staff of orthopaedic surgery. Cameron recalls that Dr. Huckell would never let him do any surgery, but the other three surgeons were very encouraging. In preparation for the Royal College exams, Dr. Rostrup put Cameron on the study program. 44

Rostrup would also give "seminars" at night, quizzing the residents on various subjects. It is Rostrup who is credited with bringing some structure to the postgraduate program at University Hospital. In an approach that was in keeping with the American method of teaching he had been exposed to at Barnes Hospital in St. Louis, Rostrup introduced basic science into the program and required the residents in orthopaedics to take subspecialties such as neurosurgery, plastic surgery and general surgery. He took the program beyond the clinical experience and psycho-motor skills to a more scientific level, and he had the residents writing small research papers, reviews and surveys of the literature. His contributions were recognized with the dedication of the annual "Rostrup Cup," which is still presented in his honour to the best resident research paper in Alberta. Dr. Gordon Gray also taught and was part of the university group, even though he had no formal appointment at the U of A. He had trained after the war in Toronto and was in Edmonton from 1951 to his death in 1985. One of Dr. Gray's greatest contributions for many years was excellent and dedicated teaching of undergraduate medical students about how to take proper histories and do physical examinations. Since the orthopaedic staff was small, its members were concerned that the program as it had developed immediately following the war was incomplete and possibly somewhat "inbred." Dissatisfied with the informal nature of his own apprenticeship, Graham Huckell never missed visiting medical centres when he travelled. Gordon Wilson also made yearly trips to various medical centres after the Second World War in order to observe work on traumatized and arthritic hands. The faculty all felt that the residents would benefit from similar experiences. Dr. Huckell had done some additional training in New York, and both he and Rostrup maintained ties to St. Louis, Missouri, where Huckell became friends with Dr. John Albert Key while attending sessions at Barnes Hospital. This connection paved the way for many of Alberta's orthopaedic surgeons to broaden their skills at that city's Children's Hospital and at the Shriners' Crippled Children's Hospital. After three years at the U of A, Cooper Johnston was sent to St. Louis to do a year's fellowship with Dr. Key, who was renowned in the field of orthopaedic surgery throughout the English-speaking world. A brilliant innovator, outstanding surgeon, and a very stern teacher -­ somewhat like Hank Mewburn, according to Cooper Johnston -- Key was called the "boss" by everyone. Cooper Johnston returned to Edmonton 45 in 1950 to practice orthopaedic surgery at the University Hospital. About four years later Gordon Cameron also went to St. Louis, where he spent four months at the Shriners' Hospital and did a good deal of work at the St. Louis City Hospital. The next fellow in orthopaedic surgery under the Marshall Plan was Tony Stanley, a native of Ontario who went to Escondido, California, following his training and has practiced there for some thirty years. He was followed by Glen Edwards, who was on the Marshall Plan from 1954-59, at which time he also went to St. Louis and worked under Drs. Relton Mccarroll and Fred Reynolds. The year that Edwards was a fellow at Barnes Hospital and at the Shriners' Crippled Children's Hospital, Mccarroll was the President of the American Orthopaedic Association and Reynolds, who later became President of the Academy of Orthopaedic Surgeons, was in charge of the new and very popular instructional courses at the American Academy of Orthopaedic Surgeons. In those days orthopaedics in St. Louis was considered to be a leading centre for orthopaedics in the English-speaking world, and the training the surgeons received was broad. When Edwards was there, one of his many tasks was to prepare the residents to pass their American Board exams in orthopaedic surgery; another was to teach the core of orthopaedic surgery to the undergraduate medical school in four one-hour courses. It was his first opportunity to teach medicine based on the system concept, and the experience helped him to set up the initial core for the medical school in Calgary. Edwards and Gordon Cameron were able to broaden their experiences in orthopaedics even further when they were selected as fellows by the ABC Club, an educational and social group of orthopaedists who have been chosen for exchange fellowships by the American, British, Canadian, New Zealand, Australian and South African associations. Both men recall the fellowship as a great learning experience, in spite of the heavy load of all-day academic programs, excessive travel, and too many formal dinners. Dr. R.I. Harris of Toronto developed the ABC in 1948, when he was President of the American Orthopaedic Association, because he knew that World War II and the times that followed had made it very difficult for young orthopaedic surgeons from Great Britain to visit orthopaedic centres in the United States and Canada. In 1948, during the first combined meeting of the Canadian, British and American associations, the first group of thirteen fellows -- among them Crawford The 1959 Travelling Fellows. Back row: John P. Adams, Washington, D.C.; Gordon W.Cameron, Edmonton, Alberta; Andrew H. Crenshaw, Memphis, Tennessee. Front row: James S. Miles, Denver, Colorado; Sherman S. Coleman, Salt Lake City, Utah.

Adams, John Charnley, P.H. Newman and Ian Smillie, and one honourary fellow, Professor J .I.P. James -- arrived from Great Britain on the Queen Elizabeth. In a tour that was partially funded by the Nufield Foundation, the group visited several orthopaedic centres. Dr. Reginald Watson-Jones recognized the tremendous benefits of the experience in the United States and Canada and urged the British to foster the idea of further exchange fellowships. The next year the British Orthopaedic Association invited fifteen young American and Canadian orthopaedic surgeons to visit selected orthopaedic centres in Great Britain. Among this group were surgeons such as William Bickel, Ted Dewar, John Fahey, Ben Fowler, Carol Larson, William MacKinnon, Frank Patterson and Lee Ramsay Straub. The fellowship program has continued since 1954 on an annual reciprocating basis and allows for the interchange of young orthopaedic surgeons between Great Britain, Australia, New Zealand, South Africa and North America. In alternate years six men and worr.~!! from North America go overseas, and the following year a similar group from Great Britain and the Commonwealth visits North America. The vast majority of fellows have gone on to become leaders in the political and academic spheres of orthopaedic surgery. ABC Travelling Fellows 1969: Clockwise from top left: Dr. Reginald Cooper, Iowa, U.S.A. ; Dr. Vert Mooney, California, U.S.A.; Dr. Frank Wilson, S. Carolina, U.S.A.; Dr. Ashby Grantham, N. York, U.S.A.; Dr. Glen Edwards, Alberta, Canada; Dr. Robert Jackson, Ontario, Canada

This sort of exchange is an opportunity that Alberta's first orthopaedic surgeons could only have imagined. Yet the need for such an arena to share problems and clinical information was recognized early on by the province's small group of orthopaedic surgeons. Dr. Gordon Townsend describes the void that was filled by the Alberta Orthopaedic Society. In these days of relative plenty -­ plenty of opportunities, plenty of specialists in every branch of medicine, plenty of equipment, plenty of ideas -- it would be difficult for you to understand the feeling of loneliness and isolation resulting from being the only member of a relatively restricted specialty in a community that embraced not only Calgary but all of Alberta south to the American border. Because of this and the over-powering urge to discuss my 48

problems with someone who would understand both them and my language, I developed a habit of going to Edmonton from time to time to spend a day with Hank Mewburn and Graham Huckell so that I could cry on their shoulder and ask their advice about the numerous problems that were bearing me down. These were very satisfying days in my life. Both of these men were extraordinarily kind and sympathetic and understanding, and from them I learned not only a great deal about orthopaedic surgery but much more about what personal association and conviviality can contribute to the practice of medicine and in fact to the sheer joy of living in general. As a result of these days spent in discussing orthopaedic problems in particular and the problems of life in general there grew amongst us three the feeling that we should continue these meetings at intervals as more orthopaedic surgeons moved into Alberta. The thought persisted, and finally in December of 1948 a meeting was held at the Red Cross Crippled Children's Hospital on Royal Avenue in Calgary of all of the orthopaedic surgeons then practising in Alberta--Hank Mewburn, Graham Huckell, Gordon Wilson and Olav Rostrup from Edmonton; Cyril Walsh, Edward Smyth and myself in Calgary. Thus was born the Alberta Orthopaedic Society which continues to function.~ According to Dr. Rostrup, these meetings made a significant contribution to the education of Alberta's orthopaedic surgeons. Initially, they were very critical but friendly meetings. The senior surgeons 49 presented their failures and problem cases with humility, and this made the meetings valuable learning experiences for all who attended.

The 2nd Junior Red Cross Children's Hospital, 1009-20 Ave.S.W. Calgary Founding Site of the Alberta Orthopaedic Society

Founding members of the Alberta Orthopaedic Society, December 1948 Left to right: Dr. Cryil Walsh, Dr. Graham Huckell, Dr. 'Hank' Mewbum, Dr. Gordon Wilson, Dr. Olav Rostrup, Dr. Edward Smyth, Dr. Gordon Townsend 50

The annual conventions of the Alberta Medical Association also provided an educational forum for orthopaedic surgeons. R.I. Harris came to the 1935 convention to speak on femur fractures, bone tumors, and osteomyelitis. In 1937 physicians watched a film on the safe transport of emergency long bone fractures. Visiting surgeons from Manitoba and the Mayo Clinic spoke at the 1938 meeting, and two films, "After Care of Poliomyelitis" and "Treatment of Fractures in Children," were shown. Charles Henry of McGill came to the 1941 meeting, and F .I. Lewis of Toronto addressed the topic of misunited femur fractures at the 1942 convention, which also included Hank Mewburn speaking on polio surgery and Gordon Townsend discussing surgical principles of compound fractures. Inevitably, discussions of war-related injuries dominated the meetings in the 1940s. In 1943 Dr. A.R. Munroe spoke on "Amputations and Prostheses," predicting that they would be "a major part of our postwar problem." That year Major Rostrup delivered a paper on "The Soldier's Feet: the most common problem in the services." The convention in late 1945 featured a symposium on traumatic surgery by Major Smitty Gardiner and Lieutenant-Colonel Bridge. In 1947 the Canadian Medical Association (Alberta) Convention was devoted to "What's New in Medicine," and the talks were published in the January 1948 issue of the Alberta Medical Bulletin. Olav Rostrup, who was in the process of obtaining his American qualifications, contributed a review of the "teeming" orthopaedic literature. The polio epidemic brought a shift in focus to the meetings, as Alberta's orthopaedic surgeons were necessarily preoccupied with the disease and its problems. Gordon Wilson and Hank Mewburn spoke on the outbreak of polio in 1951, and Tom Richardson was part of the polio panel at the 1953 convention. J .R. Fowler of Edmonton's Workmen's Compensation Board Clinic also spoke at that meeting on the rehabilitation of fracture cases. During these years many other informal opportunities also existed for orthopaedics education. At the Colonel Belcher Hospital there were the weekly seminars that Smitty Gardiner began organizing in 1946. These were not limited to war and reconstructive surgery but included Gordon Townsend speaking on bone tumors. Dr. Gardiner's long­ running "Journal Club" has been described as an important academic step in what was otherwise considered to be an unsophisticated city. Hospital staff meetings, formal consultations, and the national and international connections to be made at conventions all contributed 51 to the body of knowledge. Graham Huckell and Gordon Townsend attended the first scientific meeting of the Canadian Orthopaedic Association in 1945 in Montreal. The American Orthopaedic Association met in Banff in 1956. And Edmonton orthopaedist Dr. Joe Moreau was a wealth of information, passing along developments from the various French language periodicals and meetings which he attended both in Quebec and in France.

The first meeting of the Canadian Orthopaedic Association, Montreal 1945. Standing left to right: Ors. Beath, Rossignol, ... , Bastedo, ... , Walker, Bateman, Tremblay, Pouliot, Denoncourt, Goldman, Shapiro, MacLachlan, Townsend, McGibbon, and Ewart. Sitting left to right: Ors. Dale, Turner, Samson, Nutter, Favreau, Armstrong, Coleman, and Huckell.

One teaching tradition established in Calgary under Dr. Townsend's direction was the orthopaedics rounds at the Children's Hospital. Starting every Tuesday morning at eight o'clock, Townsend, paediatrician Dr. Morley Cody, and the Medical Superintendent would present the rounds. Any case being considered for surgery was presented and the proposed treatment analyzed, a procedure that TowQsend and Cyril Walsh felt would be helpful to those orthopaedic surgeons who had little formal training, particularly in paediatric orthopaedic surgery. These rounds developed into a "great teaching mechanism, the first at a Canadian paediatric hospital" and have continued for some forty-five years. 6 They are still an active part of the teaching format for orthopaedic residents, the orthopaedic surgeons themselves, and for nurses and medical students at the University of Calgary. 52

Teaching traditions such as these have endured in spite of the fact that the face of orthopaedics, and medicine in general, has changed greatly in the past three decades, in part because of the unprecedented growth in the education industry in post-war Canada. Between the wars university education was still a matter of privilege for the Canadian minority. By the 1950s, though, it came to be regarded as almost a right for any capable young person. Thus, Canada experienced steady growth in enrolments in these institutions: by the early 1950s the student population was twice the 1940 level; it doubled again by the early 1960s. The baby boomers then arrived at university, and education and other social spending increased even further. Economic expansion and medical insurance made possible an enormous increase in the scale of medicine. In 1966, for example, the federal government set aside $500 million dollars to be spent by 1970 on the construction and renovation of medical teaching facilities. As medical expenditures grew and great numbers of hospitals were built, an immense research establishment was created. The numbers of health care workers swelled. The number of full-time faculty increased, and research became a priority. Growth meant subspecialization, providing new avenues for academic promotions and accommodating larger numbers of residents into academic medicine. Practitioner teachers were replaced by academics. The demand for house staff increased, requiring even more residents to handle the "call." By 1964 two-thirds of Canadian medical students preferred specialization to general practice. More resident positions were provided by the creation of new medical schools, and the medical schools grew in power, becoming comprehensive health centres. Huge bureaucracies developed to administer the new changes. All of this expansion has increased the number of specialists in the province and has profoundly affected the teaching of medicine. The Alberta Medical Bulletin of May 1960 reported that there were 410 "specialists" in the province, inaccurately claiming fifteen orthopaedic surgeons. In fact, there were more than twenty men calling themselves orthopaedic surgeons, but even larger numbers were to appear in the 1960s with the expansion and modernization of the residency program at the University Hospital. Although by 1960, 42 .6 percent of Alberta specialists were listed as U of A trainees, the medical school was not yet having an appreciable effect on numbers; in an era of rapid population growth and massive immigration, 50 percent of the newly registered special is ts were immigrants. 7 53

Similar growth has been experienced by the orthopaedic service at the U of A. Whereas in 1950 there were only four surgeons on staff, in late 1987 there were eight surgeons, four residents, three or four students, as well as plaster room technicians. In the decade following the war, the program had done little to put orthopaedics on a solid footing in the province, because only two of its residents, Cameron and Cooper Johnston, stayed on to practice in Alberta. But starting in the late fifties, about one surgeon per year from the U of A entered into practice in Alberta -- i.e., a total of fifteen graduates from the orthopaedic program went into Alberta practice between 1959 and 1973. The experiences and expectations of physicians entering a residency program have also changed over the past thirty years. As Dr. Gordon Cameron of the U of A Hospital said of today's residency program in orthopaedics: "The residents now are all so skillful, knowledgeable and well travelled; money is available to broaden their knowledge. So, you feel you've failed if your residents aren't better than you are." Dr. John Huckell, who directed orthopaedics at the U of A from 1978-87, offered some reasons why Dr. Cameron might feel this is the case. When Dr. Huckell started his training in orthopaedics at the U of A in the mid-1950s, learning was pretty much an individual matter, a fairly unstructured program compared to the present. Dr. Rostrup's teaching program was nowhere near as formal as the documents that today's large academic bureaucracies can produce. To be sure, residents were given some guidance as to how to go about learning the material -­ and this was also true when Huckell was studying in Boston -- but they did not have a curriculum as they do today. Beginning in 1974, under the leadership of Dr. Lyle Davis, the program became much more academically oriented. There was a syllabus and a definite schedule as to what was expected from the residents. Mock exams assessed the residents' progress in their training and helped them to pass their Royal College exams in orthopaedic surgery. In today's curriculum, the reside~ts go through a two-year syllabus twice in four years. 54

CHAPTER THREE

ORTHOPAEDICS BY NON-ORTHOPODS

Although the scope of the specialty had been well-defined for decades, much orthopaedic work -- fractures mainly -- was done by non­ orthopods as late as the 1960s. This was so even in Calgary and Edmonton, cities which were well-supplied with specialists. Only with the greater numbers of specialists produced by the residency programs in the province did the practice of musculo-skeletal medicine fall from the hands of the general surgeons and family doctors into the hands of the specialists in orthopaedic surgery. Orthopaedic surgeons in Alberta's cities now do "all the fractures," and there are subspecialists in paediatric orthopaedics, sports medicine, hand surgery, and other fields. A simplistic but partly accurate explanation of this growth of medical specialization was offered by Dr. H.H. Hepburn, Alberta's pioneer neurosurgeon. There have to be specialists, he wrote, since no one can carry all the information in his head. 1 The increasing volume of scientific knowledge is not, however, the most important factor in the expansion of the specialty in the province. Personalities, perceived needs, economic expansion, population growth, and a multitude of other things have all played a part. It was tuberculosis, for example, that brought Gordon Townsend to orthopaedics; Olav Rostrup and Cyril Walsh seized career opportunities; Graham Huckell was brought into the fold because Hank Mewburn wanted help in managing the polio patients 55 of the late 1920s. The growth in house staff and medical school sizes allowed others to specialize. World War II created an interest in and perceived needs and facilities for orthopaedics; polio did the same in the early 1950s. Another contributing factor was the development of what can be called "specialist-consciousness." In the research-oriented postwar period, specialists became the models for professional competence. They enjoyed greater prestige than the general practitioners and were considered by the public to have more ability and expertise. The generalists, who could boast of less technical knowledge, were treated poorly in comparison. In 1950 the Alberta Medical Bulletin published an article wondering what to do with the general practitioners, who as a group were becoming less and less capable. 2 General practitioners were squeezed out of the hospitals, a certificate being the basis of hospital privileges. Specialists obtained more power to influence policy, especially in teaching hospitals, and the "specialist thinking" fostered by these centres led to a lack of understanding between the specialists and the general practitioners. A caste system developed, with specialists fraternizing among themselves. By the late 1950s 70 percent of Ontario general practitioners thought that specialists were overrated by the public. 3 With health care values and information being promoted widely in the mass media, Canadians, like the rest of the affluent world, became willing to rely on experts. Thus, by 1959 a third of all of Alberta's physicians were specialists, as were 45 percent of the doctors in the province's three largest cities. Of the 410 specialists, ninety were general surgeons, and it was this group which accounted for most of the orthopaedics by non­ orthopods. 4 In rural areas, to be sure, every doctor had some fracture cases. Before Alberta's road system expanded in the 1950s, country practice did not involve shipping off patients to the city. General practitioners and surgeons had to take whatever cases came their way, orthopaedic or not, and every one of them could tell a hair-raising tale or two. Dr. F.W. Gershaw of Medicine Hat wrote of a thrifty homesteader who tried to save a few dollars by amputating his own frostbitten toe with a shot from his rifle. But his penny pinching didn't work out as planned, and he had to be hospitalized for subsequent infection. Industrial accidents from sawmills, lumber camps, and farms generated much of the trauma surgery performed by Alberta's early 56 surgeons. It was following an emergency trauma operation on a Swedish lumberman in Fort McMurray that Colonel Frank Mewburn died "in harness," as was his wish. He emerged from the "super-heated operating room" one bitterly cold January day and walked home, contracting pneumonia. 5 And it was as the result of a farming accident that young Olav Rostrup was influenced to become a doctor. Dr. J. Mulloy was a great friend of the Rostrup family, and when Rostrup fell off a threshing machine, Mulloy fixed his two broken arms. He was called back the following year when the boy broke one of them again. These surgeons often had to treat their patients under less than reassuring circumstances, especially in the pioneer era, and they were frequently called on to improvise with what little was at hand. Dr. Andrew Everett Porter (1857-1940) of Prince Albert was described as the first private practitioner in the NWT. "He performed amputations of arms at the shoulder with the aid of a police constable holding a flickering candle in a trapper's cabin, and succeeded in establishing a practice. "6 One of Dr. G.D. Stanley's frontier improvisations was on an unusual patient, a beloved saddle-pony with a fracture of a foreleg between the ankle and the knee-joint. Dr. Stanley had never done a pony before, but he immobilized the limb by hanging the patient from the barn ceiling and applying a plaster cast. He got good union and fair alignment, and the pony's young owner was happy that the pet had been saved. 7 There were other kinds of improvisation as well. When Dr. Neville James Lindsay, arrived in Calgary in about 1883, the first patient he saw was a cowboy with a Colles fracture. Not knowing what to charge the man, Lindsay asked for $2.00, twice the Ontario rate. For his efforts the cowboy gave him $10.00 and some valuable advice: he would soon be broke if he did not raise his rates. 8 Hospitals today have credentials committees which surgeons must satisfy if they want continued hospital privileges. But in the pioneer era, any physician who felt competent to perform surgery did so at his own discretion. And why not? Formally trained specialists were rare and lack of certification was no hindrance, since a Royal College certificate was not a necessity until the 1950s. Even then, at Calgary General Hospital, for example, the increasing level of specialization within surgery led to limited privileges only for major operations. Although Calgary General had a Department of Surgery as early as the 1930s, there was no Department of Orthopaedic Surgery for two decades. This 57 change in hospital structure shows the growth of medicine in Alberta, but it also indicates when the specialty became well-defined in the city. The orthopaedic "turf' came to be defined in the province in different ways. With his position at a university which sought to be up­ to-date, Hank Mewburn seems to have had little trouble getting the specialty off the ground in Edmonton. But the transition was not as smooth in Calgary, where the general surgeons were described as "princes who acted like gods." For R.B. Deane, Alberta's first orthopaedic surgeon, the "turf' was centred around crippled children. He had done much, if not most, of his surgery as the staff surgeon at the Junior Red Cross Crippled Children's Hospital in Calgary, and he had some difficulties, as the following story by Gordon Townsend reveals. Deane had the feeling that because he had specialized, all of the other doctors in Calgary would, without fail, send all of their problems, both congenital and traumatic, to him for solution. Of course, such was not the case. There are many stories of patients coming to him with a malunited Calles fracture, or a malunited tibia, to be told rather bluntly that if they had only come to the bone doctor in the first place, this terrible thing would not have happened. Naturally this did not win for him undying friendship amongst his colleagues in the medical profession. As a result, I inherited from him not only a great personal interest and kindness, but also an element of hostility within the profession, many of whom were even more suspicious of this young man who had moved into Calgary to follow in the footsteps of Alberta's first orthopaedic surgeon. 9 Deane's friend E.P. Scarlett, also a specialist in the era when Calgary's big medical men were the general surgeons, wrote about the jealousies that grew under professional competition. Specialists were resented in Calgary until after World War II because practically every 58 physician in town grew up in general rural practice, then moved to Calgary on the road to success. The absence of a medical school or a university also tended to make the city reactionary for thirty years. Scarlett went on to say, without these institutions, ... medical organizations and medical life generally were below the level which prevailed in cities possessing such advantages. There was thus little change in the direction of cosmopolitan medicine, and this was reflected in the fact that specialists and such innovations as a Clinic were something less than welcome. 10 To be fair to the generalists, with only one orthopaedic surgeon in Calgary, the general surgeons and practitioners had to handle all the fractures and traumas. Thomas Richardson recalls how his father, after taking his Scottish fellowship in general surgery, returned to Calgary after the First World War. J. W. Richardson and the other surgeons of the period between the wars expected to do the bone work. "They did fractures and knee cartilage surgery, but no reconstructive surgery in those days. Only orthopaedic surgeons knew the techniques such as replacements, fusions, arthroplasty." They had to handle osteomyelitis, as well. "He did some plating of fractures, Dr. Mackid did some, but neither did many .. .ln the early days, he went to outlying towns. He said that he had operated in every town within a 100 mile radius of Calgary." In 1934 the American Academy attempted to lay claim to the following areas by publishing a statement of principles: bone tumors, osteomyelitis, fractures, polio, congenital defects, nutritional disorders, and traumatic conditions. 11 Hank Mewburn, having been trained in the United States, might have subscribed to a similar definition of the specialty. R. B. Deane, struggling to establish the specialty in Calgary, would probably have been happy to take these cases as well. However, in the late 1930s in Calgary, the general surgeons were not interested in giving up such a great deal of business, as Gordon Townsend soon discovered. When Townsend first arrived in Calgary in 1939, business was slow. People simply were not aware of specialists. They went to general physicians and surgeons occasionally, but usually broken bones were not referred. Dr. Townsend appeared to be unwanted by the 59

