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.