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97
Report of the Medical Officer (Education).
Allusion was made in last year's report to the serious risks of out-patient practice, the scandal
of children suffering from shock and vomiting in the streets and being refused admission to public conveyances.
An eminent surgeon, Mr. Stephen Paget, in a lecture* at St. Bartholomew's Hospital a dozen
years ago, before any public treatment had come into discussion, alluded to the conditions: <4 There
is generally slight shock at least among the ill-fed, thin, nervous children of a London out-patient
department; they are faint and miserable for a day or even two days, and want nursing, and half the
troubles that may follow the operation—otitis, bronchitis, even pneumonia—come because the child
is not taken into the wards, but must be turned out again back into the slums." But, apart from
the complications of the rough and ready treatment subsequent to operations in the out-patient room,
and remembering that striking as are the results of adenoid operations in many cases, the remote results
are not always so good, often there is still reason to doubt whether the operation was skilfully or
efficiently performed.
In an enquiry during the autumn by Dr. Pearson as to the results in children who had been
operated on during the past ten years, the returns were so disappointing that it speedily resolved
itself into seeking the reasons for such want of success. Children are not recommended for surgical
treatment because they have adenoids, but because of symptoms which are the noticeable results, such
as mouth-breathing, snoring respiration, nasal discharges, and associated deformities and defects.
If the result of treatment leaves these conditions in existence it cannot be said to have been satisfactory.
Merely to scrape a child's pharynx in a routine way is not sufficient for intelligent treatment, and yet
many cases appear to go through this process. Two of the cases in Dr. Pearson's series had been
operated on five times for adenoids and yet were not relieved as their noses were blocked by enormously
hypertrophied turbinal bones. It is not merely that these hypertrophies are recurrences,
but often also that they have not been treated at the time of operation. Just as the hundreds of
medical certificates received of freedom from disease in children who were at the time obviously suffering
from ringworm give evidence which cannot be gainsaid, so, although any surgeon knows how easy
it may be to throw stones, it is almost impossible to resist the conclusion that there is want of care
or skill on the part of manv who operate for adenoids.

The cases were considered satisfactory when there was no evident or palpable obstruction to
nasal-breathing. Among the 163 thus recorded 49 still retained the habit of mouth-breathing, although
probably by training and breathing exercises as in Dr. Wells' cases this could have been removed.
The other 237 were returned as unsatisfactory because the mouth-breathing was due to persisting but
removable causes. These were nearly two-thirds of the cases operated on, and on the 237 children there
had been 279 operations.

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