Calgary establishment. He would sometimes get calls from out of town, so he would supplement his earnings by driving there to do surgery. This practice is now frowned upon by the Royal College, since pre- and post-operative care by the surgeon is minimal in such cases. According to Dr. Townsend, some doctors at the time did not see orthopaedics as a defined specialty; he believed that there was more "infringement " into orthopaedics by general surgeons than there was into some of the other early specialties, like urology and eye, ear, nose and throat. Dr. Olav Rostrup began practicing orthopaedics in Edmonton at the same time as Townsend was starting up in Calgary. Although the University Hospital was not as "medically primitive" as the situation in Calgary, there was still competition from the general surgeons. Rostrup found, however, that people with serious injuries would sometimes ask for the specialists at the university. While the public eventually became more specialist-conscious, there was for a long time a grey area (minor fractures, mainly) that was handled by general surgeons. The general surgeons found that with immobilization, orthopaedic cases took too long to treat in the serious instances. The decade following World War II was called the "renaissance" by E.P. Scarlett, because new, young specialists like Cyril Walsh "spread the New Learning" in Calgary. It was in this era that the various specialties began to take the work away from the general surgeons. Edward Smyth, who arrived in Calgary in 1947, described the situation as follows: Townsend had more to do than he could cope with. He was also struggling to put orthopaedics more firmly on the local map, especially since most of the general surgeons considered orthopaedics well within their own remit and capability .... Trauma accounted for the main part of orthopaedics, and there was considerable rivalry, friendly for the most part, between Townsend and myself on the one hand and those surgeons who wished to treat their own fractures ... Pott's Disease and other non­ pulmonary tubercle was not common, and most cases went to the Sanatorium 60

where one member of the staff had been trained to do the spinal fusions, thoracoplasties and extra-articular arthrodeses of hips -- the standard procedures of those pre-antibiotic days. 12 By the mid-1950s the situation began to look more like today's, and a new man like Don Sturdy was able to report that relations with general practitioners and with other specialists were generally very good. The antagonism between the Associate Clinic, which Sturdy joined, and the rest of the medical community was waning when he arrived and did not present a problem. He noted that although the general surgeons did a lot of the trauma at first, there were no neurosurgeons or plastic surgeons in Calgary; thus, orthopaedic surgeons did much of that work. Although the general surgeons considered fractures to be within their domain as late as 1970, some of them seem to have done a bit of the "cold," reconstructive, orthopaedic surgery. The "Gal lie Course," under which some of Alberta's general surgeons learned in Toronto, assumed that orthopaedics could be done by general surgeons. W .E. Gallie was a general surgeon, but his original research was primarily in orthopaedics. According to Dr. D. Cooper Johnston: We in the west were much ahead of eastern Canada in the definition of the specialty of orthopaedics. We had them here in the west while the east had only general surgeons doing orthopaedic surgery. Long before they ever did, we had pure orthopaedic surgery in Wes tern Canada. But there are those who would dispute this claim. Dr. R.I. Harris responded to this type of regionalism in his history of the Canadian Orthopaedic Association: The orthopaedic developments of this period in Toronto have often been criticized by orthopaedic surgeons elsewhere in Canada on the grounds that no one in Toronto was exclusively an orthopaedic surgeon. In a narrow sense this is true. But the fact remains that in 61

that era, the original contributions to orthopaedic surgery from Toronto far exceeded those from other parts of Canada. 13 Gallie's formal program in general surgery might be seen as an important Toronto innovation, and the kind of thinking it promoted had its effect on the specialties in Alberta. The general surgeons were the "big men" even after the war, according to Cooper Johnston's assessment of the Edmonton situation. And in Calgary the relationship between the specialists and generalists was, for a long time, an uneasy one. While most of the orthopaedic work was routine, some major orthopaedic procedures were done by general surgeons. Reconstructive work was done by general surgeons like Smitty Gardiner at the Colonel Belcher Hospital after the war. Hugh Gallie, who came to Calgary as a general surgeon in 1956, recalled that they could ask for specific orthopaedic assistance at the Colonel Belcher, but he did occasional major procedures such as bone or joint replacements. General practitioners, not just general surgeons, also did a bit of musculo-skeletal work. One early example of this is the case of country doctors who made "Private Contracts" with families or with large employers to provide medical care for their employees. Since medical care was provided at a fixed rate on these contracts, it was not in the practitioner's economic interest to make referrals that would oblige him to pay the other physician out of his own pocket. So where surgery was required, the general practitioners did it themselves. As late as 1959 Alberta's general practitioners had full privileges in general hospitals, with the exception of teaching hospitals (the U of A Hospital had allowed only the surgical staff to operate since 1923). And if a late 1950s study in eastern Canada is any indication, Alberta's general practitioners probably did at least some minor orthopaedic surgery -- seven out of 100 hospital visits by Ontario general practitioners were for fracture cases. 14 In smaller towns general practitioners usually assisted in surgery, and the doctor/patient relationship was undisturbed by referrals to specialists. For the most part, Calgary's general practitioners were happy to refer and assist in the surgery, although there was an increasing tendency for surgeons to give the assist to interns. In Edmonton, where there was more teaching going on, the general practitioners were less satisfied with the referral system. It is safe to say, though, that by 1960 Alberta's general practitioners had not been forced out of the orthopaedic surgical 62 market by specialization. Complex matters were referred from rural areas to the cities, but fractures often could be and were done. According to Hugh Gallie, in the late 1950s and until around 1970, when there were adequate numbers of orthopaedic surgeons, general surgeons like himself did a fair amount of open and closed fracture work. Occasionally, he would also do an osteotomy for arthritis in the knee or hip. They also saw many foot problems, such as bunions and hammer toes. It is not surprising, then, that both general surgeons and general practitioners saw the need in their own practices for more information on orthopaedics. A late 1950 survey of general practitioners in eastern Canada revealed that 40 percent of them thought medical school teaching of fracture management was inadequate. They especially wanted hands­ on experience in plastering simple fractures. While they were not keen to learn management of long-bone fractures, spinal fractures, dislocations or skull fractures, they were interested in learning finger/toe amputations and tendon sutures. The orthopaedic education of the non-specialist began with Hank Mewburn in the early 1920s. Throughout the two decades before his death in 1954, he was particularly involved with educating Alberta's practicing physicians about orthopaedics. He and Graham Huckell worked extensively in this area, as did nearly all of the orthopaedic surgeons practicing in Alberta and a number of general surgeons. Beginning in about 1932 a yearly Refresher Course was given each spring at the U of A. Although these courses aimed to cover all aspects of medicine and surgery, a disproportionate amount of orthopaedics appears in the records. Mewburn almost seems to have had a "mission" to keep the general practitioners up to date, and with good cause. As late as 1952, 61 percent of the provincial population was rural, and about half the physicians were country practitioners. They could not afford to be afraid of broken bones. J .A. McPherson, a general surgeon, ran a fracture clinic at the Refresher Courses from 1935-40. Dr. W.A. Wilson, a well-known general surgeon in Edmonton and father of orthopaedic surgeon Gordon Wilson, covered the general principles of fracture treatment at the 1936 Refresher Course. While McPherson taught fractures, Hank Mewburn organized orthopaedic clinics. Sometimes he and Huckell would deal with the subject generally, but in other years they tackled specific topics. Dr. J. W. Bridge spoke on orthopaedic appliances in 1935 with Huckell and Mewburn. In 1937 63 their clinic considered "clubfeet, backstrain, etc.," and Mewburn lectured on "Fundamentals versus Gadgets in the Treatment of Fractures." In 1941 the Alberta Medical Bulletin reported that "the orthopaedic display created much interest and received very favourable comments." 15 Orthopaedic participation in the Refresher courses continued at least into the late 1950s, when residents Tony Stanley and John Gort published "Refresher Bulletins" on cerebral palsy and "Rehabilitation of the Surgical Patient." The Annual Tour of the executive of the AMA provided a yearly opportunity for orthopaedic surgeons to teach the general practitioners at their District Meetings. On the 1940 tour Graham Huckell presented a paper on fractures of the forearm, described in the Alberta Medical Bulletin as being "of great interest to the general practitioners and many questions were asked. "16 Another paper of Huckell's on the "Modern Painful Foot," pointed out that physicians "must pay more attention to the complaints of patients about their feet, with particular attention to athlete's foot, corns, foot strain, hammer toes, and bunions. "17 Dr. McPherson also toured that year, speaking on a variety of topics: shoulder and elbow injuries, fractures of the lower radius, and fractures of the tibia and fibula involving the ankle joint. Gordon Townsend toured in 1945 and Olav Rostrup in 1950. General surgeons addressed the district meetings of local medical societies, particularly on topics involving fractures. In 1935 in Bassano, Dr. MacCharles of Medicine Hat reported on cases of fractures and dislocated cervical vertebrae. Eardley Allin, later of the Allin Clinic and Chief of Surgery at the Misericordia Hospital in Edmonton, spoke to a district meeting in Drumheller in 1937 on "Methods of Reducing Pott's Fracture and Applying the Cast." Dr. Morgan spoke there in 1942 on forearm fractures. Dr. N.E. Alexander, a general surgeon with Canadian National Railways, lectured on tendon repair and hand injuries during the early years of the war. Occasional meetings of national and international societies also involved Alberta's orthopaedic surgeons. At the Canadian Tuberculosis Association meeting in Calgary in 1946, Graham Huckell surveyed the literature on tuberculosis of the spine. An American College of Surgeons sectional meeting in Edmonton in March 1937 offered a fracture clinic. Sir Reginald Watson-Jones visited Edmonton in 1950, and in a talk that promised to be "long remembered, advocated conservatism in treatment." 64

Orthopaedic rounds could always be attended by the non­ specialist; starting in 1957, the Alberta Medical Bulletin even advertised times at the various hospitals. By the mid-fifties, lectures by the staff specialists at the Children's Hospital in Calgary were to be attended by all staff, including nurses. Among the general surgeons there were a number of "pseudopods" who saw themselves as a kind of orthopaedic specialist. Smitty Gardiner was one of these. As he described the situation there were the orthopods, those who had the certification, and the "orthogods, 11 who had their fellowship in orthopaedic surgery. One of the first of these pseudopods was Dr. D.S. McNabb, president and founder of the Calgary Associate Clinic. In the 1920s he had the largest practice in Calgary, and "a very, very busy surgical practice." By 1933 McNabb was lecturing on the proper management of fractures, and by the late 1930s, according to Dr. A.E. Wilson, he was "posing as a specialist. 11 McNabb and R.B. Deane did not get along. Smitty Gardiner was a better liked "pseudopod." As a general practitioner in Wetaskiwin in the late thirties, he did a certain amount of routine musculo-skeletal work, but during the war he completed short, postgraduate sessions in orthopaedics, trauma, and reconstructive surgery. After the war, with the need for reconstruction and rehabilitation, the DVA hired Gardiner and others, calling them 11 orthopaedic surgeons" despite their lack of formal credentials. Gardiner took an opening at the Colonel Belcher Hospital immediately after the war, taking charge of reconstructive surgery. He did his fellowship in general surgery, rather than orthopaedics, in order to get the position of Chief of Surgery at the Belcher. But he did more orthopaedics than anything else, he said, because he enjoyed it the most. He performed much back surgery and wrote a long article on the topic. He had originally sent his disc surgery to Dr. Hank Mewburn, who was with the DV A in Edmonton. But, since Mewburn had taught him how to do discs and expected him to do them, Dr. Gardiner brushed up on the procedures. He also did hand surgery, a few knees and compound fractures, and quite a bit of work on hips. Dr. Gardiner continued to do what he liked in orthopaedics and remained an active teacher in general surgery until he retired as Chief of Surgery at the Colonel Belcher Hospital in 1971. He died in 1989 at the age of eighty-three after falling from a ski lift. 65

Banff family physician Dr. Patrick Costigan also did a considerable amount of orthopaedics, particularly musculo-skeletal trauma from skiing injuries on the slopes of Lake Louise, Sunshine and Mt. Norquay. He was noted for his frequent operative management of tibial fractures, and in the mid-1950s the Alberta Medical Bulletin published his paper on "pulled elbow," ankle injuries, and another article on "Hospital Days Following Open Reduction of Fractures. "18 These fractures are now treated primarily by orthopaedic surgeons in Calgary. In the 1960s, as adequate numbers of orthopaedic surgeons were reached in Calgary and Edmonton, more specialists began to move to the smaller cities of Alberta. The first of these was Dr. Moss Albert, who brought orthopaedic surgery to Lethbridge in 1950, when the small city knew nothing of the specialty. Like many British doctors, Albert came to Canada because he saw little economic future for himself in postwar Britain. The prospects looked good in Lethbridge, and the population of about 25,000 and 35,000 in the surrounding area could support such a specialist. Initially the practice was difficult, since the general surgeons did it all in their clinics and were firmly in charge of the local medical situation. Lethbridge's population is now about four times what it was then, and the city has three orthopaedic surgeons. Ten others are now practicing in Lethbridge, Red Deer, Medicine Hat, Grande Prairie, Camrose, and Fort McMurray. Over eighty orthopaedic surgeons have practiced in Alberta to date. General surgeons still do bone work in Alberta's smaller centres, but as the number of orthopaedic surgeons has increased, the fracture work, for the most part, has become the domain of the orthopaedic surgeons. Some general surgeons were reluctant to give up what had been their "turf." In the mid-1950s, Dr. Walter MacKenzie, professor of surgery and himself a world renowned general surgeon, demanded that every second fracture entering the U of A Hospital be admitted to a general surgeon alternating with the orthopaedic surgeons on staff. This . edict did not hold force for long, as one of the orthopaedics resident's wives was a charge nurse in the Emergency Department. Like their colleagues in other parts of the country, Alberta's general surgeons are now primarily abdominal surgeons who do very little, if any musculo-skeletal surgery. Orthopaedic surgeons began assuming the fracture work shortly after World War II, largely because of the dramatic increase in the number of specialists being trained in the sixteen orthopaedics centres across the country. For the past twenty 66 years, all orthopaedic surgeons trained have been mainly interested in and consumed by the service element of orthopaedic surgery. In the last several years, however, more and more of the young graduates are taking up academic appointments, pursuing their interest in basic bench research, clinical research, administration and teaching. 67

CHAPTER FOUR

ECONOMIC ASPECTS OF ORTHOPAEDICS IN ALBERTA

The economic rivalry between Alberta's orthopaedic and general surgeons occurred against the background of an ever-increasing volume of musculo-skeletal disease and trauma. This competition had apparently diminished by the 1950s, one of the many signs that the economic side of medicine was in the process of great change. As it was for medicine throughout the affluent world, the decade after World War II proved to be a watershed for Alberta's orthopaedists. They thrived in this era of substantial growth in government expenditures on health care, greatly increased numbers of institutional positions, construction of new hospitals, a medical services insurance plan, and the general prosperity of the postwar years. From the perspective of medical economics, the period that followed this decade was that of the Canadian welfare state. The transition to that welfare state began between the wars, as the government gradually assumed more responsibility for health care. In these years the primary economic concern of Alberta doctors was fee for service. This was not an ideal situation, for they were lean times. Many people were unable to pay their doctors' bills. The problem was equally acute for specialists, who often found it difficult to get more than a general practitioners' fee, if they were paid at all. Even a surgeon such as R. B. Deane, whose practice in Calgary was well-established, had too few patients to limit his practice solely to orthopaedics, so he accepted most types of cases and tried to capture the general medical 68 business of his patients. Deane's financial success was also thwarted by the lack of referrals from his colleagues. Much of his patient care at the Children's Hospital was strictly voluntary. He made his living from fee for service, and the incipient welfare state had little effect on his practice. Although paid by fee for service, Deane's colleagues in Edmonton, Hank Mewburn and Graham Huckell, were affected by the transition to modern medical economics, since both men held institutional positions as well. Granted, the amount they received for these positions was small -- the exact figure paid to them by the university is not known -- but their successors in the practitioner-teacher positions at university centres could receive more than half of their incomes from their institutional employers. Mewburn's career, in particular, resembled that of a practitioner-teacher in "institutional medicine." While both men assumed heavy teaching loads and cared for the public ward (non-paying) patients at the U of A Hospital, Mewburn also had his position with the Soldiers' Civil Re-establishment (SCR), which built a veterans' hospital at the U of A immediately after World War II. In addition to his work rehabilitating the veterans, Mewburn directed the treatment of crippled children through the outpatient department of the University Hospital, a task he had been given by the Department of Health in 1922. As a result of these government health programs, the orthopaedic department at the U of A was always "unusually active," and Mewburn's own economic position was more secure and more complex than that of the typical Alberta practitioner of his time. The first step towards the welfare state in Alberta, the Workmen's Compensation Act of 1918, was to have a lasting effect on the medical profession. The compulsory social insurance legislation was designed to provide benefits and medical services. The Act was part of an international movement -- the first Canadian example being the Ontario Workmen's Compensation Board (WCB) Act of 1914 -- in which governments undertook the task of providing employers with labour forces that were healthy, educated, housed and well-disciplined. Since injured workmen were required to submit to medical examinations, the Boards provided work for doctors. The Alberta Board could also order special surgical or medical treatment, to be paid out of the accident fund, in order to avoid disability payments to the workmen. Orthopaedic surgeons benefitted from the WCB plan more than most physicians, because industry creates large numbers of musculo-skeletal injuries. 69

During the Depression, WCB payments were the only regular source of income for some doctors. Thomas Richardson recalls that by the 1950s orthopaedists got about $3.00 per case for a WCB referral and that orthopaedic surgeons tended to be called for the more difficult cases. Despite the fears that physicians often expressed about government health service, Alberta's orthopaedic surgeons never seemed to have had much problem with the WCB concept. Indeed, the greatest problem with the WCB seems to have been the location of the rehabilitation clinic. Several orthopaedists noted that centralizing the clinic in Edmonton imposed considerable hardship on those patients who had to travel to the city and remain for prolonged periods for rehabilitation. A further step was taken towards government health service in Alberta with the province's 1933 decision to begin funding all medical services for the treatment of tuberculosis, a pol icy that Saskatchewan had put in place in 1929. Before that, responsibility for the disease, which was the main cause of death in Canada at the turn of the century, had been left to voluntary charitable organizations such as the Canadian Tuberculosis Association. Funding for tuberculosis did little to promote the growth of orthopaedics in Alberta, since most of the surgery was done by sanatoria staff, but it did have some bearing on the province's orthopaedic specialists. It was when Gordon Townsend was working for the Saskatchewan Anti-Tuberculosis League at the Fort Qu' Appelle Sanatorium in the early 1930s that he became interested in broadening his knowledge about the musculo-skeletal system. Dr. Edward J. Smyth's first position in Alberta was with the Central Alberta Sanatorium. Cyril Walsh consulted for the Sanatorium on skeletal matters, and Olav Rostrup treated much skeletal tuberculosis at the Camsell Hospital in Edmonton. The tuberculosis campaign is a good illustration of the medical system in transition. Facilities were constructed and government expenditures on health care grew, as did the number of institutional positiqns for doctors and the number of health care workers. The tuberculosis policy also reflected a trend in health policy that was collectivist, liberal and humanitarian. Such efforts were strengthened by World War I and would be further strengthened by the World War II. The polio epidemic in the late 1920s, the Depression, and a farmer's government committed to other health and education services all furthered a populist agenda. Even when the right-wing Social Credit government replaced the United Farmers of Alberta in 1935, the demand 70 for health services was sufficiently great for the government to enact the 1938 Poliomyelitis Sufferers' Act. This legislation allowed the Minister of Health to make agreements with hospital boards concerning the provision of funds for the hospitalization, care and treatment of polio sufferers in hospital. Like the tuberculosis policy, this legislation did not directly benefit orthopaedic surgeons, but they were clearly affected more than most physicians. The need for medical and economic rehabilitation of the many soldiers returning from World War II spurred the Department of Veterans' Affairs (DVA) to organize medical and hospital services immediately after the war. Orthopaedic treatment of these veterans took place at new hospitals such as the Colonel Mewburn Pavilion at the U of A and the Colonel Belcher Hospital in Calgary. With the government paying for medical services for veterans, Drs. Mewburn and Rostrup formed the first partnership among Alberta orthopaedic surgeons, running two or three DVA clinics per week. By 1956 the DVA was paying $3 .00 per office visit. In these postwar years the federal government was also involved in the construction of civilian hospitals. In 1948 it initiated a program aimed at creating 46,000 hospital beds and 4,600 health care jobs in five years. The year before, the Department of National Defence turned over its newly renovated, fully equipped 400-bed hospital to the Indian Health Services of the Department of National Health and Welfare. The facility became known as the Charles Camsell Indian Hospital, and by 1951 orthopaedic surgeon Gordon Gray was on staff. Olav Rostrup and other Edmonton surgeons operated there occasionally. Provincial programs such as the Auto Accident Indemnity Act of 1947 also affected Alberta's orthopaedic surgeons. Under this legislation the province paid the medical costs for hospitalized auto accident victims out of a fund created from charges paid by motorists. Payment followed the fee schedule set forth by the WCB. Another provincial program was the Cerebral Palsy Clinic established by orthopaedic surgeon Fred Day. The Social Credit Government under Premier Ernest Manning, who had a handicapped son, established itself as a leader in setting up facilities and management for handicapped children and adults. Dr. Thomas Richardson succeeded Dr. Smyth in running the Calgary version of the Cerebral Palsy Clinic, which was founded in 1950. Richardson recalled that the annual budget for the clinic in those days amounted to approximately $30,000. 71

The economic expansion of medicine in the postwar decade was not only created by the government; the general prosperity also boosted per capita expenditure on health care. The Leduc well ushered in the oil boom in Alberta in 1947, and this, too, had its effect on medicine. As Edward Smyth wrote, "Fresh strikes were reported almost daily and with Calgary firmly established as the 'Oil Capital' everyone shared in the common wave of prosperity. Building expansion went apace and before long a new downtown 'Medical Arts Building' appeared .... " The development of medical insurance enhanced this expansion. Some insurance had been available since 1933, when four Edmonton hospitals became the first in the country to offer "Blue Cross" hospital benefits, a plan that was a bit stingy and provided rather slim coverage. Wider coverage was offered by Medical Services Incorporated (MSI), which was conceived by the Alberta College in 1947 and passed by the provincial legislature the following year. Both the Alberta Blue Cross Hospitalization Plan and MSI were in effect in 1948. 1 Two years later the Alberta Medical Bulletin confidently reported that MSI was operating satisfactorily. Response to the plan was favourable, since the medical profession recognized that some type of prepaid medical insurance was desirable. Dr. Hugh Arnold of Lethbridge described it as a very successful operation. The subscribers were the public of the Province, they paid a premium into the MSI corporation and funds were distributed on the basis on what was available, generally speaking. In the beginning because of the rather increased utilization we sometimes took as little as 60% of our fee.... But generally it averaged out ultimately at about 85-90% that we were paid of our fee and the cost of maintenance operation, office overhead and so on, all came out of the pot. 2 Dr. Arnold's view may not at first have been shared by the province's orthopaedic surgeons, as only Drs. Smyth and Walsh were subscribers by July of 1950. Over the next decade, however, most physicians came to accept MSI. Thus, the way was paved for further health care legislation. 72

Alberta's orthopaedic surgeons had predicted "state medicine" as early as 1956. In that year Cooper Johnston started developing the "original" orthopaedic fee schedule in Alberta. Since "it was obviously seen to be a nationwide issue," Cooper Johnston went to the Economics Committee of the Canadian Orthopaedic Association. R.I. Harris phrased the results as follows: In 1958 a tariff committee was established which after four years of hard work under the chairmanship of Dr. Cooper Johnston, has evolved a constructive approach to the continuous problem of the remuneration of the orthopaedic surgeon in an environment strongly inclined to government health service.3 The Alberta Health Plan and the eventual acceptance of the national Medical Health Care Act, which came into force in Alberta on 1 July 1969, occurred in the period of expansion following the postwar decade, the pace of change having escalated after the late 1950s. In addition to MSI, Albertans had other coverage for medical expenses, including the 1958 provincial/federal agreement for cost-sharing in respect of hospital costs, the 1959 provincial hospitalization plan, and the various plans aimed at specific problems -- WCB, polio, tuberculosis, etc. The growth of "welfare medicine" came to fruition with these various government payment plans, and health care expenditures rose accordingly. But with this increased spending came public pressure for nationwide protection from the growing costs of health care. Government administration of medical services reached a crisis in 1962 with the Saskatchewan legislation and the resulting doctors' strike. Premier Manning responded to the Saskatchewan situation with the Alberta Medical Plan. Because he opposed universal medicare on the basis of anti-collectivist Sacred ideology, Manning hoped the plan might forestall a federal program. The intent was to provide the illusion of universal coverage for doctors' fees, but this was to be achieved "without compulsion" through private insurance supplemented by government subsidies for those who could not afford insurance. The myth of free enterprise had to be maintained, even though doctors had been on the government payroll for decades in Alberta. Manning's attempt met with 73 limited success, and the Alberta government found it economically sensible to join the federal Medicare Act in 1969, three years after it was enacted. The orthopaedic tariff outlined by Cooper Johnston in 1956, now somewhat modified, has remained in place. While Canadian doctors have accepted medicare, they have not, for the most part, embraced it. They fear the inability to set their own fee schedules; the lack of freedom to choose their own medical relationships; the possibility of diminished quality of care. Alberta's orthopaedic surgeons are no more hearty in their endorsement of the system than physicians in other parts of the country. Cooper Johnston notes that with the inability to extra bill for surgical procedures, surgeons tend to increase the volume of work they do in order to increase their income. This could create a change in lifestyle, he says, allowing less time to teach, to do research, or to spend on extra-curricular activities. There have been other frustrations with Alberta's health care system, as Dr. Donald Sturdy, now retired, points out: There were two main sources of irritation during my practice in Calgary. First there was the hospital bed shortage. This was in marked contrast to my experience in the U.S.A. There the private enterprise ensured short hospital stays and there were all the beds required for the demand. I could see a patient with an elective surgery condition such as bunions and operate the next day, whereas the same care in Calgary was on a waiting list for over a year. Also, it created friction between doctors. The period on the waiting list depended on the doctors' scruples in classifying cases as Emergency, Urgent or Elective. For example, some surgeons classified all their disc patients as Emergency whereas others would be penalized for classifying the same problem as Urgent or Elective. The second source of irritation to me was the practice of extra billing. 74

