SALVING WRECKED LIMES.

Wanganui Chronicle, Volume LXVI, Issue 17552, 23 April 1919, Page 8

SALVING WRECKED LIMES.

WORK AT CHALMERS HOSPITAL

ORTHOPAEDIC TREATMENT DE-

SCRIBED,

WELLINGTON, April 18

New Zealand's disabled soldiers are coming home rapidly, and their presence vividly reminds us that we still have a great war responsibility. This, cf course, must be largely shouldered by the State, and if will be a source of real satisfaction to the people of New Zealand to know that their Defence Department has brought to the Dominipni the very best surgical and nursing skill (exercised by New Zealanders who have had special opportunities for training), and the latest appliances for the splendid work of lessening the disabilities of our wounded men.

Chalmers Military Hospital at Christchurch, in charge of Colonel D. S. Wylie, is an example of the remarkable developments in surgical science under the stimulus of war experience. This three storied building, with its spacious wards and sunny verandahs, standing in the garden grounds of Christchurcb. public hospital, has 130 patients who need orthopaedic treatment. Close to the Chalmers Memorial Ward is a new two storied building which will soon give accommodation for another ■100 patients, while a business arrangement with the V.M.C.A. enabled f>o more disabled men to have comfortable board at the expense of the Defence Department while they receive treatment in the orthopaedic hospital.

A few hours spent in the institution watching its humane activities aroused in the writer a keen sympathy for the fine soldiers who in many instances will carry their war burden with them to the grave; and an equally keen appreciation of the resources provided to lessen their handicap. One sees here the hateful results of the war, softened by the alleviating measures, though some of the bone, muscle and nerve injuries are so severe that orthopaedics— which is not miracle working put good surgery carefully followed up with commonsense methods —can only reduce, and not completely cure the disabilities. A man's limbs may be badly lacerated by shell fragments. a bone smashed, nerves severed, and muscles torn. He has first to recover from the shock, the wound has to heal and the bone be replaced. Though this may be done successfully he is still incapacitated, for the function of the limbs may not be completely restored. This is where the development of orthopaedic surgery comes to the soldier's aid.

One of the most powerful X Ray plants In New Zealand has been, installed at Chalmers Hospital by the Defence Department. With the aid of the excellent negatives it secures, dislocated or fractured bones may be easily examined, and the surgeon enabled, to operate on a clear diagnosis of what might be a most complicated injury. The operating theatre of ihe Christchurch hospital Is used for the surgical work. But the surgeon does not complete his work operating. He has to secure if possible the restoration of the original functions of the limb, and this is where the large variety of appliances and methods of a well equipped institution such as Chalmers Orthopaedic Hospital is of tremendous value. ELECTRICAL TREATMENT. The muscles are there, but the owner might not be able to control them. If he went out into the world at this stage he would be helpless. He has to be shown that these muscles are still capable of movement, and here electrical treatment and massage has to be adopted. A good many false ideas prevail as to the use of electricity as a curative medium. It has limitations, and the orthopaedist pretends to no "black xn&gic" in the use of the current. Normally, muscJe movement is controlled by the nerves, but lesion of these sensitive controls destroys the power of conveying to them the impulses from the brain. A patient in this condition goes to the massage room for attention at the hands of the trained New Zealand women who have been selected because of their experience of the latest English methods. They use the British War Office standard electrical table which is splendidly designed to secure simplicity and thorough control. The patient lies in the massage couch, his injured limb bared, and resting on a wet pad — a good conductor of electricity. The masseuse tests the extent of his muscle control, and fro^n her intimate knowledge, reinforced with the data provided by the surgeon, "picks up" the muscles uncontrollable and dormant. At her side a metronome ticks quietly, plunging an electrical contact into a mercury bath a* each swing, sending current to two pads manipulated by the operator. In rythmic succession the current is alternately applied and released. The effect on the muscle is remarkable to the layman's eye. The patient cannot move it, but he feels the faradaic current, and he also finds that the muscle he cannot control is contracted When the current is on. As the metronome releases the current the muscle relaxes, and so the process of contraction and relaxatipn goes on, demonstrating that when the nerve comes again into action (and this is helping to that end), the muscle will once more come under the control of its owner's brain. The whole process is stimulation to muscle and nerve, and though it may take many months normal control comes back at length, and the soldier blesses the resources which science provides to lift him out of his helplessness. Ordinary massage is also given where required, and another interesting feature of this department is the muscle re-education conducted by the staff. Perhaps a man's right arm is not functioning properly, though his left is normal. So the masseuse handles the right arm, gets the soldier to slowly exercise the muscles of the left while, with her aid, the deficient limb is made to follow the same movements. And gradually the defective muscles commence to resume their functions under this practical educative process. The wide range of cases and the excellence of the equipment at^^halmers Hospital affords a good opportunity for training masseuses, 25 of whom are undergoing a course of instruction by a staff which has had experience in English orthopaedic hospitals. Thns the requirements of other hospitals of the kind in New Zealand will be maintained. WHIRLPOOL AND AERATED BATHS. A valuable adjunct to the massage department is the specially equipped bathroom, where many of the patients

