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than in other areas where the children attend hospitals at which the surgeons prefer
removal at an earlier age.
In provincial cities there is, naturally enough, a comparatively small number of
orthopaedic surgeons, and the views of the leading surgeons on such a point are likely
to dominate much more strongly the general practice. If it should so happen,
therefore, that comparison is made with a city in which the more general practice is
to abandon apparatus, London must, of necessity, show a higher proportion of
apparatus cases.
A statement as to the number of leavers still wearing apparatus, expressed as
a percentage of the total numbers in attendance at special schools, affords but a slender
basis for criticism, unless the proportion of those attending the schools who suffer
from ailments which have never required the use of apparatus is also given, and is of
a comparable order. A more correct figure is the number of those who have needed
apparatus and have been so far cured as to be able to discard it. There is no reason
to doubt that conservative surgery and operations for the restoration of function and
stability are as much in evidence in London as elsewhere.
In this connection, it should also be remembered that there may be certain
districts in which the proportion of children wearing no apparatus is greater for the
simple reason that the defects have not been consistently and continuously treated at
all owing, perhaps, to the absence of special interest in orthopaedic work among the
surgeons of the local hospitals or, simply because there are no means by which the
children are assisted to obtain the necessary appliances.
This is not the case in London, where the vast majority of children receive
treatment and are placed in a position to earn a livelihood without handicap or undue
strain and have been protected, so tar as is possible, throughout their school age.
There is always a certain number of instances in which parents decline operative
treatment, however advisable, and wander from hospital to hospital in search of
some surgeon who will accept their views as to non-operative treatment. Most
usually compulsion cannot be applied to these, for the parents are able to show
in the end that they are acting under some form of medical sanction and so claim
that this action is bona fide for the benefit of their child.
Comparing the present situation with that at the beginning of the century, there
can be no question of the beneficial effects of the steady campaign in favour of
early treatment, and the small number of cripples to be seen in the streets in
comparison with those in certain other areas is eloquent testimony to the
effectiveness of the social service rendered in connection with education.
The chronic manifestations of encephalitis lethargica are of a protean order and
include those showing moral, intellectual, emotional and metabolic changes, and
Encephalitis
lethargica.
lastly, there are the neurological types among which may be mentioned the cases
exhibiting the Parkinsonian syndrome as well as those developing contractures and
wasting of various muscles, and palsies of miscellaneous description. It is among
the last mentioned group that orthopaedic treatment and care are required.
Since November, 1925, by arrangement with the Metropolitan Asylums Board,
100 beds have been provided for children between the ages of 3 and 16 years, suffering
from the sequelae of encephalitis lethargica. They are admitted for observation and
treatment to the Northern Hospital, Winchmore Hill. The treatment necessarily
varies according to the type of case, but all facilities are provided by the Board
at the hospital for correctional treatment of cases of muscular unrest, hypertonicity
or contractures of muscles and for Parkinsonian rigidity. The treatment includes
massage, gymnastics, electrical therapy, artificial sunlight, etc., whilst splints and
surgical footwear are supplied where required. Ordinary school lessons and instruction
in various kinds of handwork are also given.
Between November, 1925, and 31st December, 1927, there were 169 cases
(including 11 readmissions) dealt with at this institutional unit, and 98 have been