The extra amount charged had no relationship to the skill, knowledge or experience of the surgeon. It was often the newest surgeons that charged the most. This discrepancy would be much less likely if the patients were comparing the full price of their surgery instead of the smaller amount extra­ billed. The problem of bed shortages has typically been resolved by hospital construction, a case in point being the 1952 polio outbreak. In 1952, as in 1928, the response at the U of A was to build new polio wings, the treatment of polio being "an ungrudged expense. "4 The bed shortage at the Children's Hospital in Calgary occurred before the 1952 outbreak, so the new facility was more or less ready to receive the victims of the disease in January of that year. But the decline of polio cases in the late 1950s led to such a bed surplus that the hospital was converted to a general paediatric facility in 1959, with orthopaedics patients making up approximately 55 percent of the case load. The facilities had to be used to full capacity in order to qualify for the maximum provincial funding. By 1965 the pressure on the hospital was again sufficient for the province to grant $2 million for expansion. Thirteen years later, in 1978, $30 million was allocated for the construction of a new Alberta Children's Hospital Centre, but with no increase in the number of beds. Once again, in 1986, there was a shortage of beds. Until 1959 the Children's Hospital was Alberta's only orthopaedic hospital. "The finest of its kind, "5 as one physician with the Red Cross claimed, it was funded by provincial grants, public donations, and the Red Cross annual campaigns. This funding, together with the city of Calgary's donation of a site for a larger hospital, had allowed the hospital to expand to 150 beds by 1952. In keeping with the hospital's original objective of providing care for poor families, the city's orthopaedic surgeons had been volunteering their services, although some patients were sponsored by service clubs that might pay half of the regular surgical fee. Gordon Townsend, who started work there in 1939, would occasionally break the rules and admit children from monied families, not only in the hopes that they would make a donation to the hospital, but also because it seemed wrong to him to deny more 75 affluent people access to the staffs expertise. In his report for the 1950 Alberta Health Survey, Townsend recommended that the government establish a provincial survey of all crippled children in the province and that "all personnel concerned in the survey and the clinics should be adequately compensated for their work." He also wrote that "the crippled children's grant for the present year might well be spent in purchasing equipment" for the new hospital being built in Calgary. The recommendations apparently were not acted upon. One of the biggest economic stories for Calgary's orthopaedic surgeons was, therefore, the Red Cross decision in 1957 to relinquish control of the hospital. In 1956 it became evident that the Red Cross could not run its blood donor clinic services, which took 60 percent of its revenues, if it continued to operate the Children's Hospital. In justification of their decision they issued a statement that summed up the state of medical affairs in the mid-fifties: With the increasingly successful control of polio and tuberculosis, as well as the number of other agencies now active in the field of crippling diseases, the cost of operating a Red Cross hospital, exclusively devoted to the care of orthopaedic cases, can no longer be justified. In 1956, the gross cost of the operation was $310,364 for 260 in­ patients and 1044 out-patients. 6 The medical staff were finally allowed to collect fees from patients who were able to pay. After thirty-five years as a Red Cross Hospital, the first bills were issued. The Alberta Crippled Children's Hospital, owned by a non-profit society as of 1958, adopted the provincial-municipal hospital scheme under which it was "obliged to charge a deterrent fee of from $1.80 to $2.30 per day to receive grants.... Collecting this fee [was] a greater problem than in other hospitals because the average patient's stay was more than 100 days. "7 Hospital costs continued to be covered by government schemes, patient fees, and funds raised by the hospital until it was purchased by the provincial government in 1972 for $2 million. How did the orthopaedic specialists fare financially in the years before the government had such a hand in payment? Regrettably, there is very little hard data regarding the incomes of those five original 76 orthopaedists in Alberta between World War I and World War II. Likely as not, it was a modest amount. What they made was primarily fee for service, and these fees , when collected, were extremely small. Some of the orthopaedists in Edmonton were able to augment their income with the very small retainer fees they received from their work for the university or the federal government. By 1941 the average net income of Canadian physicians was $5,000, a large amount compared to the 1936 average of $4,200, because the war had caused a shortage of physicians at home. In early 1950 Cooper Johnston was hired by Graham Huckell, to look after the older man's practice while he recuperated from surgical complications in Jamaica. For Cooper Johnston, who had just finished an ill-paid residency in St. Louis, the payment of $1,000 per month was "money from heaven." Don Sturdy noted that his salary with the Calgary Associate Clinic was $800 per month in his first year of practice in 1952, whereas his pay for five years postgraduate training totalled $3,600. After seven years in orthopaedic practice, his salary was up to $24,000 per year, but by that time he had five children. "We found that we could afford a better standard of living in California," says Sturdy, "so we moved to Redwood City, where I practiced with the Redwood Medical Clinic for three years." He then returned to resume private orthopaedic practice in Calgary. In April of 1940 Alberta Medical Bulletin printed as an example of a fee schedule part of the King County Medical Services Corporation Plan from Seattle, Washington. Their plan bears close resemblance to Alberta's MSI of 1948. The operation on the neck of the femur was $125.00; today it is some $500.00. At the bottom of this schedule is printed "all other fees in proportion." This notion of the relevance of fees within a specialty and between different specialties is now being closely reviewed by the Alberta Medical Association (AMA). Medical economics has become exceedingly complex and is administered by the provincial governments under very tight control and direction from the federal government through the Federal Health Act. The Alberta Medical Association (AMA) is now responsible for economic negotiations with the provincial government on behalf of the medical profession. In consultation with the various specialty groups, the AMA determines the fee schedule for each item in the schedule. The Alberta Orthopaedic Society holds an annual discussion of economic problems, and their committee reports directly to the AMA . As Dr. John Huckell points out, in 1960 the Alberta Orthopaedic Society would 77 spend approximately one hour on business affairs; in the late 1980s the business meeting would last roughly half a day. The Canadian Orthopaedic Association has an economics committee which reports to the executive, but this is strictly a lobby or resource group, as the Constitution Act of Canada gives the various provinces authority over health care. Thus, there is no strong force unifying the orthopaedic groups across this country as far as economics are concerned. 78

CHAPTER FIVE

PRACTICING ORTHOPAEDICS IN ALBERTA

Dr. Reginald B. Deane was of the era "when rounds on Sunday morning were done in morning coats and striped trousers," as Dr. Townsend noted. 1 But such observable differences were only a part of what characterized the practice of Calgary's first orthopaedic surgeon. In Deane's time the hospital was not the diagnostic and treatment centre it is now, so the office visit was the basis of his practice. Because he did not benefit much from referrals, many of his patients came of their own accord, and without a large support staff, he would have done many procedures that are now routinely done by nurses and technicians. Still, his practice must have had few distractions. He had more time for patient care, close contact with his hospitalized patients, and he could better spare the time for his work at the Children's Hospital. This type of practice was in contrast to Hank Mewburn's, with its teaching and administrative responsibilities. So while Mewburn was conducting outpatient clinics through the university from 1923 onward, outpatient work in orthopaedics in Calgary did not become common until Townsend began training the staff at the Children's Hospital. The general outpatient clinic was initiated in 1935, paediatrician Morley Cody recalls. 2 The rather leisurely pace was to change after World War II, for in the words of Gordon Townsend, medical practice in Calgary "roared 79

out of the war." Edward Smyth described the situation when he came to in Calgary in 1947: Townsend had not suggested a partnership but simply made it clear that another orthopod would be welcome, and that we should have some sort of working arrangement, since he had more to do than he could cope with... Dr. Palmer, one of the older and most respected pract1t1oners in central Calgary, came and offered me the use of his downtown office. When I asked the rent his reply was "There will be no rent until you get established." There were two practitioner groups aiming to provide comprehensive services ... Surgery in the two hospitals, Calgary General and Holy Cross, was mostly in the hands of the general practitioners.3 Thomas Richardson arrived in 1950 and for his first two years worked in association with Townsend in what was Calgary's first partnership. The pair had no shortage of patients, and Townsend even had his own X-ray machine. In his first year Richardson interpreted the X-rays and did the reports, but this practice fell prey to the radiologists who wanted to do their own reporting. Richardson also joined the city's other orthopaedic surgeons in volunteering at the Children's Hospital. When Smyth left Calgary in 1952, Richardson succeeded him in running the cerebral palsy clinic. The clinic had a few employees, a speech therapist, an aide with cerebral palsy, and a physiotherapist, all of whom were a great help. By this time the outpatient clinics had become a large part of orthopaedic practice: in 1946, 343 patients were visiting the weekly clinic, with 1,843 visits over the year. It is little wonder, then, that Dr. Townsend was content to have more orthopaedic surgeons in town. The orthopaedic outpatient clinic became Alberta's only travelling orthopaedic clinic, apparently starting in 1955 with a "very successful" visit to Medicine Hat. 4 In Edmonton the practice of orthopaedics became busy with the 1952 polio outbreak. Prior to that, the Edmonton orthopaedists attended to their university duties, their "typical office stuff," and some difficult 80 fractures and osteomyelitis for hospital cases. Rostrup and Mewburn continued with their practice of reconstructing and rehabilitating war veterans. The three orthopaedic surgeons at the U of A made morning rounds together, accompanied by the head nurse and the physiotherapist. In the postwar era they all worked at the city's four hospitals, although Rostrup and Mewburn stayed mainly at the university. Graham Huckell had tremendous energy, according to Cooper Johnston, and operated at all hospitals. It was not uncommon for him to do four operations at four different hospitals in one morning. This made for a long day, since it meant doing post- operative follow-ups and rounds in four different units. Consequently, he had little time for formal teaching. Health problems forced Huckell to slow his pace in 1950, and he and Cooper Johnston went into practice together. This partnership has involved a great deal of orthopaedic inheritance: both men had sons who joined the practice, and Huckell's older son, John, has now fathered two orthopaedic surgeons. During the 1950s polio epidemics there were seemingly few obstacles to setting up in orthopaedic practice in Alberta. Certainly there was a need for the specialists. All that was required was a hospital appointment and hospital beds, yet these were sometimes difficult to obtain. As Cooper Johnston explained, getting privileges at the Edmonton General Hospital was virtually impossible for anyone who had a university appointment. John Huckell reports that he was not able to get a University Hospital appointment for at least a year after his return to the city. For Gordon Cameron, who started in association with Dr. Rostrup in December of 1955, the biggest stumbling block was the lack of operating room space. Over thirty years later, little has changed regarding either of these problems. A number of group practices in orthopaedics came into being in the postwar decade. Fred Day and Bob Henderson each brought a few men into group practice in Edmonton. In Calgary a number of orthopaedists started with Cyril Walsh, practicing at the Calgary Associate Clinic. At one point Dr. Townsend was in practice with three other orthopaedic surgeons -- Drs. Edwards, Bazant and Dewar. Today just over one-third of those in practice -- not counting the large "Henderson group" in Edmonton or the Calgary Associate Clinic -- are in partnership with other orthopaedic surgeons. A few have purely institutional positions with no private office practice. Most of those in 81 the smaller centres are in individual practice, but there are two orthopaedic partnerships in Lethbridge. Since the late 1950s and early 1960s, however, general orthopaedic practice has been evolving steadily, with orthopaedists tending increasingly to subspecialize. This period of developing subspecialties has parallels in the other surgical specialties such as plastic surgery, cardiovascular surgery and neurosurgery. In both Edmonton and Calgary, the development was explosive in the late fifties and early sixties, with many well-trained young specialists returning to practice in all these specialties. Although the province's early orthopaedic surgeons often had a special area of interest, they treated a full range of orthopaedic problems in their practices, including serious fractures, traumatic surgery, congenital anomalies, polio reconstruction, and, in the pre-antibiotic days, osteomyelitis. If such changes can be pinpointed, Calgary's transition from general orthopaedic practice to subspecialization can probably be fixed at 1970. That was the year the U of C medical faculty opened to students, increasing the presence of subspecialized knowledge in the city. It was also the year that Calgary and Edmonton can be said to have reached 11 adequate numbers 11 of orthopaedic surgeons. As Dr. John Huckell has said, orthopaedics is now becoming very fragmented. The meetings of the American Academy of Orthopaedic Surgeons are splitting into groups much in the way that general surgery fragmented a few years ago. At the teaching centres in Edmonton and Calgary, there is now little room for new surgeons doing only general orthopaedic surgery. Both centres have young orthopaedists who do primarily joint replacements or paediatrics or spinal surgery. Because certain areas, such as oncological orthopaedics, still have extremely small volume, these infrequent cases tend to be sent to the one subspecialist in order to concentrate and develop the experience and expertise in that area. For many years the various surgical specialties worked in isolation. The team management approach that is commonplace today was certainly not the norm until the 1960s and early 1970s. One of the first well-publicized instances of team management of a trauma patient occurred in Calgary in July 1962. A sixteen-year-old girl visiting from Sacramento, California, was thrown from a midway ride at the Calgary Exhibition & Stampede, and a guywire completely severed her left upper extremity just distal to the shoulder joint. The first aid attendants brought the girl and the severed arm to the Holy Cross Hospital. The 82 author had been giving orthopaedic tutorials at the Children's Hospital on that Tuesday evening, and at 9:30 he and his resident, Dr. Brian Greenhill, now a senior orthopaedic surgeon in Edmonton, went to attend to this young patient. By 6:00 the following morning, with the assistance of Dr. George Miller, senior vascular surgeon who had recently arrived in Calgary, the girl's arm had been reattached. The team also included Dr. Hal Worral, head general surgeon, who had given emergency care to the girl on her arrival at the hospital, anaesthetist Dr. Walter Johns, who delivered the general anaesthetic, and Dr. Bert Fowlow, a recent arrival in plastic surgery, who later did some skin grafting on the girl's arm. The administration and the Sisters at the Holy Cross Hospital provided excellent support to this team approach.

Ors. Edwards, Johns, and Millar surrounding hospital bed of Hazel Donlin after reattaching her ann which was severed in a midway accident. July 1962 Calgary

This was only the second reimplantation in history, the first having been accomplished by Dr. Ron Malt at the Massachusetts General Hospital in Boston. News of the operation was widely reported in the popular press, appearing in such high-profile publications as Time and Life magazines. Dr. Ron Malt came to Calgary to compare notes and 83 observations on the first two reimplantations. Eighteen years later, when the author was a Visiting Professor at the University of Shanghai with the American Academy of Orthopaedic Surgeons, surgeons at the Peoples VI Hospital were amazed to learn that the second implant in the world had been done in 1962 in Calgary. By that time the Shanghai team had done well over 200 implantations. The practice had become a subspecialty in its own right. Such a team approach has now become the rule rather than the exception in handling complicated musculo-skeletal problems. The time for a single orthopaedist working in isolation has long past, and the development of areas of excellence within the orthopaedic field is well on its way. In fact, such areas originated many years ago, with Reginald Deane's interest and expertise in paediatric orthopaedics. Townsend and Edwards continued this tradition with their special interest in teaching the orthopaedists at the Children's Hospital. Hank Mewburn can be said to have specialized in the injuries of returned veterans, and Gordon Gray became very knowledgeable about skeletal tuberculosis through his treatment of the Inuit at the Charles Camsell Hospital. Olav Rostrup had a special interest in knee injuries in the athlete and was instrumental in establishing the Juvenile Amputee Clinics in Edmonton and Calgary, which led to the development of adult amputee clinics in the two centres. These clinics, like most others in orthopaedics, are based on the team approach. Each tends to have several prosthetists, rehabilitation physicians, and orthopaedists. The cerebral palsy clinics instituted in Edmonton and Calgary by Drs. Day and Richardson, respectively, have developed further at the Glenrose Hospital in Edmonton and at Children's Hospital in Calgary. These, too, are run strictly on a team approach and involve speech therapists, teachers, physiotherapists, occupational therapists, etc., as well as the physicians. Similarly, the spina bifida clinics held in Edmonton and Calgary use teams of neurosurgeons, orthopaedists, paediatricians and paramedics. . In the late 1970s Edmonton and Calgary were blessed by the return of well-trained young orthopaedists who have limited their practice to paediatrics: Edmonton's Dr. Mark Moreau, son of Dr. Joe Moreau, and Drs. James Harder and Gerry Kiefer in Calgary. One of the major reasons for such subspecialization has been that young trainees seeking an academic career in orthopaedics have been encouraged to go elsewhere for at least one to two extra years, gaining expertise in a subspecialty. They then have returned to practice that subspecialty and 84 some general orthopaedics as well. These men have been McLaughlin Travelling Fellows, Heritage Scholars and Heritage Fellows travelling to major centres throughout North America and to top orthopaedic centres in Europe. Another factor that has greatly changed orthopaedics over the past three decades is that legal issues are having a greater impact on the practice of the specialty. The five orthopaedists who practiced in Alberta between the wars probably had little professional concern for legal affairs; however, orthopaedics is now more affected by the law than any other field in medicine. As a result, many orthopaedists have become deeply involved in the legal consulting branch of medicine. They serve as expert advisors in cases that involve bodily injury, writing expert medical evidence and making frequent court appearances as witnesses. This branch of orthopaedics will likely continue to grow until the present system is replaced by something like no fault insurance or pre-trial assessment boards. Orthopaedic surgeons are also profoundly affected by the law of malpractice. The number of lawsuits brought against Canadian physicians has spiralled in the recent decade. Orthopaedists in Canada join neurosurgeons, cardiovascular surgeons and obstetricians as the group paying the highest premiums for malpractice insurance through the Canadian Medical Protective Association. The annual fee is now $ll,OOO, a sizeable increase over the $50 required in 1960. Malpractice suits have also changed the routine of the practitioner. The need to protect oneself from potential suits leads to more X-rays and other diagnostic tests. Some orthopaedists are doing more medicine -- that is, more nonsurgical treatment of orthopaedic problems -- and some avoid spinal surgery and other procedures that are more likely to provoke malpractice suits. Others talk of retiring early because of lawsuits. The number of trauma surgeons is declining in some areas of the United States because of the constant threat of litigation. In short, both training and practice tend to become more conservative in this litigious climate. This, too, is a sign of change within the profession. 85

CHAPTER SIX

ORTHOPAEDIC CARE OF CRIPPLED CHILDREN

Although orthopaedic surgery did not really develop until this century, the care of crippled children was long ago identified as the major function of orthopaedic surgeons: the origins of the specialty were set forth 250 years ago in Nicolas Andry's 1741 book on the straight child, L'Orthopedie. As it came to prominence in this century, orthopaedic surgery emerged surrounded by the aspirations and rhetoric of a "children's movement" ideology. Orthopaedics gives crippled children the "chance to lead normal lives," claimed a spokesperson for Calgary's Crippled Children's Hospital in 1947, "to become healthy, normal individuals, as active citizens of tomorrow." 1 In language resembling that used today to describe organ transplants, the Red Cross claimed that, to the lay person, Dr. Reginald Deane's surgical procedures "must seem like a modern miracle." This "children's movement" ideology incorporated elements of British humanitarianism and the late nineteenth century women's movement. Inspired by it, Junior Red Cross members in Alberta established orthopaedic hospitals in Calgary (1922) and in Edmonton (1928). The "Juniors" soliciting compassion and funds were "pledged to unselfish sacrifice and service." Their sympathies extended beyond the sick and crippled to encompass the poor and destitute: in 1921, for example, the crop failure prompted them to distribute thousands of toys at Christmas. The "great children's movement, "2 as they called it in a Red Cross Nurse with crippled children.

1922 fund raising publication, recognized that it was essential for the care of the sick or destitute to pass from the hands of families to those of doctors and other professionals at large institutions, and it accepted the growing influence of educated professionals such as orthopaedic surgeons. The Crippled Children's Hospital in Calgary was the first of its kind in Canada -- and only the second on the continent -- but it was the second Red Cross facility in the city. After the First World War, the Red Cross had established the Brickburn home on what was then the outskirts of Calgary and a similar institution in Edmonton, describing them in a 1921 publication as follows: Efforts to provide adequate care and education for soldiers' children who have been rendered homeless or deprived of the guardianship of parents, have been continued in the Red Cross Soldiers' Children's Home at Brickburn, and the Next of Kin Home at Edmonton. 87

The Society recognizes that the responsibility for the care of these children is a Government obligation and that the work should only be carried on by the Red Cross until such time as adequate provision can be made by the Government, for the care and education of homeless children, whether of soldiers or civilians.3 As the document spells out, the Red Cross envisaged its role as an interim one, assuming that the care of these children would eventually become a government responsibility. The Red Cross maintained that they had "saved these children from becoming the flotsam and jetsam of life and [has] given them the chance of becoming good citizens." Whether or not this description accurately captured the relationship of crippled children to their care-givers, there must have been some truth to it. After all, Dr. Deane willingly gave his time to the hospital for seventeen years.

Red Cross Automobile Calgary, Alberta 1920s Children at Junior Red Cross Hospital, Edmonton. In wheelchairs and beds on verandah, 1929 89

The hospital was designed for residential care only. Until it moved to a larger facility in 1929, operative cases were transferred to the Calgary General Hospital for surgery. While the Calgary hospital continued as a strictly orthopaedic facility until 1958, the Junior Red Cross facility for crippled children at the University Hospital in Edmonton operated for only two years, from January 1928 to December 1930. Dr. J. Ross Vant described the hospital's origins and its brief life in his history of the University of Alberta Hospitals, More Than A Hospital. The provincial government began the program, shortly after the University Hospital set up an orthopaedic department. The Minister of Health asked teachers throughout the province to send in the names of crippled kids who needed corrective surgery or therapy. As beds became available the government paid for treatment at the University Hospital, and the results were heart warming. In 1925, 88 kids benefitted from the program. The next year the Red Cross offered to take it over, and raised $13,000 to convert a section of the hospital exclusively for kids whose parents were unable to pay. At this time the numbers of ex­ soldiers were declining and the SCR wing was not being used to capacity so B Ward was converted to the Junior Red Cross Hospital section. The Red Cross sent the patients and from its fund­ raising activities paid 62.5 cents a day for their treatment. There was good financial support in the community and the plan worked well for a couple of years until the SCR patients began, unexpectedly, to increase again. On a typical day in January 1929, the hospital had 203 patients altogether -- 25 were 90 children in the Junior Red Cross section. The director of the SCR in Ottawa wanted B Ward back. The way out was another pavilion. Cecil Burgess, the university architect, provided an instant design, and the Red Cross invested S35,000 in a building for 30 beds alongside the Provincial Special Polio Unit. Although administered by the university the Junior Red Cross Hospital was a legal entity, recognized by the government for grants. The Red Cross Junior Hospital was a casualty of the depression. By the spring of 1930 the sponsoring organization was falling behind in its payments. It was able to pay only $1,000 on a bill of $3,261. Fund-raising efforts which had been successful in good times failed to provide any more. In May 1931 the Red Cross Unit was absorbed into the main hospital and the board had a chance to decide how best to use the extra units. The PSU (polio unit) was made into a children's ward and the remaining Red Cross youngsters transferred there. It did not develop then as a full paediatric unit. It was considered an overflow for the Royal Alex Hospital with most activity in the summer holidays when the kids came in to be parted with their tonsils and adenoids. However, it continued to be the centre for polio rehabilitation. The kids also enjoyed the support of a volunteer organization which typified the "helping spirit" of the depression. In the dark year of 1932, 20 young 91

women formed the Junior Hospital League of Edmonton "to assist with the care of crippled children in the orthopaedic ward of the University Hospital" ... They decided to give them the first therapeutic pool in Western Canada, which opened in 1934 at a cost of $1,400 .... 4 The Red Cross Unit was subsequently made over into a maternity unit. Crippled children from northern Alberta continued to be treated in the paediatric and orthopaedic wards in the city's general hospitals, as well as through outpatient and preschool clinics that the University Hospital held in various parts of the province. Of the city's general hospitals, the Charles Camsell Hospital for Indians and Eskimos, established in 1947, was the only one with an orthopaedic wing with children's wards. In the earliest years of the hospital, Dr. Rostrup came from the U of A to do surgery on the native children, and Gordon Gray

