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98
Annual Report of the London County Council, 1911.

The adenoids here recorded were not sought for when other cause of obstruction was apparent.
In absence of other cause the naso-pharynx was digitally examined and adenoids only recorded when
they could be palpated. They were usually felt on the lateral walls and generally on the right. When
median they often had a fibroid feel showing that they had been scraped.
It is not sufficient that provision is made whereby a third of the children who present
pathological conditions among the large numbers with enlarged tonsils and adenoids can be
medically or surgically treated in a satisfactory way with the minimum expense of time
and trouble. While one-third of the children in the schools present conditions which represent
a struggle against factors of ill-health, the causes must be sought out and removed as a public task.
It is not a mere academic enquiry which is now being suggested, but a fundamentally important
one, which also lies at the roots of tuberculosis and other causes of chronic debility. The external
factors are the various kinds of septic organisms which gain access to the mouth and nose. Each human
being goes through a period of acquiring a certain proportion of immunity against various diseases.
Provided the dose is small enough almost any disease is overcome, or rather its germs are overcome,
without the disease ever becoming evident. To judge from immunity reactions tuberculosis has affected
95 per cent, of the population before the limits of school age are past, but unless the doses of infection
are large and repeated, or the child is depressed by the results of other diseases, as measles or whooping
cough, it soon overcomes the attacking tubercular germs. In large towns almost every one acquires
permanent protection against measles at an early period of life by going through the disease. Threequarters
of the population seem to have sufficient immunity to resist scarlet fever, the rest mostly
acquire it by suffering an attack ; but there are a number of germs of comparatively low pathogenic
powers, against which only temporary immunity seems to be acquired. The common "dirt"
inflammations of the eyes and ears and fungoid rashes of the skin, so evident among debilitated children
and invalids, afford examples. Catarrhal attacks, the common cold, the micro-organisms of which
cause an enormous diminution in health annually, can be resisted easily in vigorous health, but are
so constantly present that any slight departure from a condition of resistance, a few minutes chilling,
a slight attack of indigestion, will give the opportunity for invasion. The protection can be raised
in many people for months by swallowing at the right time a medicinal dose of the protective vaccine.
In the case of young children improper clothing and the use of dumb-teats or baby comforters must
be most potent contributions to the catarrhal invasions which ultimately lead to development of the
enlarged lymphatic tissues in consideration. These catarrhal germs are practically accompaniments
of civilisation, the "stranger's cold" of St. Kilda, and the only method of dealing with them is by
dilution. Increased living room must be found not only in houses but in cities and in school rooms.
The factors contributed by the child itself depend to some extent on its bodily constitution, as a matter
of heredity. The children of a family resembling a mouth-breathing parent in other respects will often
be mouth-breathers too, wThilst the rest are like the other parent and normal; but the lack of resistance
in the cellular elements can be induced or cultivated as can be seen in the large, soft, well clothed,
scarcely exercised workhouse or institution children so apt to develop chilblains or to suffer from
adenoids. The children in some suburban localities which have no near playgrounds, who are well fed
and well clothed, but whose freedom is restricted to maintain the gentility of their parents, have been
pointed out in previous years as suffering from similar debility and adenoid hypertrophies in excessive
numbers.
The want of personal hygiene which contributes materially to permanent damage of vision
and hearing from slight dirt infections also is a factor in catarrhal conditions of the naso-pharynx. The
mentally defective children learn mouth-breathing in large numbers because the natural channels are
neglected. The children who do not use handkerchiefs are more often mouth-breathers than the others.
Breathing exercises, where both inspiration and expiration are through the nose, and the mouth is
kept shut for several respirations, should be an essential part of the infant school work. Handkerchief
drill in the lower classes is also to be thought of in the ordinary school.
The inculcation of cleanliness beyond the level of the cleansing schemes ought to be part of the
school work, and when the want of cleansing opportunities and the need of the tonic influence of bathing
are properly appreciated, school baths will be insisted on as part of the prophylaxis against the
lymphatic debility that shows ultimately as adenoids and in tuberculosis.; but although the school
cannot directly prevent the chronic catarrh, and possibly sometimes tubercular infection, set up by
the use of baby comforters, some restriction is necessary. Their action is wholly bad both mechanically
and as conveyers of infection. Their sale should be restricted.