Friday, 16 January 2009

Carole Reeves on conflciting surgeons' diagnoses

This is part of Carole's reply to Jane's query about putting up Florence's views on this. Jane had wondered whether this was rivalry between an experimental surgeon (Mr B) prepared to take risks, and a more conservative one (Mr P)who wasn't:

"As far as necessary or unnecessary surgery is concerned, I would have to do the research to determine whether these procedures were considered useful by the orthopaedic or rheumatology profession at the time and also in retrospect. She could have been part of a trial to operate or not operate, hence the selection procedure that she perceived to be biased towards private and non-private patients. But this is only guesswork on my part without seeking out the contemporary papers.

Basically, surgeons want to operate and physicians prefer to use 'conservative' management. Nowadays, it's unlikely that children with juvenile arthritis (I'm assuming this is what Florence had although she mentions rheumatic fever, which is a different thing, and the surgery carried on these patients was on the mitral valve in the heart, which is damaged by the bacteria causing rheumatic fever) would have surgery because the disease burns itself out and the management is always conservative - maybe with sparing use of steroids to reduce inflammation in severe cases. Also, they generally come under the care of rheumatologists (physicians) and not surgeons.

Hip fusion (arthrodesis) was a common procedure at the time for children with hip damage from inflammation or TB (both of which damaged the bone and cartilage of the hip ball and socket) and seemed to offer a means of restoring some degree of mobility and to reduce pain in the days prior to hip replacement. A number of our [Craig-y-Nos] TB children did have this procedure done, one of whom - Peter Wagstaff - went on to have quite severe spinal damage and now walks (with difficulty) with two sticks. So, I think possibly it was a case of therapeutic balance - balancing the long-term side effects of the operation with the effects of immobility and pain from joint damage. There could also have been personal rivalry between Broomhead and Pain (what a god awful name for a surgeon), which might be difficult to uncover without serious research."