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Such a case, therefore, presents the operator with two alternatives,
both of which are liable to give rise to criticism. He either refuses
to perform the operation until the mouth has been properly cleansed,
or surgical treatment is undertaken in an unclean field, leading
perhaps to acute sepsis, excessive haemorrhage, or other unpleasant
after effects. Many of these children have been refused treatment
by private practitioners because of their neglected mouths.
It will readily be seen that, whatever course is adopted, the
effect on both the child, its parents and acquaintances is bad.
The treatment of these cases during the same hours and on
the same premises as those accepting correct treatment is bad
propaganda for dentistry and a bad advertisement for the dental
clinic. It is wasteful in time and money and it is bad dentistry,
and I shall be glad if the restriction of such treatment could be
considered."
(h) Orthopaedic and Postural Defects.—Medical treatment
of these defects was given under the Orthopaedic Scheme in charge
of the Consultant Orthopaedic Surgeon, Mr. Whitchurch Howell,
F.R.C.S., who held a monthly clinic at the Open Air School.
Mr. Whitchurch Howell also acts as Honorary Surgeon to the
Brookfield Orthopaedic Hospital, an institution of 30 beds recognised
as a Hospital School by both the Ministry of Health and the
Board of Education, and administered by the Essex County Council.
Two Masseuses divide their whole time between the Hospital
and the orthopaedic and massage clinic at the Physically Defective
School.
Details of the work done under the scheme are given in the
section dealing with Defective Children (Section 13).
(i) Heart Disease and Rheumatism.—Dr. Sheldon contributes
the following interesting report on the work of the
rheumatism clinic during 1937, and it is satisfactory to note his
statement as to the remarkable decrease in severe heart disease.
The whole report leaves no doubt as to the value of the work
done at the clinic. Dr. Sheldon has been particularly helpful in
regard to the admission of suitable cases to his own beds at Cheyne
Hospital.
"During the past year there have been 45 sessions, with 779
attendances. Of these attendances, 176 were made by children who
were being kept under observation. Year by year these figures
were maintaining a remarkably close level. Although a large
number of children are being kept under observation, that is not to
say that they are all suffering from rheumatic heart disease—for
some have other sorts of cardiac defects, such as congenital
deformities and abnormalities of rhythm, while others have aches