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131
G.—Residential Sanatorium Schools for Children Suffering from Surgical
Tuberculosis.
21. Alton—Lord Mayor Treloar's Cripples' Hospital and College for Surgical Tuberculosis.—
Visited 17th March, 1920. Deputation:—Councillors W. M. Bolton and Mrs. Moore, and Dr. Buchan.
This institution was established in 1907, by Lord Mayor Treloar. It now consists of three
parts:—
(1) The hospital, in which children up to 14 years receive treatment and education ;
(2) The college, which has been established for the training of cripple boys from 14 to
18 years of age in trades suited to their capabilities and limitations ; and
(3) St. Andrew's Home, Hayling Island, where patients are sent for a change of air.
All are under the control of Sir Henry Gauvain, the Medical Superintendent.
The deputation saw the hospital and the college, but did not see the convalescent home at
Hayling Island.
The hospital and college have accommodation for some 250 patients of which about 200 are
in the hospital. The hospital exists for the alleviation of the sufferings, and the correction of deformities,
of the crippled child. Attention is principally devoted to the care of cripples suffering from
tuberculous disease of the bones and joints, because such patients are both the most numerous, the
most needy, and, perhaps, the most neglected class of crippled children in this country. At the
same time other crippled children are eligible for admission, but the demands of the tuberculous are
so insistent and urgent that only rarely is it possible to admit others.
It is probably no exaggeration to say that tuberculous disease causes more crippling than
all other diseases combined. The ultimate direct mortality has been variously estimated as from
20 per cent. to 70 per cent. of the cases infected, and probably 50 per cent. would not be an unduly
high estimate. A contributory factor to this high mortality is the lack of facilities afforded for systematic
and adequate treatment. Few general hospitals are able to spare a bed sufficiently long to
a serious case to ensure the patient's complete recovery, and indeed such hospitals cannot be rightly
called upon to undertake the protracted treatment necessary for these patients. It was to remedy
this defect that Lord Mayor Treloar's Cripples' Hospital was founded.
With increased knowledge of the nature of the disease, it has been demonstrated, that surgical
tuberculosis may be described as a general disease, in which the local lesion or lesions are special
manifestations. This conception of surgical tuberculosis is of the most supreme importance, because
on it is based the method of treatment adopted at this hospital. Conservative measures are adopted.
By conservative treatment is meant the adoption of all measures which tend to improve the patient's
general health, increase his powers of resistance, and preserve and restore the part attacked in contradistinction
to radical treatment, which aims at the cure of the disease by the removal of the local
lesion. This is really health work, and is a correct conception of medicine in its widest sense.
The ideals of the hospital are set out in the first medical report under the following five headings,
and if we avoid the particular application of these principles to the particular disease treated at
Alton, we get what should really be the guiding features of all health work and medicine generally.
These five points are as follows:—
(1) To so increase the patient's powers of resistance that he himself may be made to
come the disease by which he is attacked and render it innocuous;
(2) To preserve and restore any particular bones or joints diseased;
(3) To prevent deformity, or, if deformity already exists, to correct or reduce this deformity
as much as is possible;
(4) To educate the patient while he is being treated, if his condition permits; and
(5) To exercise as far as possible, efficient after-care and guidance, when treatment in the
hospital is completed, and the patient discharged.
It will be observed that the Alton Authorities recognise that the separation of preventive
from curative medicine or of either from education in the child is practically impossible.
The children while under treatment in hospital receive education, there being a head mistress
and five assistant teachers provided. Children receive three hours instruction daily, the teachers
actually working in the wards six hours daily.
In addition to various surgical apparatus, the children are as much as possible out in the open
air and Heliotherapy or Sun treatment is always in evidence.
The experience gained at Alton has shown:—
(1) That tuberculous cripples should be treated conservatively, but energetically, and for a
sufficiently long period, as soon as possible after the onset of the disease;
(2) That during treatment their education should be, where possible, efficiently undertaken,
with special regard to their limitations and requirements ;
(3) That even the most advanced cases may, in the great majority of instances, be very
materially benefited and their deformities either corrected or reduced;