Crippled Children 92 joined the Camsell as its first full-time orthopaedic surgeon in 1951. Dr. Santokh Singh, its second orthopod, joined in the early 1960s. The amount of paediatric orthopaedics done at the Camsell is indicated by Dr. William R. Barclay, who claimed that they had so many of these cases that he and his wife, Margaret, who was also on the medical staff, "spent most of our afternoons applying plaster casts. It was not entirely a pleasant task sin~e the old casts that we first had to remove were often filled with stench of suppurating fistulae. The children often resented being immobilized and did their best to prevent us from applying a cast from which they subsequently couldn't wriggle free. "5 What orthopaedic work was actually done to treat crippled children? Fortunately, the earliest records have survived in the archives of the Alberta Children's Hospital, Calgary. During the final two-thirds of 1922, the tiny Red Cross house, with its thirty-eight beds, managed a total of 133 patients. Fifty-nine of these were recorded as "orthopaedic" -- Dr. Deane's cases. They represented a variety of congenital abnormalities and musculo-skeletal difficulties, as can be seen in the following table: Number Poliomyelitis 12 Osteomyel itis 7 Tuberculosis (skeletal) --knee --Pott's --tibia --ankle Spastic paralysis Clubfoot Fractures Congenital dislocation of hip Pes Cavus -- clawfoot Deformities Coxa Vara Coxa Plana Knock-knee Exostosis (multiple) Torticollis Infra-patella kneepad Postural kyphosis 93

The earliest statistics from Edmonton, Mewburn's 1923 report on the first six months of the new Department of Orthopaedics, do not differentiate between adult and child patients, but the list is very similar to Deane's first cases. The twenty-two hospitalized patients were: Number Coxa vara 1 Deformities from burns 1 Fractures 4 Tuberculosis --spine --hip --knee Osteomyel itis Cretinism Spastic paraplegia Anterior poliomyelitis Arthritis Congenital hip Club foot

The hospital's twenty-eight outpatients were described as follows: Number Poliomyelitis 4 Tuberculosis --spine --hip Fractures Obstetrical paralysis Arthritis Faulty posture Sacro-iliac strain Scoliosis Deformities from burns Foot strain Back strain Obesity

In this list, which did not include his SCR patients, Mewburn only mentioned four surgical procedures: three were reductions of 94 fractures, and the fourth was an "ether manipulation of club foot." By contrast, the massage department did 1,850 treatments in those six months of 1923.6 Mewburn's approach seems to have been conservative, although his first patients were mainly old cases who were convalescing. Indeed, he complained in his report that the convalescent children were taking up active beds. To judge from the statistics, in the period between the wars about 80 percent of the crippled children cases were of five types: poliomyelitis, osteomyelitis, club foot, congenital hip dislocation, and tubercular bone. Statistics for Dr. Deane's orthopaedic cases at the Children's Hospital (for a sampling of the years 1922, 1925, 1930 and 1938) show: Poliomyelitis 33 % of orthopaedic cases Osteomyelitis 11 % Club Foot 14% Congenital Hip Dislocation 11 % Tubercular Bone 10%

Jim Mather and Son, December 1950, Calgary. Brace shop at the old Children's Hospital. 95

Fair amounts of scoliosis, Perthes' Disease, fractures, cleft palate with hare lip, and a smattering of paralyses and congenital deformities accounted for the remaining twenty percent of the cases. During the 1920s, when the Children's Hospital was located at 522 - 18th Avenue West, Deane averaged about sixty patients per year. With the 1929 move to the larger building donated by R. B. Bennett, a three-storey brick house at 1009 - 20th A venue S. W., seventy to one hundred orthopaedic cases could be handled in its fifty beds each year. In his 1974 lecture on the history of Alberta orthopaedics, Gordon Townsend commented on the treatment of crippled children during those years. These were the days of Thomas' club foot wrenches, of osteoclasis to correct tibial bowing. There was no preliminary traction for congenital dislocation of the hip. Instead, the child was admitted, given an anaesthetic, the tissues stretched by forced flex ion of the hip with the knee extended, and then the hip manipulated into flexion, abduction and a double hip spica applied. The child was discharged in plaster, but was readmitted at intervals so that the cast, for hygienic reasons, could be changed. Usually these intervals were approximately three months . At the end of the first three months a single spica was applied incorporating the dislocated hip, the other hip being left free. When the free hip had resumed a normal position a boot with a three to four inch lift was placed on the foot of the dislocated side and the child was allowed to walk. The theory, of course, was that an approximation of normal function and particularly pressure of the femoral head in the acetabular encouraged normal development of the acetabular roof. Immobilization was 96

continued for nine to twelve months and then abandoned. If obliquity of the acetabular roof persisted, a shelf operation was done. All of this of course was very straight-forward. Although I have no statistics my impression is the percentage of avascular necrosis was a great deal higher than that now and I must admit that the overall results were not as good. The records of the Children's Hospital give a reasonable account of the nature of the cases over the years, but the treatment outcomes were not as well documented. There are photographs showing that there were some visible successes with the young crippled patients. The best documentary source uncovered to date is the 1925 Annual Report of the Canadian Red Cross Society, which summarizes the adequacy of orthopaedic treatments at the Children's Hospital in 1925:7

No. Further Cases Cured Improved Treatment Club Feet 16 8 7 1 T.B.Hips 3 3 I.Paralysis/Polio 27 3 21 3 Amputation 1 1 Congen. Dislocated Hip 9 9 Coxa Vara 1 1 Pott's Disease & Kypo Scoliosis 1 1 Ischaemic Paralysis 1

In most cases the condition was classified as "improved," although club foot cases appear to have met with success. Since the Children's Hospital was a new institution and Alberta's first orthopaedic surgeons only began working in the early 1920s, some cases may have been difficult to treat because therapy was delayed -- congenital dislocations of the hip, for example, which are said to require the earliest possible treatment. The following document of unknown authorship tells of the work done between the wars at the Children's Hospital. 97

After twenty years of service to the crippled child we find the demand an ever-increasing one. It was thought, when the hospital was first opened, that once the then long-neglected cases were brought in and attended to the need would decrease. This has proven to the contrary and a general increase in birth deformities, as shown in Dominion Statistics, has served to keep us under continued pressure in our efforts to meet the growing need. Our province is well organized for the discovery of these cases as the hospital is the main service avenue of the Junior Red Cross program in the schools of practically all districts and with the thorough wartime organization of the senior Red Cross branches one can feel safe in saying that the entire province has knowledge of the help available. Further interpretation of the work may be desirable but this is being worked out on an ever-increasing scale through conventions, news letters and our provincial health services such as Health Units, District Nursing Service, etc. Our work is purely orthopaedic of which we take practically all types. Where a case is refused there is either mental involvement or it is a type that can be readily taken care of without special orthopaedic care. Our Poliomyelitis cases occurring in the current year are admitted and cared for under contract with the provincial government Department of Health, all equipment used in treatment being 98 supplied by the hospital. Following their period of hospitalization they too return at regular intervals for examination, treatment, and fittings in our Out-Patients' Department until the total need is met or the child has passed his eighteenth birthday. The instance of Perthes' Disease cases has greatly increased and our Osteomyelitis cases have again increased almost to the level of 1936. Considerable progress has been made in the treatment of Spastic Paralysis in our Out-Patients' Department but in connection with this group the need for increased bed capacity is keenly felt as closer supervision and more intensive work are indicated, and the value of their work in that department too soon reaches the zero mark. In all our bone infection and deficiency diseases we find it necessary to teach the children to eat vegetables. The question of liking milk seldom arises but in this group almost invariably the quantity has been most inadequate. Vitamin therapy has been practised relating more especially to the intramuscular injection of Bl. The total complex has been used extensively orally; and is now being used intramuscularly and ascorbic acid is given in bone T.B., Perthes' and Still's disease cases. In one case of Openheimer's Paralysis large doses of Vitamin Bl have given notable results. 99

Our club-foot work is extensive and takes up much of our time in the Out­ Patients' Department, as well as on the hospital wards. Here again our limited bed-capacity retards the speed of our work. Many of these cases receive their entire treatment without hospital admission. Treatment begins as soon as possible after birth, when gentle manipulations are done and an abduction splint applied before the child leaves the obstetrical department of the general hospital. As soon as the mother is able she is taught the manipulations and as the treatment progresses she learns how important is her part in obtaining ultimate results. In given cases wedging casts are used to complete the correction and no surgery is attempted until all possible results have been obtained from manipulation, splints, braces and wedges. Admission to the hospital is made almost invariably through the Out­ Patients' Department and but for this department follow-up services would be impossible and many cases would remain untreated. As it is only the most serious and urgent cases that are admitted; most of which tend to long hospitalization. In order to admit all whose conditions indicate the need, our bed capacity will have to be doubled. 8 This summary confirms that while the work was purely orthopaedic, the typical treatments were conservative, with as little surgery as possible. The author's strong concern for nutrition may have come from the lean Depression years, but it certainly presaged today's recognition of the importance of nutrition in clinical medicine. Finally, 100 the author made a plea for more beds, since acute cases were on the waiting list. The document was written shortly after Gordon Townsend arrived in Calgary in 1939 to take over from the ailing Dr. Deane. Townsend worked unofficially at the hospital for a year, after which the hospital was bound to give an appointment to the only practicing orthopaedic surgeon in the city. At least eight other doctors were also giving their time that first year. In spite of the 200 or 300 volunteers working there as well, Townsend recalled that there was always a nursing shortage. He supervised the government-sponsored polio patients and expanded the outpatient department. They made boots and braces, and Townsend did complicated plaster casts for the congenital. By the end of the year, the hospital had a waiting list of seventeen. In his 1944 annual report Townsend asked for more bed space, an operating room, an elevator to eliminate carrying the children up and down stairs, a trained physiotherapist, and a shoemaking shop to complement the brace shop that was already in place. The report made special mention of some cases in that year: four cases of club feet (two with club hands as well) and eight cases of infantile paralysis (two with deformities from previous paralysis). By the end of the war, Townsend was one of ten "specialists" on staff, including an anaesthetist, pathologist, and a general surgeon. 9 In 1945 the Outpatient Department saw 254 patients. Around this time Morley Cody, the Medical Superintendent of the hospital, began pushing hard for a new, larger facility. In February of 1947 he claimed that Alberta had 1,600 or more crippled children, and his plea to the public said that these crippled children were casualties like the returned soldiers. Without help from the Children's Hospital, they would be disabled for life. The hospital did not have the space to admit those with "mental involvement" -- his aim was to start children in life with healthy minds and bodies. He explained, "they do come in with depression and go out feeling they are one in society like other children." The children, he said, looked forward to their surgery with Townsend because they knew their deformities would be improved. 10 As early as 1926, the hospital had seen crippled children from all over southern Alberta, patients "of twenty different nationalities" from fifty districts outside Calgary .11 Rural people could obviously obtain urban medical services, sometimes without great difficulty. In 1942 the hospital saw its 3,964th patient, only 280 of whom were from Mrs. Mary Dover O.B.E. Scout Master and patients, 1950

Calgary. The hospital was able to take only sixty patients in at a time in the late 1940s, a small portion of the 1,600 or more that Cody said would benefit from treatment. Still, 8,000 patients had been seen at the hospital by 1950, a large number considering that the city's population in 1951 was 129,060 and the provincial population was about 900,000. Although Dr. Townsend's outpatient department made a big contribution, the pressure for a new hospital was strong. The Red Cross decided to build in 1947, and the building was completed in 1952, just in time for the polio epidemic. By then three more orthopaedic surgeons had moved to Calgary and were working at the Children's Hospital, which eased the load on Townsend. · The presence of these new orthopaedic surgeons affected the volume and type of cases at the hospital. The number of club foot cases, for example, nearly doubled once Drs. Walsh and Smyth were at work. Walsh immediately put his expertise with scoliosis to work, admitting several cases per year. Some new diagnoses appeared on the case records of the hospital: slipped epiphyses began to be diagnosed and more arthritis or rheumatism began to be treated. With more men doing surgery on crippled children in Calgary, Townsend was able to call for 102 a comprehensive program for their treatment in his report for the 1950 Alberta Health Survey. He had also compiled a list of equipment he felt was desirable for the new hospital. It included sterilizers, X-ray, orthopaedic table, proper operating room lighting, gas-oxygen ether machines for anaesthesia, a suction machine, a public address system for the hospital school, and a library .12 In the first year in the Children's Hospital's new facility, 149 of the 318 admissions were for polio. The daily average was ninety inpatients, and these would have been almost exclusively orthopaedic in nature. The brace shop did 2,577 jobs that year. The hospital report for 1953 showed 323 admissions, 213 for polio. Dr. Townsend was appointed Medical Superintendent that year, and the report complained of 11 a serious shortage of nurses throughout the province. 11 13 By 1955 the incidence of polio had subsided, allowing the surgeons and the hospital to concentrate on other orthopaedic disabilities. Nevertheless, the hospital report claimed it was not possible to care for all the children who had sought admission; at year's end there were seventy-five children awaiting admission for surgery. The number of admissions depended on the number of procedures the surgeons could

Main Surgery: Helen McCulloch, Scrub Nurse; Dr. Townsend, Surgeon. Note: Luck electric saw and no assistant. 103 perform, and the five volunteers could not handle such a volume of major procedures. Even so, the number of admissions rose again in 1955. The statistics for that year give some insight into the level of general orthopaedic activity at the hospital. For example, the five orthopaedic surgeons did 194 procedures in 1955; thirty years later, the eighteen men operating at the Alberta Children's Hospital performed only 496 orthopaedic procedures.

Statistics for 1955 New admissions 208 patients Total treated during year 28 patients Total patient days 31,349 Length of patient stay (average) 141 days Average daily occupancy (patients) 86 Number of laboratory tests 7,624 Number of X-ray examinations 416 Number of surgical operations 194 Number of physiotherapy treatments 14,865 Number of braces made 1, 167

Out-Patients Number of patients 1,123 Number of visits 3,772 Examinations by doctors 2,369 Laboratory tests 124 X-ray examinations 684

Orthopaedic work at the Children's continued to expand in 1956, but great changes occurred after the Red Cross gave up its commitment to the hospital in 1957, announcing that it was uneconomic for them to fund the hospital at the expense of its other activities. As the incidence of p9lio dropped off in the late 1950s, so did the hospital's occupancy rate, falling from 93 .14 percent occupancy in 1956 to 57 percent the following year. The amount of provincial funding decreased accordingly. By converting to general paediatrics, the hospital could maximize the use of its facilities and qualify for the fullest provincial grants. A decade later the staff of the 128-bed hospital included 205 doctors, thirteen of whom were orthopaedic surgeons. By the mid-1980s only 11 percent of the major surgery was orthopaedic. 104

There has been an overall change in the nature and type of problems in the crippled child population, some of which can be attributed to medical intervention. Polio and tuberculosis have declined greatly, and antibiotics have made osteomyelitis a rarity. The increasing numbers of children who are surviving with spina bifida and other severe congenital deformities are seen in clinics, as are the congenital or traumatic amputees. The number of long-stay beds has declined. Today the sixteen beds allotted to orthopaedic surgery at the Children's Hospital are continually occupied by children requiring major reconstructive surgery, most of it on the spine. But the vast majority of orthopaedic work in Alberta is now carried out on an outpatient basis, in day care surgery and in the many outpatient clinics. 105

CHAPTER SEVEN

POLIOMYELITIS

The effects of poliomyelitis in the history of orthopaedic surgery cannot be overestimated, since the specialty owes much of its growth to the handful of polio epidemics that swept through Alberta in the first half of this century, and particularly to the last full-blown epidemic in 1953. The demand for orthopaedics reached a peak that year: the waiting lists for orthopaedic surgery swelled and the numbers of long-term hospital beds dwindled. As it occurred in 1953 in Alberta, poliomyelitis was "a serious and unpredictable disease, creating a situation which was unique in its economic, sociological and medical implications. There was in fact a state of emergency which taxed the hospital, medical and nursing facilities for several months. "1 Between 1933 and 1943 the mortality rate from polio in the United States was the highest of any communicable disease. Gordon Cameron, who was the chief orthopaedic resident at the U of A Hospital in 1953, saw the tragedies and the fears. He recalled the foarsome iron lung technology at the Royal Alexandra Hospital, and he was impressed by the dedication of the people from the community and the medical personnel. Lethbridge orthopaedic surgeon Moss Albert also recalled the terrible cases, "worse than AIDS," so crippling and with so much fear. "It is common knowledge," Dr. Gordon Wilson observed in 1951, "that the parents in every household, including our own, fear the possibility of their child or children contracting poliomyelitis more than any other childhood illness. [ ... ] This fear is not entirely on a false Mamie Sproule, R.N. & Student Nurses A clinical demonstration of the iron lung, 1956. basis." On a more positive note, he wrote, "It is not common public knowledge, however, that between 65 % to 80 % of paralytic poliomyelitis cases show an almost complete recovery. "2 Polio was in the back of every parent's mind because there would be a small outbreak every autumn in Alberta. Even in non­ epidemic years, polio accounted for a quarter to a third of the cases at the Children's Hospital in Calgary. Some years were better than others: only two new cases were reported in the province in 1926. But the following year the epidemic struck with a vengeance -- 354 cases and fifty-three deaths in the province. The summer outbreak of 1937 was sufficiently serious for the unprepared Ministry of Health to ask the Red Cross to provide twenty-five more beds at the Children's Hospital. In this pre-war period, Dr. Rostrup recalled, polio was mainly of the infantile paralysis variety -- patients acquiring the disease were mostly under five years of age -- but as public health measures improved, infection could be delayed. More and more older children and young adult patients were seen. Smitty Gardiner remembered seeing some polio cases among the troops at the Colonel Belcher Hospital in Calgary. By the time of the 1948 epidemic, which had 380 cases and led to twenty-four deaths in the province (fifteen more than the previous 107 year), 17 percent of the polio cases in Alberta were over twenty-four years of age. This prompted an Edmonton public health official to comment that the disease no longer warranted the name of infantile paralysis in Alberta.

University Hospital, 1913 & 1922 wings

The first mention of polio at the University Hospital appears in Hank Mewburn's report on the first six months of the new orthopaedics department. In 1923 one of the twenty-two house patients suffered from polio, and there were four polio cases among the thirty outpatients. Dr. Vant described the early years of polio at the U of A as follows: The epidemic subsided with colder weather, but the government recognized that special facilities were required for those suffering the after-effects, and moved with exemplary speed -- as a later government did during a postwar epidemic. On November 15, 1927 a foreman from the Department of Public Works arrived with a gang of day labourers and started construction of a wooden pavilion with two wings. The pavilion didn't have a foundation. No 108

time for that. The gang literally hammered away at the project and the Special Hospital received its first patients on the following January 31. It cost $20,000. 'The unit has a capacity of 60 beds, 15 of which are cots.' That's how Hank Mewbum described the matter in his report to the Minister of Health on the first year's operation. [ ... ] Independent though it was, the special hospital relied heavily on the main hospital for support services. The work of physiotherapy fell on the broad and willing shoulders of Tommy Robson, and the skill of Miss Lennox, the masseuse, and her assistants. Meals were supplied to staff and patients at 25 cents each. The extra laundry strained the main hospital's faltering facilities to near breaking. It was too much for the laundry manager. When he resigned the crisis was relieved by hiring his wife and son. The special unit had a staff of four graduate nurses and four ward aides. As "Hank" wrote in his report to the minister: "The ward aide is an innovation in Edmonton hospitals ... "3 By the early 1930s the government felt there was no longer a pressing need for a polio treatment centre. The building was acquired by the growing University Hospital and made into a children's ward, although it continued to be the centre for polio rehabilitation. But there were more epidemics to come, and caring for and rehabilitating the patients proved to be both costly and time-consuming. No other medical problem received comparable financial attention from the government. The Poliomyelitis Sufferers' Act of 1937 provided hospitals with far more financial aid for polio cases than for other cases. In 1959, for example, the Children's Hospital received $10.25 per patient day for polio cases, as opposed to $3.40 for other orthopaedic 109 cases. This gave Alberta's orthopaedic surgeons some incentive to hospitalize more polio patients than they might have otherwise. Hospital records from that era include notations such as "Scoliosis (polio­ related)."

2958-c McD/G. t""W"\ Edmonton . May 16 th, 1928 .

Sir :

As per your request, l beq to hand you herewith the total cost of construction of the temporary Provincial Hosoital near the University

~otal cost of buil~inK. l l•,470.51. Cost of Equipment. ~5.2"._.

'l!Bkinq a total of ~55,75.

I mi~ht mention that t~~ primary need of th~ ..,.oven1ment wlien constructinR' this buildirnr was to take care of petients suffering from the after- effects of the Infantile Paralysis epidemic . It was mainly intended as a temporary exoedient for this purpose, and as the ~overnment wished to have it opened as quickly as possible the construction had to be carried on under the mo3t adverse weather conditions. In consequence of this the labor cost ran up a little hiRher than would have been the case in favorable weather. The heatinR arranqe:nents are not all that can be desired, as it was our intention, when locat­ ing th~ building, to have steam provided from the University Hospital and instal a steam heating sys­ tem in the building, but found out, after getting started, that the University could not supply steam. This necessitated using the gas heaters which are in­ stalled in the building.

I would reco~mend, in the buildiniz of any future structure of this kind, that steam heat be in­ stalled in p l ace of gas. Also, that s basement be constructed under part of the buildin~ and that foun- dations go down all round below frost -line. Also, that metal lath and stucco be used on the exterior Of the buildiniz. 'l'his would irive a fairly per manent structure.

Hopin~ this information ~111 re of some as­ sistance to :vou,

Your obedi "' nt~rvent,

) C, I Qin~t o B u~ qs . Dr.F.H.Mewburn , Professor of Surgery, University of Alberta. South Side, Edmonton.

Reprint 1928 110

Government concern regarding the disease was also evident in legislative measures such as the provincial Communicable Diseases Act. By the time of the 1948 epidemic, polio cases were required to undergo a two-week quarantine period. After this quarantine in the isolation wards of the general hospitals -- particularly the Royal Alexandra in Edmonton and the Calgary General Hospital -- patients were transferred to the Children's Hospital or to the University Hospital, the designated provincial rehabilitation centre. By the 1940s, however, public health officials knew that the practice of quarantining polio patients was largely futile, since most people carried the polio virus but were immune to it. This preventive measure seems to have persisted because of public fears rather than for any sound medical reason. To some extent, Alberta's orthopaedic surgeons confronted these fears. They counselled the public and the medical community to have faith in conservative treatment, rather than to let their overriding concern about polio lead to irrational courses of therapy. As Hank Mewburn cautioned: There has been so much discussion in the past few years regarding the various methods of treatment that the situation is anything but clear. As a result the polio conscious public are very liable to get panicky and to demand or embark upon types of treatment which are not in the best interests of the patient.4 Gordon Wilson agreed with this stance, stating that if the parent of a polio patient were not given complete insight into the condition, then loss of confidence would result and the parent would go from one doctor to another. "[ ... ] new fancies and fads in therapy in poliomyelitis are eagerly clutched at by the lay public," he explained.5 With the numbers of polio cases on the rise, parents were understandably anxious. By 1950 polio cases at the Children's Hospital had increased to such an extent that two more nurses had to be added to the small staff. The epidemic in the autumn of 1953 caused great overcrowding, and the nursing staff had to be doubled to twenty-four. Although the hospital was accredited for 128 patients that year, there were frequently 150 to 160 patients in hospital. Two-thirds of the admissions in 1953 were for polio, and at the height of the outbreak, Dr. 111

Townsend and his colleagues were treating 171 inpatients. Hospital records show that the second floor of the new building was not yet open when the epidemic occurred, but the facility was quickly put into operation, and volunteer help was requested and received. Similar demands were placed on the Royal Alexandra Hospital that year, when admissions for polio exceeded the available space as well as the medical, nursing, and technical facilities. The Royal Alex treated 440 cases in 1953, as compared to 507 in the four previous years, and only 20 percent of those patients were from Edmonton. Nurses from the armed forces and from other hospitals were transferred to the Royal Alex. Thirty-three iron lung machines were in operation for the respiratory cases. The focus at the Royal Alex was on the initial care during the 1953 surge of respiratory polio, and the hospital developed what was, in effect, "the first intensive care unit" for these victims. By November of 1953 government concern was such that the Deputy Ministry of Health notified the University Hospital Board of its intention to provide the hospital with a "polio services wing" for 200 patients. The next year the Department of Public Works began raising a six-storey steel and brick structure intended for 160 polio and 100 paediatric beds. Since the building would not be complete for two years, a temporary wing was established at the hospital itself. Even so, there "was so much polio that the hospitals could handle only the most serious cases. "6

Polio Wing, Edmonton 1956 112

Mike Carpendale, who was Head of Physiotherapy at the U of A Hospital, described the extent of polio rehabilitation: The respirator patients were moved to the sixth floor of the polio wing. On the ground floor we were treating 60 polio patients. Another floor became the orthopaedic ward for reconstructive surgery. We were operating the biggest rehabilitation centre in North America, 300 to 350 patients a day. The Mayo Clinic was the largest in the United States and was treating 250 to 300. One of the things we did was to establish a clinic to design braces for the upper limbs. We got grants to send three people to UCLA; there was Gordon Wilson, an orthopaedic surgeon; Jim Littlefair, our chief physiotherapist; and Wally Stauffer, who ran an artificial limb company. 7 -At one time, the orthopaedic ward in the polio wing had 120 beds. Reconstructive work on polio patients therefore became the most time­ consuming work for orthopaedic surgeons in the 1950s. The first documentary evidence on orthopaedic rehabilitation between the wars is in the 1925 report of the Red Cross Crippled Children's Hospital in Calgary. While the report does not indicate what treatments Dr. Deane was using, it does list the results of the treatment of polio/infantile paralysis: three cases cured, twenty-one cases improved, and three cases awaiting further treatment. Hospital records indicate that for the epidemic of 1938, "six months of special treatment" were given. 8 Dr. Rostrup was somewhat more specific about treatment at the U of A, claiming that quite a bit of reconstructive surgery was done before the war. To have custom braces made in the 1930s, they would take drawings to the University engineer, who would do the metal-tooling, and a shoemaker would do the leather work. In spite of these efforts, some of the braces were a less than desirable fit. The Alberta Children's Hospital records from 1942 refer to follow-up visits for polio patients with treatment and fittings at regular intervals in the outpatient department, "until the need is met or the child 113 is over 18." The results were apparently "most gratifying. "9 In 1947 polio rehabilitation included massage, hydrotherapy, and muscle re­ education classes. The Children's Hospital had begun including Sister Kenny's treatment of hot packs and dynamic exercises in its otherwise typical polio treatment after Gordon Townsend returned from studying with her in Minneapolis in 1942. Kenny's treatment was a change from "splints and casts and prolonged immobilization. "10 According to Townsend, this change brightened the mood at the hospital. Gone was the gloom, depression and sombre acceptance of fate, and in its place there was a cheerful atmosphere with happy smiles -- "therapy had come alive."

