Orthopaedic Specialism in Mauritius: The Early Years

It is generally acknowledged that wars have a great impact on medicine and both the First and more particularly the Second World War marked turning points in modern medicine. The use of technology during these two Wars and the mass destruction which followed caused medical researchers to find ways to protect both the military and the civilian population. After the War, the rehabilitation of those who had been physically affected or traumatised became an important aspect of medicine. Consequently, the War generated a number of medical innovations that proved beneficial to the population in general.

In Mauritius, one major development which took place and which was directly related to the war effort was the intensification of the campaign against malaria with the use of DDT for the protection of soldiers posted in Mauritius. The early success achieved thanks to DDT by the army during the war period eventually led to the widespread use of DDT in the island. This coupled with the drainage of marshy areas and malaria surveillance paved the way for the its eradication. One other development, which was not related to the war effort, was the development of orthopaedic medicine and the setting up of an orthopaedic centre at Candos Hospital.

In many countries and particularly in Britain the development of orthopaedic medicine as a specialism that is dedicated to the examination, diagnosis and nonsurgical treatment of disorders of the musculoskeletal system has often been explained as a consequence of the War. Several decades ago, Roger Cooter attributed this development more to the ideology and manipulation of a small group of orthopaedic surgeons rather than the War though it provided the context in which orthopaedic medicine emerged as a specialism.

In the 1930s and the 1940s, the two major problems facing the island of Mauritius were hookworm disease and malaria (Annual Report on the Social and Economic Progress of the People of Mauritius, 1933, HMSO, 1934). By 1947 malaria still remained the preoccupation of the government and a Malaria Advisory Board was set up in 1946 (Alan.M McFarlan – Proceedings of the Royal Society of Medicine, 1946 April – 39 (6)323-324).

Industrial injuries and fractures

Orthopaedic medicine remained an integral part of general medicine, and industrial injuries and fractures were dealt with by generalists and surgeons. There was no separate unit for orthopaedic surgery and Mauritius had no orthopaedic surgeons. Minor cases were taken care of by folk medicine and local masseurs. However, even though during the War the colonial government attempted to reconstruct the island after the labour unrest of 1937 and had set out to reform various aspects of life in Mauritius namely in the areas of education, health, industrial relations and political representation, orthopaedic medicine received some attention though it was not considered a priority.

In the context of reform, the Report on Health prepared by Dr Rankine and published in 1944 made provision for orthopaedic medicine. One could have thought that the return of soldiers from the War would have been a major reason advanced for the setting up of an orthopaedic centre in Mauritius. That did not appear to be the case. It could well have been the reason but was not explicitly mentioned. Dr Rankine justified the creation of an electro-physiotherapy department at Candos and Civil Hospitals as part of a modern hospital on two grounds. Increasing traffic and mechanisation had increased the incidence of accidents and long periods of disability.

In 1941 injuries ranked fourth in the number of admissions to hospitals. Second, district hospitals were overcrowded, and one of the objectives for setting up this new department was to reduce the period of treatment in district hospitals especially ‘as modern treatment of injuries to bones, joints and muscular structures had also reduced the period of disability’. Those with prolonged illness would be treated at the two main hospitals where there would be also a fracture clinic. One surgeon with specialised knowledge of orthopaedic surgery and a qualified masseuse would be required for each of these two hospitals.

In fact it was the poliomyelitis epidemic of 1945 which brought orthopaedic medicine in the limelight in Mauritius. Shortly after the cyclone of 1945, an epidemic of poliomyelitis broke out in one place in February but quickly spread all over the island in March and, by the end of the month, 842 cases had been registered. By 28th April there were 200 more cases bringing the figure to 1042.

The Department of Health issued its official bulletin on 5 March, and several measures were immediately taken to deal with the epidemic. Dr Lavoipierre gave a talk on radio informing the public on how to cope with the epidemic. Schools in several villages were closed down and about 25 private doctors also met to discuss the epidemic. The disease was relatively new to Mauritius though it had been identified as early as 1912 and the colonial government responded by establishing a hospital at Mangalkan in Floreal in a building which was occupied by the army.

