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Children should be tested at least annually. This would entail an increase in work, but one
which should be possible as it could be carried out by competent nurses, without the intervention of
Medical Officers.
At present, in this Borough with its largely increased and increasing population, we cannot
embark on additional work of this kind, but I look forward to the time when we may be able to
put it into practice.
E. L. ROBERTS,
Deputy School Medical Officer.
(e). Nose and Throat Defects.
Four hundred and five children were referred for treatment on account of Nose and throat
defects. Of this number, 130 were operated on under the arrangements made by the Authority
with the Hounslow and Richmond Hospitals in 1921, 37 received operative treatment by private
arrangements of the parents, and 26 cases received other forms of treatment.
Our methods of arranging operative treatment for tonsils and adenoids remain the same as
in past years. A child must be referred for treatment by one of the Medical Officers and the
parents are then given an application form on whch they are asked to state details of their income
and outgoings, number in family, etc. As soon as this form is completed and returned, it is
forwarded to the Education Secretary who fixes the amount the parents shall be asked to contribute
towards the cost of the operation. The parents are then asked to give their written consent
to the operation, and when this is received the child's name and address is sent to the appropriate
Hospital. The hospitals make the appointment for treatment, and the Authority pays one guinea
for each case operated on.

This scale of repayments does not apply to parents who are members of the Hospital
Saving Association. In these cases the Association's Voucher is accepted in lieu of a contribution,
and the Association in return pays an agreed sum per case to the Education Committee for this
treatment of their members' children.
(f). Ear Disease and Defective Hearing.
One hundred and ninety-nine cases of ear disease or defective hearing were dealt with at
the school clinics, and 7 were treated by private arrangement of the parents.
Dr. Roberts reports that the use of B.I.P. Paste in the treatment of Otorrhoea has been
continued during 1933 and that this year's results have confirmed the good opinion of it expressed
in her Special Report in 1932.
It has become the routine treatment in the two School Clinics under her charge and is
extensively used in the third under the Assistant School Medical Officer, Dr. Freeman.
In a very few cases B.I.P.P. has not appeared suitable as in these the paste has formed a
dark compound which has irritated the tissues. Such cases have been put on Rectified Spirit with
Boric insufflation and have done well, healing in a shorter time than cases previously treated with
Rectified Spirit and insufflation only, so that it would appear that some benefit is obtained by the
initial use of B.I.P.P. even in cases where its continued use is not advisable.
(g). Dental Defects.
The work in the Dental Section has been one of progress on the one hand.and retrogression
on the other, or rather lack of progress due to the fact that our Dental Department is like a plant
which is choked by weeds, owing to the lack of accommodation which makes expansion of the
work impossible.
The Isleworth Clinic so long visualised but so long delayed by various matters is responsible
for holding up the work urgently required to cope with the increase in the school population. At
long last there seems a probability of something evolving in the new area in the way of Clinic
premises, even of a temporary character to deal with the ever increasing demand at Isleworth for
adequate facilities for that end of the district.
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