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of the child in later years. Physical education also helps
to tone up the child's musculature and to correct early
deformities.
(iv) Prevention of Accidents—especially load accidents by
the inculcation of the ideas of the Safety First Organisation.
(v) Improved care of tubeiculous patients prevents dissemination
of the disease. As a result there has been a
marked reduction of crippling due to tuberculosis of the
bones and joints while the improved treatment of syphilis
had led to a reduction in the number of congenitally infected
children who frequently showed marked deformities.
(b) Care of the Cripple.—(i) Ascertainment.—Most children
are under medical supervision from birth. Through the agencies
of the midwife, health visitor, school nurse, medical officer at
the Infant Welfare Centre or School Clinic, the school teacher
the parents or the private practitioner it should be possible for any
child who requires orthopaedic treatment to be ascertained and
to be placed in the way of receiving appropriate treatment.
(ii) Treatment.—(1) The Orthopaedic Clinic is held twice a
month at the Mattock Lane Health Centre. Here the examination,
diagnosis and supervision is carried out by the Orthopaedic Surgeon.
(2) Hospital Treatment.—Children in need of operative treatment
are referred by the Surgeon to the Orthopaedic Hospital
at Stanmore. Attached to the Hospital there is a residential
open air school so that the children, some of whom are obliged to
spend long periods in the Hospital, may receive education at the
same time as they are being treated for their disease.
The Surgeon who examines the children at the Orthopaedic
Clinic is also in charge of the Hospital.
(3) Special Residential Schools.—Children who are so crippled
as to be unable to attend an ordinary school are sent to a special
lesidential school where they are educated and also taught a trade
to enable them to become self supporting.
At the present time there are only six crippled children from
the Borough of Ealing in Residential Schools. This small number
is a testimony to the value of a complete orthopaedic scheme.