"Two star pupils" Eleanor Roosevelt visits in a classroom. Dr. Gordon Townsend, Dr. Edward Smyth, Staff Member, and Mr. Dennis Yorath. Children's Hospital, Calgary 1947

Not all of Alberta's orthopaedic surgeons seem to have looked so favourably on Sister Kenny's approach. Writing in 1947 Olav 114

Rostrup claimed that, "In the past six years too much attention has been paid to Sister Kenny. She has denounced the medical profession and advanced her own theories. "11 Rostrup seems to have had reservations about the treatment on a scientific level, but he admitted its therapeutic value. "Kenny packs or foments under orthodox treatment are of value while there is muscle tenderness. Her promotion of early rising and re­ education of muscles is an improvement over the orthodox treatment where prolonged immobilization was the rule." Rostrup recalled that they would do a year of such initial treatment, with plaster casts and a long period of physiotherapy. After that, the main reconstructive procedures were tendon transfers and arthrodesis of flail joints. This treatment emerged during the war and shortly afterwards, and it became the usual approach in the 1953 epidemic. The results of the treatment were praised by a public health official: Excellent results are being accomplished in our province in the rehabilitation of paralyzed muscles following poliomyelitis. These results warrant greater publicity. There is a message of hope to those already stricken and a comfort to fearful parents in time of epidemic. The fear amounts to horror in many mothers for they know we are helpless to prevent such paralysis. There is some reason to hope that the medical answer to this may be found in the not-too-distant future .... Meanwhile, it could be that in our concentration upon bodies we sometimes fail to render that kindly psychological treatment which may bring comfort to the patient and his family .12 The need for information about polio was so acute -- and that information was being acquired at such a pace -- that many articles concerning the disease were published in the Alberta Medical Bulletin during the epidemic years of the 1950s. A 1951 paper by Hank Mewburn sums up the approach of Alberta's orthopaedic surgeons as 115 they entered the post-1953 period of polio reconstruction. Its recommendations included:

I. Rest is probably the best therapeutic agent.

2. Prevention of deformity is most important. [Mewburn claimed that there were recent, great improvements in plaster casts, splints, and bed apparatus.]

3. Avoid meddlesome therapeutics.

4. Muscle pain and tenderness is the biggest problem during the first year. This is treated at the U of A by the Kenny packs.

5. When the tenderness is gone, active treatment and physiotherapy can begin.

6. In the first two years, the only surgery should be for the removal of deformities. After two years of paralysis, reconstructive surgery was justifiable.

The polio clinic for outpatients was established, Mewburn said, because it was neither economical nor in the best interests of the patients to hospitalize them any longer than was necessary. The program operated two days a week in 1950-51. 13 The standard treatment of polio by the U of A's orthopaedic surgeons was described by J. Ross Vant as follows: As Ollie Rostrup says, the responsibility for patients was something of 'a mixed grill'. Most of the treatment was done by the new Department of Rehabilitation Medicine but except for a few cases the patients were under an orthopaedic surgeon or internist. Doctors and residents grew skilled at assembling casts on the patients and mostly on the joints of knee and foot. 116

Though made of Plaster-of-Paris they were different from the sculptures which provide so much humour for cartoons. More properly they were removable splints which had to support a joint but had to come off each day for exercise therapy, lest the patient suffer a complication called contracture. If polio left a knee with strong muscles on one side and little muscle tone on the other the stronger muscles could twist the knee out of alignment. So many splints were required that our hospital abandoned a quaint custom which had lingered with us while others were buying tailor-made casts from suppliers. We were still 'rolling our own'. Bill Bryan the orderly used to make them in a basement room. Our purchasing agent, John Beaton, bought him Plaster-of-Paris and crinoline mesh in varying widths, and Bill made them up when he wasn't helping Tommy Robson with physiotherapy. Hank Mewburn was a firm believer in Bill's casts, saying they had 'more substance' than tailor-mades. But Bill couldn't keep up with the demand of the '50s, and nowadays such splints are plastic -­ lighter, harder, and the kids can use them for war games in the wards. 14 This reconstructive surgery for polio set the orthopaedic agenda for the remainder of the 1950s and into the 1960s. According to Dr. Vant, about 30 percent of the orthopaedic work in those later years was still polio-related. Residents published papers emphasizing the rehabilitation of polio patients, and the weekly polio rounds continued until at least 1957, as did the polio outpatient clinic. Orthopaedic surgeons directed the overall course of treatment for polio in Alberta, with general practitioners and specialists from all fields 117 also playing an active part. The 1953 epidemic drew together the medical and lay communities in an unprecedented way. The provincial Department of Health, civic administrations, the College of Physicians and Surgeons, the administrations of the various hospitals, the armed forces, and many lay organizations in the community all pooled their efforts in a remarkable spirit of cooperation. According to an Edmonton physiologist, writing in 1954, "This cooperation made possible the attainment of acceptable plans for the future, as well as reasonable solutions for the difficulties encountered during the 1953 emergency." 1s Polio was to have a lasting effect on all those who were involved and on the province as a whole. For one thing, it led to the development of rehabilitation services that have had a long-term benefit for all orthopaedic patients. For another, it provided an educational experience for the institutions and the individuals who were necessarily preoccupied by the care of those who suffered from the disease. Not realizing that the vaccine just around the corner would largely resolve the polio problem in the affluent world, planners in the larger centres began to give thought to systematic plans for hospitalization, medical and nursing care for future polio epidemics. Although there was a minor outbreak in 1960, an epidemic of the same proportion as the one of 1953 did not occur. The planning that turned out to be unnecessary probably served them well for other purposes. Finally, for the physicians who were on the frontlines, polio was, as Cooper Johnston stated, "the absolute basis of all learning." Surgeons around the world used polio epidemics to experiment with new techniques, especially once the advent of antibiotics removed the fear of infecting joints during surgery, and their developments soon came to be used internationally. Thus it was that Gordon Wilson travelled to California to study carbon dioxide powered splints. On his return, Wilson ran a weekly clinic for fitting them. This, together with tendon transplants, evolved into the Rheumatism/Arthritis clinic which continued for years. You see very little polio now, says Cooper Johnston, except perhaps· in the occasional immigrant. Consequently, when such a case arrives at the U of A, the residents rush to see what it looks like, what muscles are knocked out, and what can be done for the patient. Fortunately the questions that remain to be answered about the treatment of polio are practical ones like these. The terrible, crippling cases that many of Alberta's orthopaedic surgeons cut their teeth on are no more. Gone, too, is the paralyzing fear that accompanied each epidemic. 118

CHAPTER EIGHT

SKELETAL TUBERCULOSIS

There is ample evidence of the significance of tuberculosis in Canada both before and between the wars. Tuberculosis was one of the major preoccupations of that time, and the incidence of the pulmonary type in the general population was high. Less common than pulmonary tuberculosis, tubercular involvement of the bones and joints also occurred with some frequency. As early as 1910 health inspectors were visiting schools in Calgary and Edmonton as part of Alberta's tuberculosis campaign. By 1929 there were 5,655 beds in Canada's thirty-one tuberculosis hospitals. The Saskatchewan government began paying all costs of treatment for pulmonary tuberculosis that year, and similar legislation was passed by the Alberta government in 1936. Initially, skeletal tuberculosis was eligible for free treatment only if grossly infected or complicated by pulmonary tuberculosis. But after 1949 all forms of tuberculosis were covered under Canada-wide legislation. Alberta's earliest orthopaedic records illustrate the importance of skeletal tuberculosis to the province's first specialists. Out of a total of fifty-nine orthopaedic cases at the Children's Hospital in 1920, Dr. Deane reported seven cases of tuberculosis, including two of Pott's Disease, two knees, one tibia, one ankle, and the seventh was probably a hip. Among Hank Mewburn's first fifty orthopaedic patients at the University Hospital, nine were tubercular. This small sample of cases suggests that skeletal tuberculosis accounted for 10 to 20 percent of the 119 patients hospitalized by the two surgeons. Little is known about the success of their treatments, although in 1925 Deane recorded that the three cases of tubercular hip were "improved." 1 The single death at the hospital was a case described as "Pott's Disease and Kypo Scoliosis." Both Mewburn and Deane were involved in the sanatorium treatment regimen at their respective hospitals. Developed around 1900, this conservative treatment was well underway at the Central Alberta Sanatorium between the wars. It was used primarily for pulmonary cases, but bone and joint patients were treated similarly. According to Rostrup, "we might do a spinal fusion or arthrofuse a hip, but this really wasn't very common." For the most part, the treatment emphasized rest, with draining of any abscesses.

Sunning Porch, T .B. Sanatorium 1926 (Lantern slide original)

As Mewburn wrote in 1924: In this land of sunshine, the sun tuberculosis and other chronic diseases should be used to the fullest advantage. During the summer and fall of 1923, the roof of the hospital was fitted with tents so that the patients should receive sun 120

treatment and fresh air. At present there are two pulmonary up-patients living in tents, and one orthopaedic bed patient was moved in two or three days before the end of the year. These arrangements were better than nothing, but it entailed a great deal of extra work on the part of the nursing staff particularly during zero weather. Further facilities for nursing care and treatment are necessary, if this branch of therapeutics is to take its recognized place in the treatment of the disease. 2

Tuberculosis fresh air ward on roof of University Hospital, 1930-1935. Note: Macdonald Hotel on the sky line.

In the 1925 report on the Junior Red Cross Crippled Children's Hospital, Dr. Deane recommended building a solarium for the treatment of children with tubercular bones "and other maladies which might yield to sun treatment [ ... ] these cases making visible progress under the effects of this treatment." In the 1940s and 1950s Alberta's orthopaedic 121 surgeons varied in their involvement with tuberculosis. A 1942 report of the Children's Hospital stated that Dr. Townsend treated bone tuberculosis with intramuscular injections of vitamins. This was a painful procedure, as one nurse wrote, "Our most disagreeable task was giving the children intramuscular medications. Even though tears were often shed, the little ones stoically rolled over to receive the needle. "3 Dr. Townsend also did some orthopaedic surgery for tuberculosis patients. Once a few patients were "collected up" for him, he would go out to the Baker Sanatorium for a day of surgery. Dr. Smitty Gardiner was another surgeon doing orthopaedics at the Baker after the war. In those days I was asked to go to the Sanatorium on occasion to look at people suffering from tuberculosis of the spine or of the hip joint or of the knee joint. I refrained from doing any surgery out there. If they required surgery they would be transferred to the Belcher Hospital. One case I shall remember all my life if I live to be 200, was a boy who had Pott's disease of the spine with an abscess. I had seen him up there a couple of times and he was a veteran so we transferred him to the Belcher Hospital. We had him on various medications and his fever gradually subsided and I eventually fused his spine and he got a very good result. He went to Duchess and opened a butcher shop and married about in 1948, or thereabouts. Each Christmas he brought me a turkey, 100 pounds of potatoes and a quart of cream. He did that up until he died 5 or 6 years ago .4 Most of Edmonton's tuberculosis patients were treated at the new Aberhart Memorial Sanatorium in the 1950s. Prior to this, they were seen at the Edmonton General and the Royal Alexandra hospitals. Dr. Rostrup said the orthopaedic surgeons were seldom involved with these cases, and he did not treat any bone tuberculosis until the Charles 122

Camsell Hospital opened after the war. There was the "odd case of Pott's disease at the Sanatorium," explained Rostrup, "but we would never see them." Rostrup also recalled seeing the odd case of Pott's among DV A patients, but all in all he recalls that skeletal tuberculosis was not very common in the non-native population. By contrast, there was "tons of t.b." at the Camsell, where the aim was to treal: tuberculosis in the native population. Tuberculosis always has been a serious health concern for Alberta's native peoples. At the end of the war nearly one percent of Alberta Indians had tuberculosis. By 1947, when the Camsell opened, this figure was down to five cases per 1,000 Alberta Indians, still more than ten times the incidence in Canadians as a whole. Socio-economic problems such as malnutrition, overcrowding, and poor housing conditions were the cause of this increased susceptibility to the tubercle bacilli. Although there had been native hospitals in Alberta at Gleichen, Cardston, Brocket and Morley, the federal government undertook to provide native health care only after 1945. Dr. Barclay of the Camsell Hospital has said that he saw tuberculosis in "every joint in the body: hip, knee, ankle, wrist, spine, shoulder; none were immune. "5 In the immediate postwar period orthopaedic matters at the Camsell were attended to from time to time by physicians from other Edmonton hospitals, primarily Dr. Rostrup. The following case of bone tuberculosis spreading from the left leg appears in the hospital's records, written by the patient himself, Leo Sowan: My left leg was amputated on Friday, October 9, 1947. The operation was performed by Dr. Meltzer. Dr. Rostrup didn't operate on Fridays and Dr. Meltzer felt that my condition was such that the surgery had to be done then. 6 Dr. Gordon Gray became the orthopaedic specialist at the Camsell in April of 1951. Gray's father had been one of the rugged individuals of the prewar medical community in Edmonton; in fact, it was said that he ran the Misericordia in the palm of his hand. Gordon Gray had left Alberta to enter the medical school at the University of Toronto, where he graduated in 1940. He then enlisted in the Canadian Army in 1941 and was posted to Hong Kong. Along with the rest of Canadian servicemen there, he was taken as a prisoner of war. For over 123 three years he provided medical care to his fellow POWs. He spent 1946 as a general surgeon at the Toronto Sick Children's Hospital, trained in orthopaedics in Toronto until 1951, and returned to Alberta to go on staff at the Camsell, which was bringing many native people down from the north for the treatment of tuberculosis. According to Cooper Johnston, Gray was the only orthopaedic surgeon in this part of the world to study skeletal tuberculosis in the native population. He presented a paper entitled "Tuberculosis in the long bones of hands and feet of Indians and Eskimos" to the Annual Convention of the Canadian Tuberculosis Association in 1954. He also had a great appreciation for the ingenuity that he observed on the survey trips he made to the north to check for orthopaedic diseases in the native population. To find solutions to their own orthopaedic problems, the natives had designed their own canes, crutches, and prostheses. Dr. Gray said that "he often felt it was better to let some patients in the north remain with their self-made limbs in their own areas rather than bring them to civilization on an expensive trip which they don't like. "7

The Gavel presented to the Alberta Orthopaedic Society by Nellie KaitakofCambridge Bay, N.W.T. Dec. 3, 1960.

Over the years Gray collected a number of prostheses that natives had made for themselves, and this collection is still in the hospital museum. Photographs show one that was carved from a single piece of birch by a man from Fort Norman, NWT, following a knee amputation 124 in 1926. The man used the limb for twenty-four years and became "the most proficient trapper in his area." The "Gavel" of the Alberta Orthopaedic Society also came from one of these annual Arctic Medical Surveys. In 1954 the survey team had noticed a thirty-one-year-old Inuit woman named Nellie Kaitak in the Cambridge Bay area of the NWT. She "walked" in a peculiar manner, holding in her right hand a fifteen­ inch cut-down shovel handle that she used as a cane. Thus she made her way, with "back and hips flexed to nearly 90 degrees and both knees slightly flexed." She had inactive skeletal tuberculosis in five joints and a destructive lesion in her left hip. Her orthopaedic treatment was minimal: she was simply given a new, slightly longer shovel handle. The original improvised cane was presented to the Alberta Orthopaedic Society by Kaitak and Dr. Gray in 1960. As an orthopaedic surgeon, Gordon Gray was described as a perfectionist. According to one of the Camsell medical staff, "Dr. Gordon Gray was an excellent orthopaedic surgeon. What I admired most about Gordon was how very much he liked his patients. His special interest in them knew no bounds and he was especially fond of the children." He also cut quite an impressive figure and was "a social hit because of his piano playing and his arrival in a tuxedo, a formal, white tie, and top hat -- a stunning appearance." 8 Gray was the sole orthopaedic surgeon at the Camsell until several months after his appointment as Medical Superintendent in 1961. He was succeeded as staff orthopaedic surgeon by Dr. Santokh Singh, who had graduated in medicine in Amritsar, India, in 1950 and trained in orthopaedics in New York, Montreal, and Toronto from 1960 to 1963. Like many Alberta orthopaedists, Gray accepted a position with the SCB in Rehabilitation Medicine following his retirement in 1968. Tuberculosis is now an infrequent condition, particularly skeletal tuberculosis. This is primarily due to the improved living conditions, prevention of the disease, and to the medicinal management of primary tuberculosis. "Modern anti-tuberculosis drugs are truly spectacular drugs," says Dr. Matas of the Camsell Hospital. "Today rest in bed is provided only when the patient is clinically ill and weak. "9 When skeletal tuberculosis does appear, its management follows the general concept of chronic infection of bones and joints. 125

CHAPTER NINE

ORTHOPAEDICS FOR ADULTS

While much of the history of orthopaedic surgery in Alberta has revolved around children, orthopaedics for adults presents different issues. The approach to adults has been conservative, dominated by a traditional treatments such as heat, rest, plaster and appliances, but it has also used medications and emphasized the surgical corrections of deformity. As in most areas of medicine, such treatment has been undergoing steady and rapid change. Not only is more orthopaedic surgery being done now in the province, it is also going beyond "the correction of deformities." In the 1920s hospital conditions encouraged conservative treatment, if only by discouraging surgery. Even twenty years later, not much had changed. Rumours of the "medically primitive" Calgary that Dr. Townsend referred to in 1939 can certainly be substantiated by the author, who vividly recalls his younger sister undergoing surgery on the family's kitchen table in west Calgary in 1943. The general open drop ether was administered by his father, an insurance agent. This illustration in itself is evidence of how far medicine and surgery have evolved in just over forty years, let alone the roughly seventy years that have passed since orthopaedics first came to be known in this province. In his book Canadian Hospitals, Harvey Agnew describes the technology and material amenities of the 1920s. There was no post­ anesthetic room or surgical recovery room, no blood transfusion service, 126 no electronic aids, no antibiotics, no bone banks, and the radiology was slow and primitive. Yet the hospitals did not seem inadequate -- many were impressed by the fact that they seemed modern and progressive. The following paragraphs from Hank Mewburn's first report on the Department of Orthopaedics at the University Hospital give an idea of what conditions were like in the early 1920s. The equipment of the hospital on formation of this department was practically nil, with the exception of a privately owned Thomas wrench and two or three old osteotomes which have been part of the institution from time immemorial. There were no appliances of any kind for the application of plaster casts and the bandages themselves were of the manufactured variety. Since July the department has been allotted a plaster room, which is being gradually fitted up. This equipment has all been made in the University Hospital or in the University Works Department. At present it consists of a plaster table, designed after a Massachusetts General Hospital model, frames for the application of plaster of paris jackets, complete with fittings and various other smaller articles of equipment. The plaster of paris bandages are now being made in the institution, and are less expensive and more satisfactory than the ready made ones. Manufacture of Balkan frames and a series of stock splints is now under way. This latter equipment is absolutely essential for any first class hospital attempting to treat fractures in the way that they should be treated. The most necessary adjunct to any orthopaedic treatment is a good massage 127 department where not only the time honored "massage and electricity" can be dispensed but where proper muscle training and exercises can be given under trained supervision. Muscle training is work which required endless patience and technical skill. The success of this department so far has been due to Miss Phillips, who is in charge of this phase of the work. The quarters at present consist of two rooms in the basement, one being used for hydrotherapy, and the other as a massage room. These quarters are somewhat cramped, and there is not room to do postural exercises proper! y. At present it is necessary to carry on several treatments simultaneously in the same room and the presence of other people doing different things is very disconcerting for children doing muscle training. The staff at present consists of Miss Phillips and two assistants, the latter being available for duty in the plaster room when required. The making of orthopaedic appliances is progressing favorably, and the amount of apparatus made is increasing and the quality improving. At present the iron and steel work is done in the University shops, and the leather work is done in the city. The sewing work on cloth apparatus is done by the seamstress at the Hospital. It is hoped that in the future these specialists may be grouped together at the Hospital to form the nucleus of an appliance shop. This is the procedure followed by most of the leading institutions, and is 128

infinitely more satisfactory than the present methods. This condition of affairs would enable apparatus to be made more accurately and in less time, which would be a great saving to the patient. In the present state of things, as much would not have been accomplished were it not for the skill and co-operation of Miss Holland at the University Hospital, Mr. Coull the University Blacksmith and Mr. Putters of The French Shoe Shop. 1 Mewburn's patients during this time were mostly children and soldiers, and what civilian adult patients he had were probably fracture cases. He did very little surgery in his first six- month period: out of fifty patients listed in the first report, only five received surgery, four of which were open reductions of fractures. John Huckell also stated that in his father's time, only 10 percent of the patients would require surgery. Treatment was conservative in those days, 11 a buckle and brace business, 11 said Huckell. An example of such conservative treatment is Dr. Deane's fondness for treating small injuries by wrapping them in red flannel -- the colour of the cloth was of utmost importance -- as part of the heat-and-rest approach. There were no modern drugs to assist in treatment, although medications were used. According to Dr. Rostrup, they would try to relieve rheumatic pain with ten drops of potassium iodide in a glass of water, two or three times a day. Some would inject milk into the buttocks for back or hip pain. Protosil, a red dye, was said to control septicemia. While the sulfa drugs available prior to the war were of little value in treating osteomyelitis, penicillin was to change all that. Penicillin was believed to be worth its weight in gold, and Alberta physicians were aware of its possibilities at least as early as April 1944, when the Alberta Medical Bulletin published its first article on the drug. It had obvious benefits for orthopaedic surgeons, since it lowered the incidence of acute osteomyelitis, skeletal tuberculosis, and suppurative arthritis, and reduced the need to drain and splint such affected areas. It also eliminated the fear of infection and made orthopaedic surgeons less reluctant to undertake joint surgery. Olav Rostrup agreed that penicillin therapy was a great help in controlling osteomyelitis and 129 surgery-related infection, but he sounded a note of caution. In 1947, just after the introduction of the "wonder-drug," he warned Alberta's surgeons not to let their reliance on antibiotics create a lack of "preparations and safeguards." As he said, "A death in an elective procedure is a calamity. "2 Cooper Johnston stated that the first use of penicillin in Alberta was for a case of chronic osteomyelitis of the femur in a particularly valued lab technician at the Royal Alexandra Hospital. The Head of Pathology relied heavily on this man, so he somehow got 400,000 units of penicillin from the American Army, who were in town in 1944. The pathologist was so impressed by the drug that he scrubbed, got gowned and gloved, and then gave the injection. Rostrup's 1947 article on "What's New in Orthopaedic Surgery" provides some insight into what he and his colleagues were thinking about in that era. In addition to the obvious concerns about penicillin, the war, and polio, Rostrup claimed that "with improved surgical techniques and newly devised procedures, diseased joints can now be made moveable." Among the "exciting" developments during the war, "the most revolutionary proposal in the treatment of fractures was skeletal fixation." Inert metals for internal use had "reached a high degree of efficiency," and, Rostrup asserted hopefully, the "right" plastic would soon appear to increase the success of arthroplasties. 3 Albertans were not immune in this age of experimentation. Rostrup recalls that there were some "wild operations." One example, circa 1970, was Alvin McKenzie's "Swedish Ball," a steel ball inserted between vertebrae after discectomy. The idea came from a Swedish orthopaedic surgeon who attended the Canadian Orthopaedic Association convention in Jasper in 1971, and according to Rostrup, McKenzie had the procedure performed on himself. The evolution of the management of scoliosis is an example of how orthopaedic surgery as a whole has evolved. In the 1930s and 1940s. the management of scoliosis, curvature of the spine, involved applying body cast for correction of the scoliosis and then fusion of the spine to maintain the correction. But these external cast methods resulted in poor correction. In the late 1940s, Dr. Paul Harrington of Houston, Texas, conceived the idea of internal fixation and correction of the scoliotic curve. He presented an initial report on his instrumentation at the International Polio Congress in Switzerland in 1950. One of his first patients was Kindred LaBorde, a beautiful, Dr. Paul Harrington intelligent Calgarian, who had developed a very severe curvature of her spine secondary to poliomyelitis. A victim of one of western Canada's many polio epidemics, she was virtually a polio quadriplegic and confined to a wheelchair because of severe paralytic spinal curvature. Her father, prominent oil man Edward LaBorde, heard of Harrington's work in the late 1940s, and wishing to learn more about the surgeon and his procedure, he consulted his friend, Gordon Townsend. They flew to Houston in the early 1950s. Kindred thus became the first foreign patient that Dr. Harrington treated, and Dr. Townsend became the second surgeon to use this procedure. The first half dozen cases outside of Houston were accomplished at the Children's Hospital in Calgary using the instruments Harrington had made for himself. Considerable problems arose in those early days, as hooks were placed on the ribs and transverse processes, causing frequent hook failure and loss of correction. Dr. Townsend presented his first small group of patients to the Alberta Orthopaedic Society in 1957, but because of the many complications, a moratorium was placed on instrumentation until 1961, when the author spent three weeks in Houston learning Harrington's new techniques. These new techniques have withstood the test of time and are used to this day. In 1962 Dr. Harrington was brought to Calgary as a Visiting Professor to demonstrate his procedures to orthopaedic surgeons from across western Canada. He performed surgery on some ten patients at 131

the Children's Hospital and was made a member first of the Alberta Orthopaedic Society, then of the Canadian Orthopaedic Association. The results of Alberta's first forty-five patients treated by Harrington instrumentation were presented to the Canadian Orthopaedic Association Meeting in 1962, causing tremendous interest in other centres. Harrington's procedure subsequently became the standard treatment of scoliosis throughout the world. The role of the Alberta Children's Hospital in the evolution of scoliosis management has been recognized by the Scoliosis Research Society, of which Harrington was a founding member. Scoliosis management has continued to progress, and both Edmonton and Calgary have teams of young orthopaedic surgeons carrying on this work. Kindred LaBorde went on to become an active attorney in the Pentagon for the United States government. In the past decade, probably the most significant advances in adult orthopaedic surgery have been in the field of joint replacement, primarily in the hip and in the knee joint, which has been a boon to degenerative joint disease in the elderly. Vast improvements in technology can now alleviate discomfort, allowing some older patients to walk and live without pain. Another area of growth in the past ten to fifteen years has been arthroscopy of joints, the procedure that was initiated in Japan and brought to Canada in 1969 by Dr. Robert Jackson of the University of Toronto. Arthroscopy is now one of the most common orthopaedic procedures, extending beyond the knee to include other joints such as the shoulder and wrist. With arthroscopy much of the open surgery in these joints can now be avoided. The third significant development in the last decade has been limb-sparing procedures for the removal of malignant tumors of the extremities. By removing the tumor along with the bone and the surrounding soft tissue, amputation can be avoided . A final development in orthopaedic care of adults has been less technological than it has social. Albertans are becoming more physically active, even in the middle and older age groups, and orthopaedists are now seeing more sports or sports-type injuries resulting from activities such as climbing, skiing, racquet sports, and jogging. Both Edmonton, with its Glen Sather Sports Clinic, and Calgary, with the U of C Sports Medicine Centre, can manage these problems with a service and a research component. 132

