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The total attendance during the year was 2,416—1,395 boys and 1,021
girls.
During the year 111 new cases were examined, and these have been
analysed by Mr. Seddon. The tabulation is set out below, together with
a report on the work of the clinic during the year.
"The work of the schools section of the Orthopaedic Clinic during the
past year has been remarkable in two respects: the small number of new
patients seen, and the large number, 22, admitted to Hospital.
"The second group illustrates well one of the features of orthopaedic
treatment that is not generally appreciated. Most people imagine that a
condition requiring operative treatment is dealt with in hospital as soon as
the diagnosis has been made. This is true in the majority of general surgical
conditions, but it is far from being the case in orthopaedics. Infantile
paralysis affords the best example of the need for delay before operative
treatment is undertaken. Let us suppose that a child suffers from this
disease at the age of four, and one leg is affected. The appropriate treatment
is given, but it is found that recovery is incomplete. The deficiency can,
however, be remedied by operation; but it is necessary to wait until the bones
of the foot are sufficiently developed to permit of an operation being performed
without interfering with the growth of the foot. Meanwhile an instrument
has to be supplied—until the child is eleven or twelve years of age. Thus
there may be an interval of six years or more between the onset of the
condition requiring treatment and the final operative correction.
"This means that the number of admissions to hospital may bear little
relation to the number of new patients seen during the same year. Many of
the children requiring operative treatment are legacies from earlier years.
This was the case last year.
"Continuity of observation and treatment is of the first importance in
the successful handling of crippling defects, and this is where the clinic
system is invaluable. Thanks to the Child Welfare and School Medical
Officers, there is every prospect of a defect being recognised at an early
stage. The health visitors and clerical staff enable us to keep in continual
touch with our patients, and the principle of working with one hospital
ensures continuity of supervision and treatment. The great fault, however,
is that this almost ideal state of affairs comes to an end abruptly when a child
leaves school. The restriction is a legal one, but it is not recognised by a
number of the more important conditions, particularly scoliosis and infantile
paralysis, that we are called upon to treat. It is important that we should
not lose sight of a certain small proportion of our patients after they have
left school, and I am glad to report that the Medical Officer of Health has
given me permission to keep in touch with such cases through the clinic for
as long as may be necessary.
"It is to be hoped that more inclusive legislation, similar to that covering
the treatment of tuberculosis and the acute specific fevers, may one day be
available for cripples, actual and potential, irrespective of their age, or if
school children, the type of school they attend."
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