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100
APPENDIX E.
REPORT ON THE WORK OF THE ORTHOÆPDIC CENTRE FOR THE YEAR ENDED
31st December, 1938.
By H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council.
The Orthopaedic Clinic was opened in June, 1930, and I think the time is opportune for a general
review of the work of the department during the eight and one half years of its existence.
To what extent has the incidence of crippling conditions diminished, or the severity of such
conditions as continue to appear ?
Statistics dealing with admissions to hospital ought to be valuable in this connection ; one
would expect that preventive work should lead to a gradual fall in the number of patients admitted
year by year. Yet examination of these figures has proved inconclusive. Many of the patients
requiring hospital treatment were new to the district and came to Willesden with untreated or imperfectly
treated disabilities. Another factor is that the surgical treatment of a number of conditions
has not stood still during the past eight years, and one cannot say that a group of patients treated in
a certain way eight years ago would be dealt with in exactly the same manner to-day. Lastly, there
is a group of cases treated at other hospitals and I have no figures dealing with them ; even if they
were available I doubt if a conclusive analysis could be made.
The most helpful figures are those dealing with attendances at the clinic; these are shown

The early peak figures were due to our dealing with a population not previously subjected to
regular inspection and preventive treatment. The number of treatments given remained high for
several years, but the steady fall since 1935 may safely be interpreted as a sign of effective preventive
work.
The orthopaedic clinic cannot claim all the credit for this notable drop; it is possible that
factors such as better nutrition may have caused a fall in the incidence of rickets in infants and postural
deformities in older children. The figures are as yet too small to permit of reliable analysis along
these lines, but it will make an interesting study some years hence. Where we can confidently count
on the clinic having a favourable influence is in the many conditions that respond in an encouraging
way if treated early. This may properly be called preventive treatment. Club foot and congenital
dislocation of the hip, for example, are not usually serious problems if recognised and treated at an
early stage. But if neglected they are a never-ending source of trouble.
The new cases seen during the past year may be divided into the following groups:—
Cases with a recognisable crippling condition actual or potential 63.3%
Cases showing some slight departure from the average but with normal limits 22.2%
Cases in which there was no orthopaedic defect ascertainable 14.5%
The present state of orthopaedics in Willesden is in many ways most satisfactory for there is an
attitude of vigilance which is making the preventive work thoroughly effective.