TRAUMATIC INJURIES AND ORTHOPAEDIC SURGERY

In Alberta, as elsewhere, traumatic injuries caused by the world wars allowed the expansion of the orthopaedic specialty. After World War Two the demand for orthopaedic services was so great that, at one point, Smitty Gardiner had six officers assigned under him at the Colonel Belcher Hospital to study "war and reconstructive surgery and rehabilitation." The specialty continued to grow not because of distant wars, but because of the "battlefield" closer to home. Growing industrialization, farm mechanization, and the rising numbers of motor vehicles have all increased the amount of trauma in the province and have provided what could be described as a window of opportunity for orthopaedic surgeons in the province. While the volume of reconstructive surgery for trauma showed its first increase during the post-war years, trauma has always been a major portion of the specialty in orthopaedics. Four out of Hank Mewburn's first five surgical procedures at the University Hospital in 1923 were open reductions of fractures. In 1942 surgical work in Alberta hospitals included 1,650 fractures, all but seven of which received plaster of Paris casts. 4 As it probably did for other orthopaedic surgeons, trauma accounted for the better part of Edward Smyth's Calgary practice in the late 1940s. Around 1960 the major hospitals, particularly the teaching hospitals, developed special fracture clinics, staffed by the orthopaedic surgeons, to deal with the management problems posed by complicated and difficult fractures. Much of the trauma has traditionally been caused by industrial accidents, and this has increased as industrialization has progressed in the province. The roots of industrial medicine in Alberta are in the building of the railways, which began in the early 1880s and continued steadily until World War I. Even by the turn of the century, the province's small population supported substantial amounts of industry: the Prince empire in Calgary, to cite just one example, was diversified into about a dozen different fields. Of course, Alberta's three orthopaedic surgeons could be involved in only a small portion of the many industrial accidents that occurred -- in 1936 alone the WCB reported 11,058 -- so the bulk of this work went to general practitioners and surgeons, many of whom had business contracts that formed the basis of their practice. Dr. Hugh Arnold of Lethbridge claimed that one could make a good deal of money from a mine with 1,000 workers, supplying everything for a flat rate of 133 about two dollars per family per month. 5 Nevertheless, orthopaedic surgeons have always been heavily involved with the WCB and with industrial medicine. Olav Rostrup expressed the orthopaedic community's concern in 1947, when he wrote that major amputations from industrial accidents were three and one-half times as common as they were during World War 11. 6 Edmonton and Calgary have developed into major referral centres for the severe orthopaedic trauma. Severely injured patients are brought to both centres by air ambulance services which use helicopter and fixed wing aircraft to evacuate patients for immediate team management of their injuries. More than the industrial accidents and the casualties of war, it was the automobile that affected the incidence of trauma and escalated the growth of orthopaedics in the province. Alberta has become an automobile culture, and orthopaedic surgeons and others in the medical system have served to keep the carnage within manageable limits. As early as 1936 the Alberta Medical Bulletin was warning that motor vehicle accidents were on the increase in Canada, and that the costs were a burden to physicians and hospitals.7 Canada had 1,309 deaths from auto accidents that year, and the figure was increasing annually. 8 In July of the following year, the Bulletin reported that Alberta's auto accident rate of 9.3 deaths per 100,000 was the fourth lowest in the country. Fifty years ago, in 1941, it published a British report on the role of alcohol in driving accidents. 9 By 1947 the provincial government had enacted legislation that allowed patients to apply for indemnity for their medical costs after auto accidents. As Alberta's oil boom developed through the 1950s, and as the roads were paved, the medical community was worrying. Statistics revealed that auto accidents were then the third most common cause of death in Canada, and the most common cause in the fifteen to twenty­ five age group. 10 Joe Moreau was the orthopaedic surgeon on the CMA (Alta.) Committee on the Medical Aspects of Traffic Accidents. Their 1956 report noted the increased prosperity and suburban living, and the consequent increase in the number of cars. They also singled out the time lost by the injured and the health care system as large social costs. Dr. Rostrup, who observed first-hand the effects of the automobile on orthopaedics, offered an orthopaedic surgeon's perspective. When he began orthopaedic practice at the beginning of World War II, there were relatively few cars on the road, partly due to 134 wartime conditions. The province's unpaved roads reduced the speeds that were possible as well as the level of danger. But the prosperity of the 1960s, two-car families, and fast roads brought the bulk of the accident victims. Even so, Rostrup said, it was not like it is now, when the world's roads kill a quarter of a million people every year. According to John Huckell, trauma is now the bread-and-butter of the orthopaedic surgeon in Alberta, and orthopaedic trauma work makes up a large part of the off-hours work in most emergency departments. He claims that since 1970 the management of fracture and trauma injuries has increased sixfold at the U of A Hospital, where they have developed a high-volume ICU and an aggressive plan for trauma management. 135

CHAPTER TEN

ORTHOPAEDIC ASSOCIATIONS AND OTHER ACTIVITIES

As of the 1980s orthopaedics was not one of the high-profile specialties in Alberta. With issues such as AIDS, cancer, research, pharmaceuticals, economics, and transplant surgery to preoccupy the medical community and the public, orthopaedic surgeons are rarely thrust into the spotlight. But such was not the case at mid-century, when orthopaedic causes had mustered great public and governmental support. Orthopaedic surgeons were responsible for the reconstruction of war injuries and for the medical management of WCB cases. The children's hospital movement involved them with volunteer groups such as the Red Cross Society, the Junior League, which staffed the outpatient clinic at the Children's Hospital, and the Children's Hospital Aid Society, all organizations that helped to improve the specialty's profile in the community. Three polio epidemics had profound effects on Albertans, setting the orthopaedic surgeons at centre stage. Even though the resear'ch "breakthrough" concerned medical intervention rather than surgery, the victory over polio in the mid-1950s enhanced the specialty's prestige. Finally, with· an ever-increasing incidence of car accidents, orthopaedic surgeons were required in greater numbers by a society which favoured treatment rather than prevention. Surgeons like Mewburn and Deane had struggled "to put orthopaedics on the map." By mid-century, their efforts had been rewarded. 136

"Putting orthopaedics on the map" was part of a broad social phenomenon which attached growing social importance to the educated professional. In the twentieth century we are increasingly consumers of the services of experts who provide, or claim to provide, technological solutions to social and personal problems. Specialists in all fields have become the models of competence, and this is no less the case in orthopaedics than in other areas. But this affirmation has not come without responsibilities to the profession and to society at large. Throughout the short history of their profession, Alberta's orthopaedic surgeons have demonstrated a strong belief in the importance of organized medicine, throwing their support behind a number of medical organizations. Some physicians may join and attend the meetings of professional associations out of a sense of duty; others become members simply out of habit or training. But for many, the desire to join such an organization stems from a sincere interest in furthering the goals of their profession. Olav Rostrup, for one, belonged to fourteen medical organizations at local, provincial, national and international levels and held office in half of them. Five of these were orthopaedic organizations, three were surgical, and the remainder were general medical organizations. Alberta's own Orthopaedic Society, formed in 1948, was a small group and attending the meetings was mandatory. But it would not have thrived were it not for what Dr. Gordon Townsend called a "common bond:" . . . orthopaedic surgeons the world over are really a friendly and in many ways a clannish lot -- and the orthopaedic surgeons in Calgary and Edmonton are no exception to this. We have our professional interest in common, and our ambitions within our specialty are our shared ground. True we have our differences of opinion, but our ultimate goal is to contribute to continuing improvement in the orthopaedic realm of health care delivery in every manner that will do credit to our specialty and to ourselves.' Alberta Orthopaedic Society with Sir Walter Mercer as Guest Speaker - 1958 . Clockwise from left back: Dr. Gordon Gray, Dr. Vince Murphy, Dr. Cooper Johnston, Dr. Tom Richardson, Dr. Donald Sturdy, Dr. Gordon Townsend, Dr. Graham Huckell, Dr. Gordon Wilson, Sir Walter Mercer, Dr. Cyril Walsh, Dr. Joe Moreau.

These sentiments were echoed by John Huckell, who saw the value in 11 a regional group to deal with the concerns of orthopaedic surgeons in the trenches, concerns about their economic aspects of orthopaedics, relationships with hospital and managing difficult complicated problems. 11 The development of Alberta's medical organizations followed a historical pattern seen elsewhere in the West. The Alberta Orthopaedic Society was formed to satisfy the educational and social needs of physicians in a province that was just shedding its pioneer status. The recent discovery of oil in Alberta had cast it abruptly into the international business world, but travel and communications with the rest of the continent remained tedious and time-consuming. In fact, the situation in Alberta was much the same as it had been in 1925 for the surgeons of the Pacific Northwest states. There are clear parallels between the origins of Alberta's fledgling organization and the history of the one described by Dr. Frank Smith. 138

Each of the states and provinces of the Northwest United States and Canada had its developing metropolitan centres with their rapidly growing populations. In each, the number of physicians was increasing, though at a less rapid rate than that of the general population. This placed an extra burden upon all physicians practicing in the area. Even the younger and better trained doctors became increasingly aware of their need for some form of continuing medical education. Though true of all physicians in the area, it was especially true of men practicing in the new and growing specialty of orthopaedic surgery. Where could these physicians look for the reliable knowledge concerning recent advances in their field of practice? For those who still looked to the established medical centers in the East, they were faced with transcontinental train travel requiring three to four days and as many nights. Some physicians looked to their local medical societies. Medical journals were available. They had access to the medical school in Portland, Oregon, the only teaching medical centre in the entire area north of San Francisco. These sources were helpful and were used, but most physicians felt an increasing need for exchange of medical knowledge and experience with colleagues outside their respective hospitals and immediate communities. It was not surprising, therefore, that the suggestion to form a regional medical society attracted some interest at 139

the time. Especially interested were those physicians who were beginning to limit their practice to one branch of medicine or surgery. 2 The organization they formed in response to these circumstances, the North Pacific Orthopaedic Society, is the second oldest orthopaedic society in the United States.

Alberta Orthopaedic Society, Fall 1964. Back row, left to right: Ors. Bazant, Cameron, Gort, J. Huckell, Crooks, Driedger, Kindrachuck, Gray, Albert, Walsh, de Haas, Edwards, Henderson, Day, Moreau, Richardson, Sturdy. Front row: Ors. Rostrup, Gulley, Murphy, C. Johnston, G. Huckell, Townsend.

Despite their comparable history, there is at least one major difference between the Alberta Orthopaedic Society and the larger American organizations. Membership in the Alberta Orthopaedic Society is open to all qualified orthopaedists in the province. But as Dr. Thornton Brown, historian of the American Orthopaedic Association, stated, theirs is an elitist body which specifically limits its memberships to "movers and shakers" within orthopaedic surgery in the United States. 3 Deane was the first Albertan member of the American Orthopaedic Association, elected in 1931 as an emeritus member. As for 140 the North Pacific Orthopaedic Society, Alberta's movers and shakers became eligible for membership in 1962, when Dr. Joseph Moreau was the first Albertan elected to membership. The more open nature of the Canadian organizations has its advantages. Through their association with the Royal College of Physicians and Surgeons of Canada and the Canadian Orthopaedic Association, several of Alberta's orthopaedic surgeons have had the opportunity to become deeply involved in the national orthopaedic scene. Alberta members have sat on the committee of the Royal College which formulates policy for the various subspecialties, and they have played a part in the training programs established to advance orthopaedic surgery. Dr. Gordon Cameron was the first examiner from Alberta in orthopaedic surgery from 1964-69, followed by the author. At that time there were only three orthopaedic examiners -- one from western Canada and two from the eastern centres -- and the examinations were held in Toronto or Montreal. Alberta's two representatives played a prominent role in altering the examination scheme to include an examiner from each training program across the country and to rotate the sites of the examinations throughout Canada. These strides made the examination a truly national one. The Canadian Orthopaedic Association has maintained a strong commitment to advancing orthopaedic surgery and helping the sixteen orthopaedic training programs across the country. It sponsors annual on­ site reviews and assessments of at least two training programs and has been so successful that all programs have attained extremely high standards for postgraduate training. The growth of the orthopaedics profession is mirrored in the growth of the Association, which held its first scientific meeting in Montreal in 1945. Drs. Townsend and Graham Huckell were among the twenty-four surgeons present that year. Within three years the Association boasted seventy-eight members, and this number has climbed to well over 600. The Association now meets in Alberta about every ten years and has held meetings in Jasper and Banff, as well as Edmonton and Calgary. Five of Alberta's orthopaedic surgeons have served as its president: Graham Huckell, Gordon Townsend, Olav Rostrup, Glen Edwards and, most recently, John Huckell. During the year in office the president travels extensively throughout the world, representing the Association at various orthopaedic meetings. Dr. Graham Huckell 1952

Dr. Gordon Townsend 1966 Dr. Olav Rostrup 1971

Dr. Glen Edwards 1980 Dr. John Huckell 1986

Presidents of the Canadian Orthopaedic Association from Alberta 142

For Graham Huckell, the first of these men to hold the office, his presidency in 1952 was the symbolic highlight of his career. While attending the Joint Meeting of Orthopaedic Surgeons of the English­ Speaking World in London, England, the Queen Mother presented him with the Jewel of Office. These Jewels of Office were presented to the British, Canadian, American, South African, New Zealand and Australian orthopaedic associations and are held by the president of each association. The Royal Family, wrote Huckell, had always been a great supporter of orthopaedic surgery. At the suggestion of the Alberta Orthopaedic Society, the text of the Queen Mother's address was published in the Alberta Medical Bulletin the following year. Though the province's subsequent presidents missed this brush with royalty, their contributions have been no less noteworthy. As President in 1966 Gordon Townsend rewrote the bylaws of the Association and worked to improve relationships between the COA and the Royal College of Physicians and Surgeons, whose P.resident that year was Professor Walter Mackenzie from Edmonton. Olav Rostrup was President when the annual meeting was held in Jasper. For many years he had been the Chairman of the Examination Committee, working closely with the Muttart Centre of Examinations in Edmonton. In fact, following his retirement from active orthopaedic practice, Rostrup devoted his energies full-time to the Muttart Centre, along with Dr. Sam Kling, general surgeon. As president in 1979-80, the author concentrated on assessing and developing the plan for continuing medical education in orthopaedic surgery. The presidential address was a summation of several years' involvement in the Association's subcommittee on CME. Dr. John Huckell, then Chief of Orthopaedic Surgery at the U of A, was President in 1987. He served as a travelling ambassador to the other English­ speaking orthopaedic associations around the world. These men all served many years on the various committees and subcommittees of the Canadian Orthopaedic Association, a tradition that is continuing among the younger physicians. Drs. Bill de Haas and Norm Schachar have recently served as Presidents of the Orthopaedic Research Association. With the growing numbers of orthopaedic surgeons in the province and in the affluent world as a whole, the organizations naturally have changed and tend to be more science-oriented. Because the 143 specialties are now widespread and fragmented, the mutual teaching function is reduced. The very size of the medical community has also affected the social role of medical organizations. Gone are the days when Esther and Cyril Walsh would throw a party and invite every physician in Calgary. It is the medical organizations that have assumed this function of providing occasions for socializing, albeit on a larger scale. The social opportunities are invariably a significant part of the meetings. One sad but memorable social gathering took place during the 1966 COA meeting in Banff, when an Indian pow-wow was held just west of Calgary to induct Dr. R. I. Harris of Toronto into the Stony Indian Tribe as an honourary chief, "Father of the Straight Child." The tribute to Canada's "Dean of Orthopaedics" was well-deserved. Dr. Harris not only developed numerous procedures in orthopaedic surgery, but he was the only person to have held the presidency of both the American and Canadian Orthopaedic Associations. The author of numerous scientific articles, he also wrote a book, The History of the Canadian Orthopaedic Association, and instituted the renowned ABC Travelling Fellowship. Unfortunately, the event intended to honour an outstanding life in orthopaedic surgery also precipitated its end. When Dr. Harris was participating in the tribal dance around the bonfire with the chiefs of the tribe, he suffered a fatal heart attack. He died a few days later in the hospital in Banff. In addition to their contributions to the "orthopaedic realm" and to the executive medical staff organizations of the various hospitals, Alberta's orthopaedic surgeons offer their musculo-skeletal expertise to the community through their own professional associations and through various lay-medical organizations. Dr. Rostrup advised the Canadian Arthritis and Rheumatism Society and the Co-ordinating Council of Crippled Children and Adults. Thomas Richardson's work with the latter organization in the early 1950s took him to a Toronto arthritis centre .and led to a paper on the orthopaedic treatment of rheumatoid arthritis. Joe Moreau served for several years in the fifties on the Motor Vehicle Accident Committee of the CMA (Alberta). This was a timely committee, as the number of cars in Alberta increased considerably in the more suburban and prosperous post-war period. Orthopaedists have also served on the Canadian Haemophilia Society and a number of other organizations. 144

Professional sports teams have also benefitted from the voluntary services of orthopaedic surgeons. Although some teams were cared for by general practitioners, postwar professional teams were most often tended by orthopaedists. Gordon Townsend was the team doctor for the Calgary Stampeder Football Club in the early 1950s. He, in turn, was followed by Drs. Cyril Walsh and Vince Murphy. Olav Rostrup served as medical consultant to the Edmonton Eskimo Football Club and was succeeded by Gordon Cameron, who turned his interest in several teams into something of a subspecialty in sports medicine. He also worked with the Edmonton Oilers hockey team, the Trappers baseball club, and the Drillers soccer team. Townsend, Edwards and Bazant have been the rodeo surgeons for the Calgary Exhibition and Stampede for some thirty years and were recently joined by Dr. Dewar. Many orthopaedic surgeons played their part in the Commonwealth and University Games held in Edmonton and in the Winter Olympics held in Calgary in 1988. 145

CHAPTER ELEVEN

POST-GRADUATE MEDICINE COMES TO CALGARY

In the late 1950s the Royal College of Physicians and Surgeons of Canada strongly recommended that all orthopaedic training programs in Canada include in their three years a formal period of six months of paediatric orthopaedic surgery. The recommendation resembled one made by Gordon Townsend in the 1950 Alberta Health Survey when he suggested that the Junior Red Cross Crippled Children's Hospital be used for specialized orthopaedic training, including orthopaedic nursing. However, it was not until the late fifties, when the economic expansion of medicine began in earnest, that postgraduate medicine could come to Calgary. The first steps in that direction were made in 1959-60, after the University of Saskatchewan had begun to show an interest in using the Alberta Children's Hospital for their orthopaedics residents. At that time the U of A's Walter Mackenzie and Eric Nanson, professor of surgery at the U of S, made an arrangement with the hospital for their residents to come to Calgary to obtain their training in paediatric orthopaedic surgery. The first resident, Dr. Michael Emery from the U of A, started his six months' paediatric training in July of 1961. The first Saskatchewan resident arrived in January of 1962, establishing the practice of alternating one resident from Edmonton and one from Saskatoon. The residents continued to rotate to the Children's Hospital 146 until the two universities established their own paediatric orthopaedic units in the 1970s. During the 1960s orthopaedics was the only surgical discipline running a training program in Calgary. The residency program was approved by the Royal College in 1963. According to Dr. Edwards, who directed the postgraduate program at the Children's Hospital for more than twenty years, over fifty orthopaedic surgeons had trained there by 1980, all of whom were successful in the Royal College examinations. The Alberta Children's Hospital paediatric residency training enjoyed an extremely high rating. Its accreditation in 1963 followed an on-site review by Dr. Charles Drake who became head of neurosurgery and head of surgery at University of Western Ontario. The residents at the University of Calgary orthopaedic program now rotate through the Children's Hospital for six-month periods. They have the benefit of two orthopaedic surgeons who devote their time exclusive! y to paediatric orthopaedics -- Dr. J. Harder and Dr. J. Kiefer, both of whom were graduates of the orthopaedic program at the U of C. Harder studied in Toronto with Dr. Robert Salter, and Kiefer took additional training in Denver under Dr. Sherman Coleman. One of the strong points of the program was the week! y seminars with a structured study period. The residents were supplied with reading lists one week in advance and then had a tutorial session for two or three hours each Monday evening. These sessions formed the didactic basis for the fellowship exams of the Royal College of Physicians and Surgeons of Canada, and prepared the candidates for the oral portion of the Royal College exams. Many of the orthopaedic surgeons now practicing in western Canada and the United States had their first introduction to the clinical investigation process through the Children's Hospital practice of assigning a clinical investigation project to each resident. This has led to many scientific presentations at meetings of the Royal College, the Canadian and Alberta Orthopaedic Societies, and to publications in journals such as the Canadian Journal of Surgery, the Canadian Medical Journal, and the Journal of Bone and Joint Surgery. Much of this material has pertained to poliomyelitis, cerebral palsy, scoliosis and Legg Perthes disease. The results of these clinical investigations and presentations have changed the methods of managing these various afflictions of the child. For instance, Dr. Bazant presented a paper reviewing the Legg Perthes disease to the Royal College in 1962, 147 and it changed the management from one of recumbency in bed for two years to an ambulatory type. The hospital's "Paediatric Days" have also been extremely popular, with orthopaedists attending from British Columbia and all parts of Alberta. Each October this paediatric seminar hosts two eminent specialists from other major orthopaedic centres, presenting their work along with local research. The seminars have been held for some twenty-five years, and for the past thirteen years the annual R. G. Townsend lecture has been a highlight of the evening banquet, the topic being of interest to orthopaedists and their spouses. The seminars have been generously sponsored by the Children's Hospital Aid Society and the Alberta Children's Hospital Foundation. The Foundation has been a tremendous supporter of orthopaedic research in Calgary, particular! y in funding initial bench research undertaken by residents and fellows.