Dr Cumpston, an Australian, was recruited on contract to administer the hospital and his wife who was a nurse was made matron of the Floreal hospital. During the first few months of 1945, 1018 cases of poliomyelitis were registered. In 851 cases, 64% of patients were under 5 years of age and 95.5% were under 10. Only 4% were without definite paralysis. In 86% of cases, legs were affected.

In 1946 210 children were admitted to the Floreal hospital, all victims of the epidemic of 1945. The majority were bedridden; a few had been fitted with calipers and none with spinal braces. By the end of 1947, there were still 100 cases, of which 50 were too severely paralysed to return home and were regarded as permanent in-patients. All of them had been fitted with appliances except for the new admissions. It was reported that ‘in the same period 360 patients had been admitted to hospital and 420 discharged though they were not all cases of poliomyelitis’.

In 1946 an orthopaedic centre was opened at Candos; the technical staff included one orthopaedic surgeon, one orthopaedic sister, two physiotherapists and one rehabilitation officer. In fact, of the five women being sent to be trained as nurses in England, two were being trained as physiotherapists.

Close cooperation

There was close cooperation between the public health service and private doctors. Government medical doctors and dispensers worked together with doctors on sugar estates to organise regular clinics and, as a result, prejudice on the part of patients to go for treatment at hospitals was gradually overcome. More and more children attended clinics and hospitals and more children were discharged from hospital with improved health. Throughout the island, there were 400 children who were treated and fitted with instruments and each one of them was visited once a month by district visitors to ensure that the appliances were kept in good repair and their parents learnt how they were to be fitted.

In 1947 there were 100 cases of poliomyelitis dating back to the last century; they were examined and half of them treated. Treatment was also provided for other orthopaedic conditions such as tuberculosis disease of the bone and congenital deformities which had a high incidence in Mauritius. Forty-seven cases of rheumatoid arthritis and ankylosing spondylitis were identified and some of them were completely crippled. About 40-50 amputees had been through the orthopaedic centre. Appliances were obtained from overseas and some made in orthopaedic workshops in Her Majesty’s Prisons. In April 1947 an operating theatre was improvised in an empty ward. Over 200 corrective and reconstructive operations were performed by the end of 1947. Other empty wards had been adapted, one for a school room, a second as an outpatient department and a third as a carpentry shop for older boys.

Outpatients presented several problems. All known cases had to be reviewed, lost cases traced, undeclared cases found as prejudice against treatment in hospitals which had been overcome persisted. Nurses from Floreal hospital visited the rural areas for tracing cases and for follow-up visits. As from October 1947, patients received rehabilitation treatment at the Civil, Victoria and Floreal Hospitals. However plans for the construction of an Orthopaedic Department and a Rehabilitation Centre at Candos were completed and construction was to be started in 1948. The plans provided for an Orthopaedic Centre, including an operation theatre, an x-ray unit, orthopaedic wards and a rehabilitation centre. A new x-ray plant was also ordered from England.

In the 1950s, orthopaedic services had increased considerably and orthopaedic medicine had become a well-established specialism in the island. In 1953, the number of patients attending the Floreal, Victoria, Civil and domestic hospitals reached 8556, and 29,231 attended Victoria hospital for physiotherapy treatment. In 1955 the number of attendances at the Candos Physiotherapy department reached 46,602.

In 1956 an orthopaedic hospital, the Princess Margaret Orthopaedic Hospital, was set up at Candos. It was inaugurated by the Princess herself during her visit to Mauritius in the presence of Dr R. Lavoipierre, the Director of Medical Services and R. Seneevassen, the Liaison Officer for Health. In 1959 there was a fourth outbreak of poliomyelitis in the island but by that time vaccines had been introduced in the island and thousands of children had been vaccinated. Writing in the British Medical Journal in 1960, Dr Boodhun Teelock reported that the vaccines had provided considerable protection to the population and the fourth epidemic was the least severe one since 1945.

* Published in print edition on 14 June 2013

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