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(4) Frequent attacks of tonsillitis. A moderately enlarged
tonsil may cause these, and is only to be adequately removed
by dissection and not by merely cutting the tonsil.
(5) Much enlarged cervical glands with no other apparent cause
than enlarged tonsils.
Even when the operation has been performed little
benefit may be expected unless after-treatment is carefully
carried out in the shape of breathing exercises, and
the school nurse will in future give printed as well as oral
directions. The habit of mouth-breathing has a serious
effect on the mental development of the child, and is only
to be remedied by much parental patience.
The operative treatment of a child suffering from much
enlarged adenoids is an urgent one. Until the condition is
relieved, the child's progress at school is retarded, it is
mentally lethargic and suffers from frequent attacks of sore
throat."
(c) Tuberculosis.—No case of definite tuberculosis of the lungs
was detected at medical inspection. This confirms the generally
accepted opinion that Pulmonary Tuberculosis is a comparatively
rare infection at school age. Six suspected cases of Pulmonary
Tuberculosis were detected, and these were referred to their own
medical attendant or to the Tuberculosis Dispensary, for observation
purposes.
(d) Skin Disease.—Ten cases of Ringworm, 30 of Scabies
{Itch), and 40 of Impetigo were discovered at routine medical
inspection. These figures alone show the value of medical inspection
and its importance in preventing the spread of these infective
ailments among school children.
(e) External Eye Disease.—Thirteen cases of Blepharitis or
inflamed eyelids, and 1 case of Conjunctivitis were discovered.
Blepharitis may be simply an infective condition of the lids, or
may be due to defeat of vision, and is rapidly cured when this
is corrected.
(/) Vision.—570 children, or 16 per cent., were found to be
suffering from vision so defective as to require treatment.
Further particulars of these cases will be found in the School
Clinic Report.
(g) Ear Disease and Hearing.—37 children, or .7 per cent.,
were found to' be suffering from defective hearing. The cause in
most of these cases was wax in the ear. In addition, nine children
were found to be suffering from a discharge of the ear, resultant
on old otitis media.
It has not been found possible, with the conditions under
which medical inspection is performed, to adopt the forced
whisper heard at 20 feet as a standard. The most satisfactory
method of testing the hearing has been found for the examiner
to be placed behind and to one side of the child, and, while
stopping an ear with the finger, to test the hearing in the