View report page

100
APPENDIX E.
REPORT ON THE WORK OF THE ORTHOPAEDIC CENTRE FOR THE YEAR ENDED
31st December, 1937.
By' H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council.
In my report on the work of the Orthopaedic clinic during the year 1936 I drew attention to
certain defects in the organisation due, not to any fault peculiar to Willesden, but to the limitations
imposed on us by the legislation providing for the care of the cripple. I was concerned most of all
with those children whose condition is such that it is desirable that they should be kept under observation,
and perhaps treated, long after school-leaving age.
On September 11th, 1937, the leading article in the "Lancet" dealt at some length with this
same subject, under the title "Continuity in Orthopaedics," and the Willesden report was quoted
extensively. The "Lancet" however, developed the theme on broader lines, and so wisely that I
am taking the liberty of repeating what was said : "The orthopaedic clinic is only open to children
attending a welfare centre or a public elementary school; other municipal services, such as provision
for the treatment of tuberculosis and for vaccination, the fever and maternity hospitals and V.D. clinics
are available for all ratepayers. The solution of the particular evils to which Mr. Seddon has properly
drawn attention should be amenable to the broad principle which has been successful in a neighbouring
field. Tuberculous disease, whatever the site of the lesion or the age of the patient, is recognised by
the State for purposes of treatment. The principle is the same whether the disease is or is not pulmonary
; for our present argument tuberculous disease of the joints is most instructive. An orthopaedic
surgeon attends a clinic in a county borough, which is a recognised authority for treating
tuberculosis. He sees cases of joint tuberculosis side by side with ordinary orthopaedic cases. Among
the first group he is free to treat or follow up a case to any age ; in the second, official recognition
ceases the moment the child leaves school. True, a post-school patient may be dealt with, so far as
payment for treatment is concerned, under public assistance, but this entails the drawback that
every case has to be considered by the committee on its merits. Why should not non-tuberculous
crippling diseases be put on the same footing as the other conditions that we have just enumerated ?
A cripple may not be a menace to society like the patient with pulmonary tuberculosis or venereal
disease—but neither for that matter is the patient with a tuberculous joint. He is, however, often a
burden to society, to his family, and to himself; financially, too, a persistent burden, for his disease
does not, as a rule, diminish his expectation of life.
The logical step would be to extend official supervision to the crippled or maimed of all ages,
not forgetting the manifold forms of arthritis. It will be objected that the cost would be prohibitive.
But someone is paying already for the maintenance of people crippled through lack of adequate treatment,
or for treatment that is not properly equipped and organised. Efficient handling of children
has already banished the more gross crippling defects, and long periods of hospital treatment are
becoming less necessary. Such expenditure has come to be regarded as a long-term investment, and
for young adults the term would still be long. The cost would be diminished by the fact, of which they
need no reminder, that local authorities are at liberty to recover part or all of the money spent on treatment
from the patient himself or from his family. Whatever may be the derivation of the word
orthopaedics—and no word in the medical vocabulary has been more misunderstood—the orthopaedic
hospital and the orthopaedic surgeon have long ceased to limit their activities to straightening children.
Orthopaedics has grown up and the State would do well to recognise its majority."
It is, unfortunately, only too clear that until the legal limitations of our work are removed,
conditions will remain satisfactory only for the majority of pre-school and school children.
However, Willesden has done its best to extend the service of the Orthopaedic Clinic along the
lines suggested and, on October 5th, I received the following memorandum from Dr. Buchan, the
Medical Officer of Health :
"In December last, authority was given for the Middlesex County Council to be
approached on the question of the treatment of orthopaedic cases above school age, as the
County Council were then the competent authority. The Council are now authorised to afford
this treatment by Section 181 of the Public Health Act, 1936, and we recommend that the
Medical Officer of Health be instructed to carry out this work in conformity with the Act."
The Borough may congratulate itself on having made excellent use of one of the provisions of
the 1936 Act; we are already beginning to benefit from this new ruling, and its value will be cumulative.