The Rostrup Cup, 1980 Dr. Maivin Tile - Visiting Professor, Dr. Olav Rostrup, Dr. Cy Frank

From this very active research environment at the Children's Hospital grew the annual Orthopaedic Residents' Research Day, when residents from both the Edmonton and Calgary programs meet in April to present their formal bench and clinical research projects. This full day of stimulating presentations by bright residents vying for the Rostrup Cup, the ultimate prize for the resident research, is sponsored by the Zimmer Orthopaedic Instrument Company. Visiting professors are brought in to adjudicate the papers, and the best of these are presented 148 at a national orthopaedic research meeting held at a different site across the country each May. This event is also sponsored by Zimmer, which funds the travel, lodging and prizes for all the orthopaedic residents throughout Canada. This national meeting has been a tremendous success and has given rise to some very bright young minds in orthopaedic research. Probably nothing better illustrates the expansion of medical education specifically, and medicine generally in Alberta, than the creation of the U of C medical school. There was no thought of a medical school when the U of A opened its Calgary campus in 1945. The population was only about 100,000 and the city's medical community was small, with only a few specialists. But the postwar expansion attracted more specialists to the city and, according to Dr. Cyril Levine of the U of C Department of Morphological Anatomy, they brought with them a desire for advanced medical support and intellectual stimulus; after all, they all had long associations with academic medical centres while in training. With the new Foothills General Hospital set to open near the university campus, and with the federal government's 1964 Hall Report recommending Calgary as one of a half dozen places where new medical schools should be built, the time was right for a second medical school in the province. Dr. William Cochrane was appointed the first Dean of Medicine, having been the Chair in Paediatrics at Dalhousie University, Halifax. The founding faculty decided to teach medicine by the systems method rather than by the traditional Flexnerian method. The syllabus for the musculo-skeletal system was developed by a committee chaired by Glen Edwards with Cyril Levine as secretary. Over a two year period the committee defined the "core" of the system, the knowledge required by a medical student to become an undifferentiated physician. The U of C was to have a very different kind of medical school: no traditional anatomy was to be taught; very few courses were to be didactic; and all teaching was to be done in the small group tutorial mode. The medical school was unique in that it was to have a school term of three years, rather than the traditional four, with the school year being eleven and one-half months long. The first two years taught the various systems in block fashion, and the final year was a clinical clerkship like a rotating internship of yesteryear. Most of the eleven orthopaedic surgeons in Calgary participated in the teaching program of undergraduate students. The curriculum has 149 caught the eye of many visiting educators and has thus influenced many other universities throughout the English-speaking world. It has been incorporated into one of the oldest medical schools, in Edinburgh, Scotland, and into one of the younger ones, in Christchurch, New Zealand. Musculo-skeletal medicine has been a prominent system taught at the U of C, and most of the students rotate through the service during their clinical clerkship year, where they learn the basic psycho-motor skills, such as suturing and plaster application, as well as history-taking. Many of the students at the medical school have gone on to pursue orthopaedics as a specialty. U of C's orthopaedic residency training program was one of four surgical specialties allowed by the Royal College of Physicians and Surgeons in 1970, the others being surgery, neurosurgery and plastic surgery. Glen Edwards was the first program director for the Department of Orthopaedic Surgery at the University of Calgary, as well as head of orthopaedics at the Foothills Hospital and head of the orthopaedic program at the Alberta Children's Hospital. He continued as director of the training program until 1982, when he was succeeded by Dr. Gary Hughes, who graduated in medicine from Manitoba and took his orthopaedic training in Montreal and in Oxford. Three residents now go through the program per year, and the same number go through the program at the University Hospital in Edmonton. The weekly Tuesday morning rounds at the Alberta Children's Hospital, as well as monthly journal clubs, morning breakfast seminars on basic science, and weekly hospital rounds constitute an intensive educational experience in orthopaedic surgery in Calgary. The Monday evening tutorial seminars and a prescribed reading course which has been in process for some twenty-eight years continue to be strong elements of the program. Like their counterparts at the U of A, the U of C residents have enjoyed an extremely high success rate in the Royal College of Physicians and Surgeons orthopaedic examinations. Those young orthopaedists who wish to pursue academic orthopae

in special areas and to bring their expertise back to Calgary. Young orthopaedists are now doing the majority of clinical teaching and research at the U of C and at the U of A Hospital. 151

CHAPTER TWELVE

BASIC ORTHOPAEDIC RESEARCH

Both the postgraduate programs in Edmonton and Calgary are aware that basic research must be an integral part of teaching and training in orthopaedics. Although research is not a compulsory part of the training programs in either city, young orthopaedic scholars are encouraged to develop their interest in basic research. Each year all trainees must be involved in a clinical and/or basic research project in conjunction with one of their preceptors. The primary objective is to learn the scientific approach to orthopaedic surgery. Understandably, the founders of the specialty in Alberta had little knowledge of basic research, and they did not have the facilities to pursue research even if they were inclined to do so. Of the five orthopaedists who practiced between the wars, only Dr. Rostrup was able to pursue an interest in research. Long after the war, he began clinical investigations into prosthetic replacement of the anterior cruciate ligament of the knee. In 1958 he and Glen Edwards presented a clinical review of the role of hemiarthroplasty in the management of primary osteoarthritis of the hip joint. In the early sixties, the pair published an article in the Canadian Journal of Surgery on prosthetic replacement following excision of the radial head for comminuted fractures. Each orthopaedic resident on the Marshall Plan had the option of spending six months in the McEacheren Research Laboratory at the U of A. Edwards, for instance, conducted research on the effects of steroid on 152 bone. Early in 1960 Dr. John Huckell published a timely and significant paper in the Journal of Bone and Joint Surgery entitled "Menisectomy -- Is it a Benign Procedure?" This retrospective review of the problems following simple menisectomy asked orthopaedists to rethink the procedure, with the result that the number of menisectomies declined in favour of arthroscopies. One of the original bench researchers in Alberta was Dr. William de Haas in Calgary, who investigated induced electrical currents on bone and their effect on bone production and healing. This research began in private labs in the mid-sixties and carried on in the research laboratories at the U of C in 1969-70. Dr. de Haas had one of the first research labs at the U of C. Early money for his work came from private sources -­ including funds raised by the annual antique sale held at the YWCA -­ and his work was later funded by the Medical Research Council of Canada. He may have been the only surgeon in private practice who was able to get funding through the Council. He also received considerable funding through the Calgary Research Foundation and the Alberta Children's Hospital Foundation. Dr. de Haas reported his work in the Journal of Bone and Joint Surgery. His work culminated in a prospective clinical study using magnets to induce healing in delayed and non-union of fractures of the tibia. It became apparent at the University of Calgary that in order to develop a world-class research centre, young graduates in orthopaedics had to be encouraged to enter into research. With this in mind Dr. Edwards solicited the help of Dr. Satan Rowlands, an eminent nuclear physicist from Cambridge who was a senior researcher at the U of C. Dr. Rowlands was very interested in red blood cells membrane, and Norman Schachar did a period of basic research in his lab during his residency in orthopaedics. Schachar's investigations into the cellular membrane of the red blood cells in severely burned patients developed his interest in basic bench research in orthopaedics, and he obtained a two and one-half year position working in cartilage research with Dr. Henry Mankin at the Massachusetts General Hospital and Harvard University. On his return to Calgary, Dr. Schachar became the first full­ time surgeon in orthopaedics at the U of C. He was posted to the Calgary General Hospital to pursue his research in the preservation and storage of cartilage and to lead the undergraduate and postgraduate training at that hospital. 153

Another young orthopaedist with an interest in research was Dr. Cy Frank, whose career in orthopaedic surgery undoubtedly had its start when Dr. Rostrup performed surgery on his knee after he sustained a serious injury to the lateral collateral ligament while playing baseball. Dr. Frank initially undertook a computerized examination of all ligament injuries that had gone through the U of C. One of the findings of this clinical investigation was that untreated primarily torn anterior cruciate ligaments did just as well as primarily treated (sutured) anterior cruciate ligaments. Dr. Frank carried out intensive basic orthopaedic research during his residency and spent another three years developing his research skill under Dr. Wayne H. Akeson in San Diego. During his undergraduate training in orthopaedic surgery Frank was twice awarded the Rostrup Cup for his bench research in ligament injuries. Cy Frank returned to Calgary as a Heritage Research Scholar to set up the musculo-skeletal research unit at the University of Calgary. At any given time, Drs. Frank and Schachar have several graduate students working on their master's and doctorate degrees in their very productive laboratory. They have recently been joined by another Heritage Researcher, Dr. R. Bray. At the most recent American Academy research meeting in Las Vegas they presented the largest number of papers from a single research centre. An entire day of the 1989 Canadian Orthopaedic Research Meeting was devoted to their papers. In Edmonton Dr. David Reid has been involved in basic research regarding shoulder injuries as well as developing locomotion modalities for paraplegic patients. Much clinical research is being conducted at the Glen Sather Sports Clinic in Edmonton and at the Sports Medicine Clinic at the University of Calgary. In his address to the Canadian Orthopaedic Association at Honey Harbour, Ontario, in 1963, as the Presidential Guest speaker of President Dr. Ian Davidson, Dr. R.I. Harris said: In the twenty years in which our Association has existed, we have grown from a small group of visionaries to a sturdy and influential professional body. Our members are steadily increasing. Our responsibility is to guide the future of orthopaedic surgery in Canada into a high state of excellence in every field: 154

medical education, orthopaedic training and practice, and research in the fields of basic science and clinical problems. There is every hope that we shall attain these ends. This quote summarizes very succinctly the objectives of orthopaedic surgery in Canada, not only for the present but in the years to come. The future of orthopaedics in Canada rests in the hands of the bright, well-trained and scientifically oriented orthopaedists of today. 155

ENDNOTES

Throughout the years the Alberta Children's Hospital in Calgary has been known by a variety of names, among them, the Junior Red Cross Children's Hospital, and the Red Cross Children's Hospital. For the sake of brevity, it has most often been referred to in the text simply as the Children's Hospital.

CHAPTER ONE

1. Thorton Brown, The American Orthopaedic Association: Fiftieth Anniversary Anthology. (Park Rigde, Illinois: American Orthopaedic Association, 1987) p.8.

2. Gordon Townsend, "The History of Orthopaedic Surgery in Calgary," (Paper delivered at the First Annual Dr. R. G. Townsend Lecture, Calgary, Alberta, October 1974), p.8.

3. H.H. Hepburn, "The Evolution of Medical Practice During One Man's Lifetime," Alberta Medical Bulletin (hereafter cited as AMB) 24:3 (August 1959): p.129.

4. "The University Hospital," The Press Bulletin 2:9 (19 October 1923), issued by the Department of Extension, University of Alberta: p.1. 156

5. Townsend, "Orthopaedic History," p.4.

6. Peter M. Campbell, "Frank Hamilton Mewburn," Calgary associate Clinic Historical Bulletin, 15:4:61 .

7. Reginald Burton Deane, "Frank Hamilton Mewburn," (Address delivered to the Medical Society, Calgary, c.1921), p.2-3.

8. Earle P. Scarlett, "Reginald Burton Deane," Calgary Associate Clinic Historical Bulletin, 6: 1 (February 1942), p.9.

9. Earle Scarlett to Mrs. R.B. Deane, 27 June 1941, Manning Collection of Deane papers, Calgary.

10. Olav Rostrup, notes made after the death ofR.G. Huckell, 1967.

CHAPTER TWO

1. F.H.H. Mewburn, "Report to the Orthopaedic Department, University of Alberta Hospital," unpublished transcript, 1924, p.1.

2. Ibid., p.3.

3. A.E. Wilson, interview with D.B. Harkness, Calgary, 30 November 1987.

4. Hepburn, "Medical Practice," p.131.

5. Townsend, "Orthopaedic History," p. 8.

6. Glen E. Edwards, "Historical Review of the Residency Program, Alberta Children's Hospital, Calgary," unpublished typescript, 1979.

7. "Table Showing Number of Practitioners in Alberta by Type of Practice," AMB 25:2 (May 1960): p.81. 157

CHAPTER THREE

1. Hepburn, "Medical Practice," p.130.

2. P.B. Rose, "The Status of the General Practitioner," AMB 25:2 (May 1960): p.14.

3. Kenneth Clute, The General Practitioner: A Study of Medical Education and Practice in Ontario and Nova Scotia. (Toronto: University of Toronto Press, 1963), p.51.

4. "Table Showing Number of Practitioners in Alberta by Type of Practice," AMB 25:2 (May 1960): p.81.

5. John D. Higinbotham, When The West Was Young. (Toronto: Ryerson Press, 1933), p.173.

6. E.C. Shortcliffe, "Dr. Everett Andrew Porter," AMB 16:4 (November 1951): p.28.

7. George D. Stanley, Fun in the Foothills, (Calgary: private printing for the author, 1951), p.59.

8. D.A. Stanley, "Dr. NevilleJames Lindsay," AMB 17:3 (August 1952): p.30.

9. Townsend, "Orhtopaedic History," p.6.

10. Earle P. Scarlett, "Historical Sketch of the Calgary Associate Clinic," typescript, c.1965, Glenbow Archives.

11. Brown, AOA Anthology, p.118.

12. Edward Smyth to D.B. Harkness, 12 February 1988.

13. Robert I. Harris, A History of the Canadian Orthopaedic Association.(Toronto: Canadian Orthopaedic Association, 1968), p.4. 158

14. Clute, The General Practitioner, pp.228,247.

15 . News item, AMB 6:3 (July 1941): p.8.

16. News item, AMB 5:2 (April 1940): p.4.

17 . Ibid.

18. AMB 17:2 (May 1952): p.7. AMB 18:2 (May 1953): p.43. AMB 21:4 (November 1956): p.11.

CHAPTER FOUR

1. News item, AMB 15:1 (January 1950): p.37.

2. Hugh Arnold, interview with A.K.Kirchner, c.1980, typescript in collection of the University of Calgary Medical Library.

3. Harris, History of the COA, p.44.

4. J. Ross Vant and Anthony Cashman, More Than a Hospital: University of Alberta Hospitals 1906-1986. (Edmonton: University Hospitals Board, 1986), p.281.

5. W.S. Stanbury, "Toward a United Mankind," Canadian Red Cross Society Annual Review, (Toronto: 1956), p.7.

6. Stanbury, "United Mankind," p.7.

7. "Bills Will Be Issued After 35 Year History," news item, c.1958, collection of Alberta Children's Hospital.

CHAPTER FIVE

1. Townsend, "Orthopaedic History," p.5.

2. Morley Cody, "The Junior Red Cross Crippled Children's Hospital, Annual Report," (address delivered at the Annual 159

Meeting of the Canadian Red Cross Alberta Division, Edmonton, 21 February 1947).

3. Smyth to Harkness.

4. M.G. Graves, "Alberta Red Cross Crippled Children's Hospital Report, 1955," copy in collection of Alberta Children's Hospital.

CHAPTER SIX

1. Junior Red Cross Crippled Children's Hospital (hereafter cited as JRCCCH) Annual Report, 1944, quoted in D. Geneva Lent, Alberta Red Cross in Peace and War. 1914-1947, undated typescript in collection of the Alberta Children's Hospital, p.110.

2. Canadian Red Cross Society Alberta Division, "Nation Builders: Are You One?" pamphlet, 1922, p.22.

3. lbid,p.11.

4. Vant, More Than A Hospital, pp.79-81.

5. Margaret Barclay and William Barclay, "First Years at the Camsell Hospital," The Camsell Mosaic: The Charles Camsell Hospital 1945-1985. (Edmonton: Charles Camsell History Commttiee, 1985), p.23.

6. Mewburn, "Report of the Orthopaedic Depart.," pp.3-4.

7. JRCCCH Annual Report to the Canadian Red Cross Society Alberta Division, 1925.

8. Anonymous typescript, c.1942, on the history of the JRCCCH, collection of the Alberta Children's Hospital.

9. JRCCCH Annual Report, 1944, in Lent, Alta. Red Cross, p.95.

10. Cody, "JRCCCH." 160

11. JRCCCH Annual Report, 1926, collection of the Alberta Children's Hospital.

12. Gorden Townsend et al., "Report of the Alberta Health Survey," AMB 14: 1 (January 1949): p.28.

13. JRCCCH Annual Report, 1953, collection of the Alberta Children's Hospital.

CHAPTER SEVEN

1. Harold V. Rice, "Poliomyelitis in Edmonton, 1953," AMB 19:4 (November 1954): pp.55-56.

2. Gordon Wilson, "Poliomyelitis," AMB 16:4 (November 1951): p.24.

3. Vant, More Than A Hospital, p.79.

4. F.H.H. Mewburn, "Some Notes on the After Treatment of Poliomyelitis," AMB 16: 1 (February 1951): p.6.

5. Gordon Wilson, "Orthopaedic Therapy in Poliomyelitis," AMB 17:4 (November 1952): p.10.

6. Vant, More Than A Hospital, p.202.

7. Ibid.

8. JRCCCH Annual Report, 1938, in Lent, Alta. Red Cross, p.69.

9. Ibid., JRCCCH Annual Report, 1942, p.86.

10. Townsend, "Orthopaedic History," pp.13-14.

11. Rostrup, "What's New," p.90.

12. G.M. Little, "Poliomyelitis," AMB 15: 1 (January 1950): p.20. 161

13. Mewburn, "Poliomyelitis," pp.6-8.

14. Vant, More Than A Hospital, p.224.

15. Rice, "Poliomyelitis in Edmonotn," pp.55-56.

CHAPTER EIGHT

1. JRCCCH Annual Report, 1925.

2. Mewburn, "Report of the Orthopaedic Department," p.3.

3. Miriam Wright, "Wards 7 and 8 in the Early 50's," Camsell Mosaic, p.71.

4. J.S. Gardiner to D.B. Harkness, 4 November 1987.

5. Barclay, "First Years at Camsell," p.24.

6. Leo Sowan, "I Have a Great Deal to Live For," Camsell Mosaic, p.93.

7. "Unique Artificial Limbs Show Native Ingenuity," Camsell Mosaic, p.28.

8. "Matthew Matas, My Recollections," Camsell Mosaic, p.21.

9. Matthew Matas, "What is Tuberculosis?" Camsell Mosaic, p.248.

CHAPTER NINE

1. Mewburn, "Report of the Orthopaedic Department," pp.1-2.

2. Rostrup, "What's New," pp.87-91.

3. Ibid. 162

4. "Surgical Work in Hospitals," AMB 9:3 (July 1944): p.20.

5. Arnold to Kirchner, p.24.

6. Rostrup, "What's New," p.50.

7. News item, AMB 1:6 (July 1936): p.12.

8. "Increase in Auto Accident Deaths," AMB 2:10 (July 1937): p.4.

9. News item AMB 6:2 (April): p.22 .

10. Joseph P. Moreau, "Medical Aspects of Traffic Accidents," AMB 21:2 (May 1956): p.25.

CHAPTER TEN

1. Townsend, "Orthopaedic History," p.3.

2. North Pacific Orthopaedic Society, Fiftieth Anniversary Anthology 1925-1975, (Oregon and Washington: NPOS 1975), p.1.

3. Brown, AOA Anthology, p.29. 163

BIOGRAPHIES

Colonel F. H. Mewburn, OBE, MD, CM(McGill), LLD(McGill), LLD(Alberta)

Alberta's pioneer figure in orthopaedic surgery, Lieutenant­ Colonel Frank Hamilton Mewburn, descended from a long line of physicians begun in 1765, when James Mewburn, yeoman, of Turham, England, apprenticed his seventeen-year-old son, Francis, to Thomas Hormby for seven years in "the art, science and mystery of apothecary." Francis's second son, John, followed in his father's footsteps. He trained as a doctor, obtained his MRCS in England, and came to Upper Canada in 1832. His son, Francis Clarke, who also became a doctor, 1was first apprenticed to his father and later studied in Philadelphia. He returned to Upper Canada and practiced first in Weston then in Drummondville (Niagara Falls). Frank Hamilton Mewburn was the youngest of Francis Clarke Mewburn's seven children, born in 1858 and named for his father's close friend .and associate, Dr. Frank Hamilton, Professor of Surgery at the University of Buffalo. Mewburn graduated from McGill in medicine in 1881, interned at the Montreal General 1881-82, and was House Surgeon at the Winnipeg General Hospital from 1883-84. In 1885 the Second Riel Rebellion broke out, and Mewburn was appointed surgeon-in-charge of the base military hospital established in the wards of the Winnipeg General Hospital. 164

In 1886 he moved from Winnipeg to Lethbridge, where the construction of the CPR and the opening of the West had led to the development of coal mines. Mewburn became the doctor for the Lethbridge community and surrounding district and was put in charge of the combined RCMP and miners hospital completed in September of 1886. This hospital was the beginning of the Lethbridge Galt Hospital. In 1913 Mewburn moved to Calgary and limited his practice to surgery. In 1914 he enlisted and was placed in charge of the Surgical Division of the Military Hospital at Taplow, England, where he remained for the duration of the war. In 1918 he was invested with the Order of the British Empire. He returned to private practice and in 1922 was appointed Professor of Surgery in the new University of Alberta medical school in Edmonton and continued in this capacity until his death in 1929. The Mewburn Military Pavilion at the U of A Hospital was named to commemorate his contribution to orthopaedic surgery, particularly in the area of war injuries.

Dr. R. B. Deane

Dr. Reginald Burton Deane was born 23 July 1870 in Yeoville, Somersetshire, England, the eldest son of Captain R. Burton Deane and Martha Ridout. Captain Deane had been educated at the Royal Military College, Sandhurst, and was commissioned in 1866 as a Lieutenant in the Royal Marines. When advancement opportunities became limited, he left the marines and sailed to Canada, leaving Liverpool on the S.S. Toronto and arriving on 31May1882. He joined the North West Mounted Police on the recommendation of his influential and politically well-known cousin, T.C. Patteson, and reported to Regina. In 1883 he brought his family out to Regina. Captain Deane became Adjutant in Regina and there compiled the first published edition of Regulations and Orders of the Force (1889). He was also responsible for Louis Riel during his imprisonment in Regina, gave evidence at Riel's trial, and was present at the execution, as was Reginald. Captain Deane was posted to Lethbridge, then to Maple Creek, Saskatchewan, and finally to Calgary, where he built the Deane House, now a well-known historical site on the Fort Calgary property in east Calgary. Captain Deane retired from the RCMP in 1914 and returned to England to write his memoirs of life in 165 western Canada, Mounted Police Life in Canada, which were published in 1916. When his father was stationed at Chilton, Kent, Reginald Deane had attended school, but after the family came to Canada his schooling was provided mainly by tutors. At age seventeen he started work as a clerk in a government office in Regina. Although he wanted to be a veterinarian at first, his friendship with the RCMP physician, Dr. Jukes, kindled his interest in medicine. He always spoke of Dr. Jukes as his "guide, philosopher and friend whose influence has pervaded by entire life." Deane's education had been so irregular that he had to attend St. John's College in Winnipeg before he was able to enter McGill Medical School in 1894. He graduated in 1898. In 1899 Deane registered with the Northwest Territory Medical Council and opened a practice in Maple Creek, Saskatchewan. That same year he married Bertha Finch, a graduate of nursing from Montreal General Hospital. Deane practiced in Maple Creek for nine years, then moved to Lethbridge in 1908 to become assistant to Dr. Mewburn, whom he had met while his father had been posted there. In 1910 he became Mewburn's partner and moved to Calgary with him. In 1919 Dr. Deane went to England to study Orthopaedic Surgery in London, Bristol and Liverpool. He returned to Calgary in 1921, one of the first trained orthopaedic surgeons to practice in western Canada. He spent much of his professional career at the Junior Red Cross Crippled Children's Hospital in Calgary, retiring in 1939 because of ill health. Dr. Deane died of pulmonary emphysema and its complications on 23 June 1941 at the age of sixty-nine. His Honourary Pallbearers were Colonel G.E. Sanders, Dr. A.H. McLaren, Dr. E.P. Scarlett, Dr. E.R. Selby, Dr. A.W. Park and Hugh Farthing. Active Pallbearers wereH.A. Allison, Dr. H.M. Jennings, Dr. M.C. Cody, Dr. R.R. Hughes, Dr. R.G. Townsend and Dr. F.D. Wilson. Upon Dr. Deane's death, Dr. E.P. Scarlett, then Chancellor of the University of Alberta, described his friend as a man who was "fiercely honest, blunt to a fault, and did not suffer fools gladly. He was not a mixer and as he aged he retired into himself." His obituary in the Alberta Medical Bulletin. 1941 said, "He was meticulously careful and methodical in his work and seldom wrong in his diagnosis, yet he was inclined to minimize his own abilities. He was greatly beloved by the children, and they had complete confidence in him. He was a constant 166 reader of good books on many and diverse subjects. It is a matter of regret that Dr. Deane did not review in writing the historical events of the early days in the Northwest Territories, for of these he had an intimate knowledge. He met many of the notable personages of the west who had much to do with moulding public opinion and who were instrumental in fashioning the course of events in the Northwest Territories."

