H.—3l

46

SECTION 2.—KING GEORGE V. HOSPITAL, ROTORUA. Dr. W. Stanley Wullis, Medical Superintendent; Dr. F. VV. Lurasden •. Dr. W. B. Fisher; Miss E. Hodges, A.R.C.C, Matron. Staff. —Before submitting my report I would pay my tribute to those officers who have left the staff during the year —namely, Dr. Hogg and Dr. Hockin —who by their merit and ability have laid the foundations for a successful administration and an efficient special department. By a reallotment of the duties of those medical officers remaining it has been possible to carry on without the replacement of those who have retired, this having been rendered possible both on account of the sound foundations laid down by my predecessors and the loyalty of the present staff, who have with energy cheerfully undertaken their additional duties. Surgical Division. —During the year 369 surgical operations have been performed, 183 of those having been definitely reconstructive in character, and of these latter 86 have been taken for their basis one or other form of sub-astragaloid arthrodesis, upon which plan the architecture of the foot is remodelled amd stabilized before applying those additional procedures to gain increasing function. This procedure, which is a new attempt as far as New Zealand is concerned to effectively deal with the problem of the paralytic foot, has been undertaken only after a careful study of the reports of Commissions set up in other countries to consider the best means available to combat this disablement, and has in this Hospital given such uniformly good results that I feel confident that the publicity that will be given to it by its presentation at the last Conference, and its publication in the journals, will bring it into universal use throughout the country by those surgeons competent to deal with the condition. We are further developing along new lines, again as far as New Zealand is concerned, the surgery of the spastic paralyses —hitherto a class of case which has been a sore trial to the parents, a bugbear to medical men in attendance, relegated by the latter to the status of the incurable, thereby rendering the former open to the depredations of charlatans and humbugs. In this class of case, with selected types, we can show results which, by the combined aid of muscle re-education, hospital and school discipline and training, and reconstructive surgery, render the subject of our attention definitely able to make his contribution to society rather than the reverse. The third definitely new procedure which has been introduced is a surgical plan, to gain increased length in a limb when this has been tho sole disability, or has assumed such serious proportions in considering tho whole aspect of the case that the attempt to carry out this measure would bo justified. Further, to the above we have brought into routine use Steindler's procedure for releasing a muscle-bound claw Toot. This consists of a sub-peri osteal resection of the soft structure from the oscalcis, and replaces the older and usual method of dealing with.this condition —namely, plantar fasciotomy—in the same way that Soutar's operation for fioxion contracture of the hip-joint replaces the cutting of tendons and muscles. Tho improvement in the results has been marked. The last now procedure that we have introduced is one concerned with the reconstruction of the shoulder-joint, and the utilization of the fibula, in part or in its entirety, to repair the loss of the humerus, whether as a result of traumatism (gun-shot wound) or after its operative removal following bone-disease (sarcoma, infection, &c). Ancssthetics, —The introduction of the warmed-aether apparatus and its continuous use tells its own story, thus : Even after prolonged anaesthesia, necessary in these tedious reconstructive operations, administered in the great proportion to children, I can recall no case where the surgeon has been worried during the course of his work regarding the condition of his patient, nor can I call to mind any post-operative complications attributable to anaesthesia. Tuberculosis of the Bones and Joints. —During the year fuller and more extensive use has been made of that ancient but none the less valuable curative system designated heliotherapy ; and, favourably situated as we are in Rotorua, I am confident that we can establish here, a sun clinic which should be unrivalled in its opportunities and demonstrate its results accordingly. Physiotherapeutic Department (Dr. Lumsden). —During the year 53,827 treatments have been given. According to your request I am submitting the following analysis in percentages of the functional improvement gained by considering one hundred cases just as they appeared in the admission and discharge book. Those included cases not amenable to treatment and whose functional improvement was nil. The estimate was conservative, yet fair, and was arrived at by a study of the records of each individual case. It varies from nil to 75 per cent. It is as follows : Average percentage of functional improvement in relation to limb affected, 40-82 ; average percentage of functional improvement in relation to whole body, 45-6 ; average duration of stay in hospital, 10-3 months. The average percentage of improvement according to treatment accorded works out as follows, the groups being made according to the particular form of treatment that has been the factor contributing towards the greatest functional improvement, although, of course, all forms are to some extent interdependable and interchangeable : P.T. (physiotherapeutic), 43-835 per cent. ; 0. (operation), 42-465 per cent. ; A. (apparatus), 8-219 per cent. ; 0 + A, 1-369 per cent. ; P.T. + A., 1-369 per cent. ; nil, 2-739 per cent. In considering the above figures, which have taken some time to compile, I will cite a typical case which demonstrates the difficulties in estimating in cool figures functional improvement:— A man, " B," came to this Hospital on crutches —both thighs functionally useless, the whole of one limb paralysed, a small residum of power below the knee being left in the other leg. Briefly, he was useless below the waist. His method of progression on crutches was peculiar. He moved both crutches in front of him, and swung from the hips both limbs together, the heels landing on the ground in front of him synchronously and in line. By a locking-back of the knee (he had a subluxation of these joints) he was enabled by a push on his crutches to pivot forward and bring his crutches in front again. He was not well educated, had not studied, and since the outset of his disease had not done any useful work. He had outlined no policy for the future. After treatment and a series