have a preliminary course of treatment in whirlpool and aerated baths. Legs or arms are immersed in specially designed baths, while an electrically driven turbine in the bottom stirs up an artificial whirlpool ,and as an additional resource, the attendant can set the whole bath bubbling violently wi<h compressed air. This treatment has a valuable effect in softening the skin and improving the circulatory system before massage. The masseuse often has to do her work at the bath-, as more movement of an injured limb is often possible under water, with the stimulating ef- j feet oE aeration and the whirlpool. i ORTHOPAEDIC GYMNASTICS. But orthopaedic treatment does not end with these things. It has many phases, all bearing on the one great object, the restoration of function of the injured parts of the body. The soldier cannot be constantly in the bath, nor can he get continuous massage. Something more than spaomodic treatment is necessary, consequently the orthopaedic gymnast nm and the curative workshops lorm an essential part of the system. In the gymnasium carefully designed exercises are carried out by small squads of men with similar disabilities, inducing them to use their deficient muscles and restore full control. Many of them, as a result of long disability, are very chary of activity, but the knowledge that their instructor is trained in this branch of gyrarmstics, and that behind him is the advice of the surgeon, gives the men confidence. They attempt mvements which they thought impossible —and they succeed. When the -set exercises are over the class plays a round game well within physical capacity, and in the excitement of competition the cautious ones do things they would not cold-bloodedly essay—and another step has been made in the restoration of function. A mirror facing a walking track is one of the fittings. This enables a man to correct mistakes in his gait which has been brought on by injury. He sees his awkwardness, is told how to correct it, and gradually gets back the poise and balance which will reduce the outward signs of his disability. IN THE WORKSHOPS. It is in the workshops that the most constant development of deficient functions can take place. Massage, baths, and gymnastics can necessarily fill only a part of the day, but in the workshops the soldier may put in "some Hours of useful work — doubly useful for the reason that the output has an economic value and in securing it the soldier helps to cure himself. Thirty men attend the carpenter's shop daily. Their principal work just now is the making of massage couches for the New Zealand Orthopaedic hospitals. The knowledge that they are . doing «* useful wort stimulates their interest, and the task set for them, steadily pursued, helps them to regain control of the limbs and facility in their use. Men who were once right-handed are sometimes obliged to train the left hand to a wider range of duty so as to make up for deficiencies. Then they find the carpentery interesting means to that end. It is the same in the leather work and basket making shops, which are very useful in the numerous cases of hand injuries. Stiff moving fingers are applied to these delicate hand operations, ana under the direction of skilled and sympathetic women instructors, the patients are encouraged to persist in work which helps to bring back their old facility of movement and strength of fingers. IMPROVEMENT IN SPLINTS. The making cf splints and surgical appliances is an important activity at Chalmers Hospital, and it is evident that this art has developed enormously during the last few years. We see nothing of cumbrous wooden splints, because sheet Iron and aluminium are now the principal materials. Splints can be shaped to fit and to gently correct almost any deformity. The iron workers who have an airy well equipped shop include specially trained men who were selected by Colonel Wylie from among the New Zealanders who gained experience in England. Men are being trained here for splint work in other New Zealand orthopaedic hospitals, and a number of the patients also gain benefit from the handling of the tools and machines. Fnished splints are faced with soft lint, making them very comfortable and neat. Their variety is infinite, corresponding to the unfortunately large range of injuries which they receive in modern warfare, "drop foot" and "drop hands" are familiar signs of the cripple, and it is pleasant to note how the splint deBigner gives improved appliances to help men suffering from these troubles. For the "drop foot" patient there Is a splint with spring attachments to the leg which gives the foot strong but elastic support, encouraging the patient to use the foot until, with the help of the splint and other orthopaedic treatment, he can regain tne use of the lower muscles and walk without a crutch. A more elaborate splint on the same principle with the fingers attached to spring loops working from the forearm, gives an artificial grip to an otherwise helpless hand, thus assisting to pave the way to normal muscular control. Plaster splints have also to be used, as this Is the most sultame medium for some deformities which are the result of nerve lesion. These eplints, made by English trained experts, are particularly one pieces or work in which strength and economy of material (for the sake of the patients' comfort) are cleverly blended. This department makes plaster casts of deformed limbs as a record of the patient's original condition. A •collection of these casts already constitutes a "war museum" which will preserve for posterity vivid evidence of what war means to the men who risk their lives for their country. As it is often impossible to get a limb back to its original shape, the art of the bootmaker has to be applied to surgical boots. This is another department in the busy hos•pital. A shortening of the leg up to one inch can usually be concealed by a well made surgical boot, but some of the shortenings are three inches, which necessitate building up the sole in visible fashion. Many books have been written on this interesting subject of orthopaedic surgery, and as the Chalmers Hospital embodies all its features, one would have to go a long way beyond the length of newspaper articles to do justice to all the work. We •have no space in which to deal for instance, with the valuable assistance of vocational training which aims at interesting the soldier in his civilian future, and encouraging him to make

practical preparations for it. What is to be seen at the Chalmers Hospital is a development of surgery which will be of the utmost value to civilians as well as soldiers, because these modern appliances imported by the Defence Department for its own purposes will demonstrate their value in ■general hospital practice, and will t3nd to become part of the standard (equipment of every public hospital.