Dr. F.H.H. Mewburn, OBE, VD, BSc, MD, CM(McGill), FRCS(C), FACS

Dr. Frank Hastings (Hank) Hamilton Mewburn was born in Lethbridge on 6 September 1888, the son of Colonel Frank Mewburn. He enlisted in the Canadian Army immediately following his graduation from McGill Medical School and served first in France with the Twentieth Battery Canadian Artillery Unit, transferred to the Royal Canadian Army Medical Corps, and at the war's end was on staff at the Canadian Hospital at Taplow, England. While in England he co­ authored a 1918 article in the British Medical Journal on "The Technique of the Carrel-Dakin Treatment." Hank Mewburn returned to Canada in 1918 and served as an orthopaedic surgeon with the Soldiers' Civil Re-establishment in Edmonton until the fall of 1920, when he left for postgraduate studies in Boston. He came back to Edmonton in 1922 and was appointed by the Department of Health to direct the treatment of crippled children admitted through the Outpatient Department of the University of Alberta Hospital. He was surgeon in charge, orthopaedics, from 1922-24; director of the Department of Orthopaedics from 1924-48; and senior surgeon from 1948-54. After he retired as director in 1948, he continued in private practice until his death in 1954. He was survived by a son, Dr. Robert Mewburn, Vancouver, B.C.

Dr. R. G. Huckell, MD, CM(McGill), FACS, FRCS

Dr. Robert Graham Huckell was born at Lakefield, Ontario, in 1898 but moved to Alberta at an early age and attended school first in Calgary, then in Edmonton. He served overseas with the First Canadian Mounted Rifles during World War I. Following demobilization Huckell 167

enroled at McGill University, graduating MD, CM in 1924. After graduation he returned to Alberta to intern at the U of A Hospital, then entered general practice in rural Alberta for two years. In 1927 Huckell returned to the U of A Hospital and associated himself with Dr. Hank Mewburn. In 1930 he opened his office for the practice of orthopaedic surgery. On Hank Mewburn's retirement in September of 1948, Dr. Huckell became Clinical Professor of Orthopaedic Surgery at the U of A and Director of Orthopaedic Surgery at the U of A Hospital. In 1957 he retired as director and returned to private practice. Dr. Huckell was a founding member of the Surgical Society of Western Canada, as well as of the Canadian Orthopaedic Association, of which he was President in 1952. Dr. Huckell served the U of A Hospital for forty-three years and was remembered as a very kind, skillful surgeon who never complained of his physical disability of a drop foot from a lumbar disc. He died in Edmonton in 1967. As Dr. Robert McBeth noted in the permanent minutes of the Faculty of Medicine, University of Alberta, "Those of us of sufficient age and memory will recall the devastating poliomyelitis epidemics of 1926, 1927, and 1930-31 in Western Canada and a consequence, the Provincial Special Unit erected adjacent to the University Hospital in 1928. It was in this setting that many remember Dr. Huckell most vividly and remember him too for his remarkable anatomical knowledge in relation to the exposure of bones and joints and the speed and precision with which he performed his surgery."

Dr. 0. Rostrup, MD(Alberta), FRCS(C), FACS, Diplomat of American Board of Orthopaedic Surgery

Dr. Olav Rostrup was born in Rosthern, Saskatchewan, had his early education in Cardston and Stettler, Alberta, and graduated in medicine from the U of A in 1937. He took three years of orthopaedic training at the U of A Hospital and practiced a year in Edmonton with Drs. Mewburn and Huckell before joining the Canadian Army. He was posted to England for a short time and then was at the Colonel Belcher Hospital in Calgary with Dr. Smitty Gardiner. Dr. Rostrup returned to Edmonton to head up the Chronic War Injuries Treatment Centre in 1945. The following year he travelled to 168

St. Louis for two months to study for the American Boards in orthopaedic surgery. He received the Royal College Fellowship in 1948. Dr. Rostrup acted as President of the Canadian Orthopaedic Association in 1972. For many years he was the Assistant Director of the R.S. McLaughlin Examination and Research Centre in Edmonton, which was responsible for developing and carrying out the examination process for the Royal College of Physicians and Surgeons of Canada. He was also Medical Consultant for the Edmonton Eskimos Football Team from 1949-60. Dr. Rostrup was the first orthopaedic surgeon in Alberta to do scientific research and extensive scientific writing. His initial scientific paper was written during World War II and was entitled "Inspection and Treatment of Soldiers' Feet," published in the Canadian Medical Association Journal in 1942. He later did a great deal of work and writing on knee ligament injuries, especially with substitutes such as tetlon, and his work was printed in the Canadian Journal of Surgery in 1959, 1960 and 1964. His co-authors for this work were Gort and Emery, two of his early residents. One of his papers on prosthetic replacement for the head of the radius and fractures was co-authored with one of his early residents, Dr. Glen Edwards, and was also published in the Canadian Journal of Surgery. He remained very active following his retirement from orthopaedic surgery. In fact, he suffered a heart attack while chairing the Fiftieth Reunion of his Medical Class in Calgary in 1987. He enjoys his retirement, pursuing his various hobbies, among them painting, silversmithing, greenhouse gardening (particularly orchids), fly fishing, hunting, and his long-standing interest in the history of western Canada.

Dr. G .L. Wilson

Dr. Gordon Wilson graduated from the U of A in 1940, served in the Navy during World War II, completed his orthopaedic residency in Montreal, then returned to Edmonton in 1948-49. He was a U of A instructor and his practice became specialized in arthritic surgery, primarily deformities of the hand. He retired early to Victoria in the 1970s. 169

Dr. R.G. Townsend

Dr. Gordon Townsend was born in Woodstock, New Brunswick, on 22 December 1903 and moved with his parents to Saskatoon when he was two years of age. He graduated with BSc from the University of Saskatchewan in 1925 and in medicine in 1929 from McGill University. He did postgraduate training in Montreal (at the same time Dr. Norman Bethune was doing surgical training), then took one year of thoracic surgery in Ann Arbor, Michigan, before going to Cardiff, Wales for three years of orthopaedic surgery under Dr. O.A. Parker. Dr. Townsend returned to Canada to practice at the Tuberculosis Sanatorium in Fort Qu' Appelle, Saskatchewan. In 1939 he moved to Calgary and entered into an orthopaedic practice that was to last for half a century, until his formal retirement on 31 March 1990. Townsend was the sole orthopaedist in southern Alberta until the late 1940s. He practiced with Dr. Tom Richardson for two years in the 1950s and with Drs. Edwards, Bazant and Dewar from 1960-82, when he took up solo consulting. Townsend was active with the Alberta Red Cross Crippled Children's Hospital, serving not only on the medical staff and executive but also on the Hospital Foundation. He was also involved for many years in the Easter Seal Campaign to raise money for the Children's Hospital. His contributions to the hospital were recognized when the integrated school was named the R.G. Townsend School in his honour. Townsend was President of the Calgary Medical Society, a Director of the Alberta Medical Association, and President of the Canadian Orthopaedic Association in 1966. He was involved in the staff associations of several hospitals in Calgary and was chief of staff at the Rockyview Hospital. He received an honourary doctorate from the University of Calgary in recognition of his long standing service to medicine in the city. His service to the community in orthopaedic surgery was recognized when he was made an Honourary Professor of Surgery at the University of Calgary at the same time that this honour was given to Dr. Smitty Gardiner. Townsend had also been a member of the Rotary Club, the Shriners, United Way and was President of the Churchill Society of Calgary. Today he remains in good health in retirement at the age of 87 . 170

Dr. E.H.J. Smyth

Dr. Edward Smyth served as a surgeon in the British Army from 1939-45 and in 1946 was at the Grenfell Mission in Labrador. On his arrival in Calgary in 1947, he worked for a short time at the Central Alberta Sanatorium before starting an orthopaedics practice in the city. One of the main magnets drawing Dr. Smyth to Calgary was its proximity to the mountains, and he did a lot of mountain climbing with the Alpine Club of Canada. He climbed with Drs. Smitty Gardiner and Keir MacGougan of Calgary, as well as with Lawrence Grassi of Canmore. An article by Dr. Smyth, "First Ascents in the Palliser­ Kananaskis Area," was published in The Canadian Alpine Journal in 1952. Dr. Smyth returned to his native Britain for non-professional reasons in 1952.

Dr. A.C. Walsh

Dr. Cyril Walsh was born in Winnipeg on 27 October 27 1912 and received his MD from the University of Manitoba in 1939, having been awarded the Gold Medal in medicine in his fourth year. He received his training in orthopaedics at the Mayo Clinic and the University of Minnesota. Walsh was a Lieutenant in the Royal Canadian Army Medical Corps in World War II and came to the Calgary Associate Clinic in 1948. He practiced mainly at the Holy Cross Hospital and the Children's Hospital. A very competent, able surgeon, Cyril Walsh encouraged a number of young orthopaedists to come to Calgary, including Vince Murphy, Don Sturdy, and Bill de Haas. He was manager at the Calgary Associate Clinic for many years and was very active in all their functions. He was the doctor for the Calgary Stampeder Football Team for some twenty years until his death in 1971 at his resort home in Windermere, BC. 171

ABOUT THE AUTHORS

Dr. Glen E.Edwards

Dr. Edwards graduated from the University of Alberta in medicine in 1954. He trained under Dr. Walter C. MacKenzie in general surgery and under Dr. Olav Rostrup in orthopaedics, before going to the Barnes Hospital in St. Louis, where he trained under Dr. Fred Reynolds and Dr. Mccarroll. He returned to Calgary in 1960, and joined practice with Dr. Gordon Townsend. He was a lecturer in orthopaedic surgery at both the I ' University of Alberta and the University of Saskatchewan, starting the residency training program in paediatric orthopaedic surgery at the Alberta Children's Hospital in 1961. He became Professor of Orthopaedic Surgery at the University of Calgary, was the Chairman of the Musculo-Skeletal Unit for the undergraduate curriculum at the University when it started in 1970, and started the postgraduate program in orthopaedic surgery at the U of C in the same year. Dr. Edwards has been a teaching professor at a number of institutions in Canada and overseas and has served in many professional associations. He was President of the Canadian Orthopaedic Association in 1980, President-Elect for the North Pacific Orthopaedic Society, and was one of the original founding members of the Scoliosis Research Society. He is the author of over fifty scientific publications and presentations covering broad aspects of orthopaedic surgery and paediatric orthopaedic surgery in particular. Dr. Edwards still teaches at the University of Calgary and maintains an active private practice.

Mr. Douglas B. Harkness

Mr. Harkness was born and raised in Calgary and is the grandson of Calgary politician Mr. D.S. Harkness. Mr. Douglas Harkness was educated at the University of British Columbia and the University of Victoria. After completing degrees in history and law, he has worked researching the social history of Western Canada. 172

BIBLIOGRAPHY

I. ORAL HISTORY

Interviews done in Calgary and Edmonton in 1987-1988 by D. B. Harkness: Dr. Moss Albert Dr. Gordon Cameron Dr. Glen Edwards Dr. Hugh Gallie Dr. J. S. Gardiner Dr. John Huckell Dr. D. Cooper Johnston Dr. Thomas Richardson Dr. Olav Rostrup Dr. William Rothwell Dr. R. Gordon Townsend Mrs. Esther Walsh Dr. A. E. Wilson Dr. Gordon Wilson, Victoria, B.C.

II. UNPUBLISHED DOCUMENTS

Arnold, Dr. Hugh, Interview c.1980 by A. K. Kirchner, 173

,.. typescript in collection of the University of Calgary Medical Library. Canadian Red Cross Society (Alta. Div.), Annual Report 1922. Canadian Red Cross Society, Annual Report, 1946. Cody, M., Address to Red Cross Annual Meeting, 21 February 1947. Deane, R.B., Address to the Calgary Medical Society, 1921, on the subject of Col. Mewburn, typescript in the private collection of Audrey Manning, Calgary. Edwards, G.E., "Historical Review of the Residency Program, Alberta Children's Hospital, Calgary," typescript, 1979. Junior Red Cross Crippled Children's Hospital -Annual Reports: 1925, 1938, 1939, 1942, 1944, 1947, 1950, 1951, 1952, 1953. -Patient Records -Anonymous typescript, c.1942, on the history of the J.R.C.C.C.H. Levine, C., "A Brief and Selective History of the Calgary Medical School," typescript, 1986. Macbeth, R.A., "Brief Review of the Career of R. G. Huckell," in the Minutes of the Faculty of Medicine, University of Alberta, 1967. Mewburn, F.H., "Notes on the Re-organization of the Department of Surgery, University of Alberta," typescript, 1923. Mewburn, F.H.H., "Report of the Orthopaedic Department, University of Alberta," typescript, 1924. Province of Alberta Department of Public Works, letter to Dr. F.H.H. Mewburn, 1928. Pryce to Kinnear, Letter concerning the history of the Alberta Children's Hospital, 12 August 1967, in the collection of the ACH. Scarlett;, E.P., "Responsibilities of the Hospital Administration to the Medical Staff," typescript, Glenbow Archives, Calgary, EPS Papers #414, 1949. -"Historical Sketch of the Calgary Associate Clinic," Glenbow Archives, c.1965. -Interview by C.G. Roland, 1978, typescript in the University of Calgary Medical Library. 174 ,.. -Letter to Mrs. R.B. Deane, 1941, collection of Audrey Manning. Smyth, E.H.J., Letter to Harkness, 12 February 1988. Sturdy, Donald, Letter to Harkness, 7 December 1987. Townsend, R.G., "The Early History of Orthopaedics in Alberta," typescript, 1974.

III. PUBLISHED ARTICLES

Gort, J. & Stanley, A., "Rehabilitation of the Surgical Patient," Alberta Medical Bulletin, Feb. 1957, p. 33. Graves, M.G., "Red Cross to Relinquish Control of Hospital After 35 Years of Service to Crippled Children," The Volunteer, Dec. 1957. Harris, R.I., et al., "Fifty Years of Orthopaedic History in Canada," Journal of Bone and Joint Surgery, 1950: 32B: 587. Little, G.M., "Poliomyelitis," Alberta Medical Bulletin, Jan.1950, pp. 19-20. "Medical Pioneering," Calgary Associate Clinic Historical Bulletin, 15:4:61:, 8:1:16:, 7:1:12. Mewburn, F.H.H., "Some Notes on the After Treatment of Poliomyelitis," Alberta Medical Bulletin, Feb. 1951, pp. 6-8 . Moreau, Joseph, "Medical Aspects of Traffic Accidents," Alberta Medical Bulletin, May 1956. Platt, H., "The Orthopaedic Hospital," Canadian Medical Association Journal, Dec. 26, 1964, vol. 91, 1339. Rice, H.V., "Poliomyelitis in Edmonton, 1953," Alberta Medical Bulletin, Nov. 1954, 45-56. Rostrup, 0., "What's New in Orthopaedics," Alberta Medical Bulletin, Jan. 1948, 87-91. Scarlett, E.P., "Reginald Burton Deane," Calgary Associate Clinic Historical Bulletin, Feb. 1942, pp. 9-16. Stanbury, W.S., "Toward a United Mankind," Annual Review of the Canadian Red Cross Society, 1956. "Surgeons Welcomed By Sarcee Indians," Calgary Herald, 6 June 1966. Townsend, R.G., in "Recommendations of the 1950 Alberta Health Survey," Alberta Medical Bulletin, May 1953 . 175

Wilson, G., "Poliomyelitis," Alberta Medical Bulletin, Nov. 1951, pp. 24-8. -"Orthopaedic Therapy in Poliomyelitis," Alberta Medical Bulletin, Nov. 1952, pp. 10-11.

IV. BOOKS

Agnew, Harvey. Canadian Hospitals. Toronto: University of Toronto Press, 1974. Bick, E.M. Source Book of Orthopaedics. New York: Hafner, 1948. Blishen, B.R. Doctors and Doctrines. Toronto: University of Toronto Press, 1969. Brown, Thornton. The American Orthopedic Association: A Centennial History. American Orthopaedic Association, 1987. The Camsell Mosaic. Edmonton: Charles Camsell History Committee, 1985. Clute, Kenneth. The General Practitioner: A Study of Medical Education and Practice in Ontario and Nova Scotia. Toronto: University of Toronto Press, 1963. Dawson, C.A. and Younge, E.R. Pioneering in the Prairies: The Social Side of the Settlement Process. Toronto: Macmillan, 1940. Feasby, W.R. The Canadian Medical Services: 1939-45, vol. 2, Ottawa: Cloutier, 1953. Hardwick, Evelyn. The Science. the Art. and the Spirit. Calgary: Century Calgary Publications, 1975. Harris, R.I. A History of the Canadian Orthopaedic Association. Toronto: University of Toronto Press or the COA, 1968. McDougall, Gerald, ed. Teachers of Medicine. Calgary: University of Calgary Press, 1987. McGugan, Angus. The First Fifty Years. Edmonton: University of Alberta Press, 1964. North Pacific Orthopaedic Society: Fiftieth Anniversary Anthology. NPOS, 1975. Scollard, D. Hospital: A Portrait of Calgary General. Calgary: Calgary General Hospital, 1981. Scott, J. W. The History of the Faculty of Medicine at the University of Alberta. Edmonton: University of Alberta, 1963. 176

Shortt, S.E.D., ed. Medicine in Canadian Society. Montreal: McGill­ Queens University Press. Stanley, Dr. G.D. Fun in the Foothills. Calgary: private printing, 1951. Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1982. Vant, J.R. and Cashman, A. More Than A Hospital: University of Alberta Hospitals 1906-86. Edmonton: University Hospitals Board, 1986. 177

UNIVERSITY OF ALBERT A Residents Training Program -- 1938 to Present

Allen, Gordon Lavoie, Mitch Anderson, Robert Leung, Paul Arnett, Gordon D. Mahood, Jim Balyk, Robert Makar, Donald J . Bauman, John McDonald, D. M . Bazant, F. James Mclvor, John Boucher, Peter R. McMillan, James F. Bradford, Mike McNaught, D. Ross Bredo, Lance K. Myers, W. N. Cameron, Gordon W. O'Brien, Peter J. Cinats, John O'Connor, Greg Constantini, William A. Oedekoven, Garrod Cook, Chris Okamura, Garry Davis, Lyle A. O'Neill, Micheal 0. Dick, Don Ong, Hong-Ke Dinwoodie, Donald A. Ordman, Jack A. Donnelly, Patrick J. Otto, Dave Edwards, Glen E. Otto, T . G. Emery, M. A. Penny, J. Norgrove Fuller, J. A. Purnell, Roger Glasgow, Robert M. Reid, David C. Gort, John Richardson , Al Green, Edward A. Rittenhouse, Brian Greenhill, Brian J. G. Roberts, Melville G. S. Greidanus, Thomas H. Rostrup, Olav Henderson, Ron Russell , Gordon Hicks, Tracy E. Russell, Kelvin J . Hjelkrem , Mike Sendziak, Joseph C. Hollinshead, Robert M . Siaw, Michael Hopp, Philip G. Skura, Doug Hu , Richard Smith, Bruce Huckell , John R. Stanger, Michael A. Hunka,. Larry E. Stanley, A. A. W. James , Kenneth W . Sunohara, Philip T. Johnston, D. Cooper Taillon, Mario Kass, Vello Tatebe, Rodney Y. Kastelen, Nick R. Taylor, Scott Kortbeek, Frank Traub, Gordon E. Koshman , Robert W. Urban, A. S. , Kwok, Man-Kwong (Joe) Vandeguchte, Robert Lake, Dave Vokey , Sue Latham, T . Wakefield, John K. Lavoie, Guy Weisgerber, Kim 178

UNIVERSITY OF CALGARY Residents Training Program -- 1970 to Present

ABELSETH, G. KESMARKY, Susanne BANKS, G. KIEFER, G.N. BEATON, W.N. KING, G. BEA VER, Patti LAPP, Ralph A. BUCKLEY, R.E. MACKENZIE, Don BURKART, Brian MACKENZIE, J. BRAY, Robert C. MCAVOY, G. CHENGER, J.D. MILLER, S.D. CRAGG, G. MISSIUNA, P.C. CROUS, R.O. MOHTADI, N.G. DEWAR, Richard D. NATTRASS, G. DONAGHY, J .J. O'BRIEN, Maureen D. DOUGALL, Hugh R. PENNER, D.A. FALLON, P. PERLAU, R. FRANK, Cyril B. REIKIE, W.R. FENNELL, C. SALO, Paul T. GRAVEL, C. SCHACHER, Norman S. GRYPMA, M. SCOTT, C.D. GOLDSTEIN, S. STEWART, J. HARDER, James A. SUNDBY, K.A. HILDEBRAND, K. VAN ZUIDEN, L.J. INSTRUM, K. WAHL, Dal E. JENKINSON, DJ. WALLA CE, Tom JOHNSON, R. YEE, G. JONASSEN, E.A. ZWICK, R. 179

Rotation of Residents in Training for Paediatric Orthopaedics at the Alberta Children's Hospial 1961-1980 from The University of Alberta The University of Calgary The University of Saskatchewan

Date Program Date Program Emery 1961 U of A Makar 1973 U of A Baz.ant 1961 U of A McMillan 1973 U of A Gort 1961 U of A Stanger 1974 U of A Gneuchtel 1962 U of S Dewar 1974 U ofC Greenhill 1962 U of A Bauman 1974 U of A Lewke 1963 U of S Sendziak 1974 U of A Ozshain 1964 U of A Schachar 1975 U ofC Pritchard 1964 U of S Kass 1975 U of A McNaught 1965 U of A Hicks 1975 U of A Zarkesh 1965 U of S Arnett 1975 U of A Urban 1966 U of A Kosh man 1976 U of A Green 1966 U of A Wahl 1976 U ofC Myers 1967 U of A Crous 1976 U ofC Silver 1967 U of S Ongl 976 U ofC Yandel 1967 U of S Lapp 1977 U ofC Siaw 1968 U of A Penny 1977 U of A Russell 1968 U of A O'Neill 1977 U of A Khan 1969 U of S Harder 1977 U ofC Traub 1969 U of A Reid 1978 U of A Glasgow 1969 Uof A Reike 1978 U ofC Baria 1970 U of S Johnson 1978 U ofC Davis 1970 U of A Kwok 1978 U of A Greidanus 1970 U of A Latham 1979 U of A Mehta 1970 U of S Hollinshead 1979 U of A Roberts 1971 U of A Dinwoodie 1979 U of A Sunohara 1971 U of A Zwick 1979 U ofC Kastel en 1972 U of A Frank 1980 U ofC James 1972 U of A Tatebe 1980 U of A Woodruff 1972 U of A 180 03CfCf~ / ALBERTA ORTHOPAEDIC SURGERY --A.M.A. Register 1991

Edmonton Albert, Moss Edmonton Johnston, Donald C. Anquist, Kenneth A. Calgary Joughin, V. Elaine Calgary Arnett, Gordon D. Edmonton Kiefer, Gerhard N . Calgary Austin, Martin Calgary King, Graham J .W. Calgary Edmonton Bauman, John Calgary Lavoie, Guy J. Bazant, F. James Calgary Lavoie, Michel V. Edmonton Bell, G. Douglas Calgary Leung, Paul Man K. Edmonton Boucher, Peter R. Edmonton MacKenzie, James R. Calgary ouwman, Henry W. Thorsby MacKenzie, Roderick I. Medicine Hat Edmonton Bray, Robert C. Calgary Mahood, James K. Bredo, Lance K. Red Deer Makar, Donald J. Edmonton Buckley, Richard E. Calgary Mcivor, John B. Edmonton Cameron, Gordon W. Edmonton McKenzie, Alvin H. Edmonton Cinats , John G. Edmonton McMillan , James F. Edmonton Colter, Donald R. Edmonton McMurtry, Robert Y. Calgary Costantini, William A. Calgary Miller, Stephen D. Calgary Crooks, William L. Calgary Mohtadi, Nicholas G. Calgary Davis, Lyle A. Edmonton Moreau, Joseph P. Edmonton Dewar, Richard D. Calgary Moreau, Marc J. Edmonton Dick, Donald A. Edmonton Murphy, Vincent J. Calgary Donaghy, John J. Calgary Myers, William N. Lethbridge Donnelly, Patrick J. Red Deer Narang, Rajendra Edmonton Driedger, Gerhard Lethbridge O'Brien, Maureen D. Calgary Edwards, Glen E. Calgary O'Connor, Gregory J. Edmonton Esmail, Salim M.A. Leduc Ordman, Jack A. Red Deer Fairbanks, Calvin J. Calgary Penner, Darrell A. Calgary Fennell, Colin W. Calgary Reid, David C. Edmonton Frank, Cyril B. Calgary Reikie, W. Rod Red Deer Glasgow, Robert M. Edmonton Richardson , Thomas A. Calgary Gort, John Edmonton Rigal, Wynne M. Edmonton Greidanus, Thomas H. Edmonton Rostrup, Olav Edmonton Grypma, Martin Lethbridge Russell, Kelvin J. Edmonton Harder, James A. Calgary Schachar, Norman S. Calgary Harvey, John H. Edmonton Scott, Earl D. Medicine Hat Henderson, Robert S. Edmonton Sendziak, Joseph C. Grande Prairie Hollinshead, Robert M. Calgary Singh, Santokh Edmonton Huckell, John R. Edmonton Sunohara, Philip T . Grande Prairie Hughes, Gary N.F. Calgary Townsend, R. Gordon Calgary Hunka, Larry E. Edmonton Urban, Albin S. Calgary Hunter, John M. Calgary van Zuiden, Lowell J. Calgary Hurdle, Ian B. Lethbridge Vincent, Nancy E. Lethbridge James, Kenneth W. Edmonton Wakefield, John K. Red Deer Jenkinson, David J. Calgary Johnston, D.W.C. Edmonton

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