View report page

152
boroughs on special enquiry forms. These cases are followed up and, at the end of three
months, institutional treatment at Queen Mary's Hospital is offered. If the parents'
consent is obtained, an application form is filled up by the medical officer of health
concerned, and, if approved by the Council's medical officer, the form is sent to the
Metropolitan Asylums Board and the child is admitted within a day or two. A
similar procedure is adopted with regard to any non-notified cases which come to
light and those cases in which application is received from a voluntary hospital.
When the children are discharged the medical notes on the case are sent by the
medical superintendent of Queen Mary's Hospital to the Council's medical officer of
health, who communicates them in turn to the voluntary hospital which the patient
attended prior to admission and to the medical officer of health of the borough
concerned. The children are specially examined to see if attendance at a day (P.D.)
school is desirable.
There is no doubt that the scheme has been successful in the amelioration of
the crippling conditions resulting upon poliomyelitis, and even greater success will
be accomplished as hospitals, medical practitioners and others concerned become
more familiar with the facilities available and earlier attention is drawn to such cases
with a view to the prompt and appropriate treatment in the early and acute stages
of the illness. For this purpose the Council places at the disposal of the medical
profession the services of its expert medical staff for assistance in early diagnosis.
Special care is taken in following up to see that all children who have suffered
from poliomyelitis wear suitable apparatus for such periods as the surgeons who
have had charge of their cases deem necessary, or, if splints have been omitted
and there appears to be any further risk of seeondary deformity or weakness, that
the case shall be reconsidered.
The
continued use
of splints.
London has been criticised in the report of the Chief Medical Officer of the
Board of Education from the standpoint of the relative number of children who leave
the special schools wearing apparatus up to the date of departure. It should be
recognised, however, that it is only those who are severely crippled who are admitted to
the P.D. schools. It is also the fact that in London there is a large body of expert
orthopaedic opinion which holds that apparatus should be worn as a precautionary
measure for a considerable period after discharge from hospital, more especially in
those cases where the wearing of such apparatus does not increase the social disability
of the sufferer. Surgeons holding this view recommend children to continue to wear
apparatus while at school. This advice applies, not only to cases of infantile
paralysis, but also, and perhaps even more so, to cases of bone and joint tuberculosis.
There are fashions in orthopaedic surgery as in other matters and sound arguments
may be put forward by each side in support of the varying opinions held on
this point. In any event the fact remains that some surgeons aim at so managing
their cases that apparatus shall be abandoned at the earliest moment while others
prefer that its use shall be continued for prolonged periods. The surgeons in
question, on either side, are of the highest eminence, attached to the best known
hospitals in this country, and each of them can and do put forward specific cases in
support of their respective views. The system of following up adopted by a public
authority to secure treatment does not provide for taking sides in a clinical dispute
on differences of method of treatment, though the officers by drawing the attention
of surgeons to after-results may frequently provide valuable information which
ultimately may or may not influence surgical opinion. The fashion in any area may,
however, seriously influence the proportion of the children in any given number of schools
who wear apparatus.
In London, with the number of hospitals available, there are examples of all
varieties, and it may be that, in certain parts of the county, where the children tor
the main part attend hospitals at which the orthopaedic surgeons prefer the apparatus
to remain, there will be more cases at the age of fifteen years wearing such apparatus