View report page

Appendix.
The routine at the Health Centre has remained unaltered. The work of the nursing staff,
optician, and district visitors has been efficiently maintained.
The new style of padbridge frame adopted during 1936 has been a distinct advance.
The strength of the frame is much greater than that of the old type, and breakages and distortion
of the frames have been considerably less frequent. The appearance of the spectacles is more pleasing
and the change has been welcomed by parents and children.
Since the publication of the 60th Annual Health Report, in which were outlined the advantages
that would result from the orthoptic training of suitable cases of squint, I have observed these cases
carefully. I am convinced that the number of children suitable for training would amply justify the
institution of an Orthoptic Clinic.
APPENDIX F.
REPORT ON THE WORK OF THE ORTHOPAEDIC CENTRE FOR THE YEAR ENDED
31st December, 1936.
H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council.
The work of the Orthopaedic clinic has run so smoothly for a number of years that one might be
tempted to think that no adjustment in the organisation is called for. But the passage of time has
revealed weakness at two points.
There is a small group of cases in which, although the treatment may have been completed
long ago, prolonged observation afterwards is necessary. Congenital dislocation of the hip is a good
example. The dislocation may have been reduced, apparently satisfactorily, at the age of two years.
It is not sufficient to know that the child is walking well at five years and at ten years ; one should be
able to see how the hip is behaving at fifteen and twenty. Such observations are not merely of academic
interest ; they might, and probably would, lead to improvement in methods of treatment, though it
would be too late to apply them to the patients who were found to have poor joints at the age of twenty.
The need for following certain cases over a long period is clear.
In a second small group we find conditions that require continuous observation and perhaps
treatment during the 12-20 age period ; for example, infantile paralysis and scoliosis. These diseases
and their treatment do not recognise any legal time limit. It is agreed that continuity of treatment
and observation is one of the most important factors in successful orthopaedic practice and it is unfortunate
that the present organisation does not allow of this principle being carried to its logical
conclusion.
The two groups referred to constitute not more than two or three per cent, of all cases attending
the clinic, and yet this small minority is important and well worth our attention. I hope that some
way can be found to deal with this problem. Ad hoc arrangements such as transferring these children
to the care of a colleague at a town hospital, or asking them to attend (generally on a Sunday !) at
Stanmore, have been tried and are manifestly unsatisfactory.
An analysis of the cases admitted to Hospital may throw light on the efficiency of the preventive
side of our work. During the past year twenty-six children have been admitted. In eighteen cases,
with our knowledge in its present state, admission to Hospital was inevitable ; four of these children
were admitted only for investigation. The remaining cases were as follows : club feet, 4 ; congenital
dislocation of the hip, 1 ; rickets 3.
The children with club feet were admitted for correction of deformity that had failed to respond
to treatment at the clinic. There is no doubt that our manipulative treatment was inadequate in these
three difficult cases, and I have tried to remedy it. A method of splinting recently described by
Denis Browne appears to be far superior to the older methods and his results are excellent. The
method has been tried out at Stanmore and is now being employed regularly at the clinic and is
promising well.
The child with congenital dislocation of the hip came to us late with a poor joint that had been
treated elsewhere. The time for obtaining a good result was unfortunately long past.
Two of the cases of rickets required operative correction of deformities. One looks forward to
the time when these deformities will no longer be seen. Rickets is an easily preventable disease.