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Orthopaedic cases
Mr. R. C. Baird, F.R.C.S., the Council's Consultant Orthopaedic Surgeon, has given
the following comments on the changes over the years, as far as orthopaedic cases are
concerned :
' In the three years surveyed in Table (ii) and Diagram " A " the proportion of
orthopaedic cases has remained remarkably constant at approximately half of the total
numbers. The fall in the total numbers of orthopaedic cases has, therefore, marched in
step with the fall in the total numbers of all types of cases.
' The conditions which have contributed most to the fall in numbers of orthopaedic
conditions are tuberculosis of bones and joints, rickets and osteomyelitis. In 1928 these
three conditions totalled 883, whilst in 1951 the total was 195 and in 1957 it was 88.
Thus ten children were at a special school because of these three conditions in 1928 to
every one in 1957. As one would expect, the sequelae of these conditions, when they do
occur, are undoubtedly very much less severe. One now very rarely sees tuberculosis
involving more than one bone or joint site and the deformities following osteomyelitis
are usually minimal : for this reason a large proportion of these cases will spend only a
limited time at a special school.
' It is difficult to comment on the figures for post-poliomyelitis cases. This condition
occurs mainly in epidemics and the severity of the cases as a whole varies with each
epidemic. So far there has been no dramatic improvement in the treatment of the acute
case when it occurs, but there has been a steady improvement in the treatment of the
deformities which subsequently occur. A large proportion of the severe cases of postpoliomyelitis
will remain at a special school for the remainder of their school life, but
the less severe cases may well be transferred to an ordinary school once the optimum
result from physiotherapy and surgical treatment has been obtained. As many of the
schools now have physiotherapy facilities on the school premises, much school time
can be saved by thus eliminating the travelling to and from hospital.
' Still's disease is responsible for the bulk of the cases listed as arthritis. The lowering
of the incidence of this very disabling condition in schools for the physically handicapped
is due very much more to the higher standards of living than to any advance in medical
science.
' The figures in Table (ii) suggest that the incidence of progressive muscular dystrophy
has increased in the post-war years. The probability is that this is not true. Prior to the
advent of chemotherapy many of these children died at an early age from chest complications.
Now these acute chest conditions can be rapidly cured and, as a consequence,
they live very much longer. Consequently the incidence in the more recent surveys
tends to be higher.
' The all round improved standards of treatment, with the great help of chemotherapy
and the better standards of living, have resulted in considerably reducing the numbers
of orthopaedic cases attending special schools in post-war years.'
Poliomyelitis
In Table (iii) are shown the notifications, admissions to fever hospitals of the Metropolitan
Asylums Board, discharges and deaths from Queen Mary's Hospital, Carshalton,
and admissions to special schools, for the period 1920-29.
It is clear from this table that the annual rate of admission to special schools is not
inconsistent with the 'spot' figure of 771 cases in 1928, since the age-range of the
schools was 7-16 years. On the other hand, the notifications are not high enough to
account for the numbers of paralytic cases requiring admission to special schools, or
having been treated at Queen Mary's Hospital. It would appear, therefore, that reliance
on notifications alone would lead to a serious under-estimation of the level of attack
in these earlier years when the disease was endemic.
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