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90
Annual Report of the London County Council, 1914.
Of the 34 girls showing symptoms, 7 were in the middle age group and 27 in the leaver group of
children. All had definite enlargement of the thyroid gland.
In 22 cases the enlargement was bilateral and symmetrical, in 8 the left lobe only was involved,
in 3 the right lobe and in one case the isthmus was affected. In 18 cases there was tenderness of the
gland, showing the presence of some amount of actual inflammation. In all there was some abnormality
of the heart or its action; in ten cases the eyeballs were prominent (exophthalmos); in 5 cases, of which
one had been mistaken for a case of chorea, tremor was found. In 28 cases nervous and emotional
disturbances, including night terrors, sleep walking and enuresis, were present.
Amongst boys 18 were found who showed symptoms of thyroidal over-action. In all there was
enlargement of the gland, but in no case so marked as in the most pronounced cases of enlargement
among the girls; in practically all the cases the outstanding features, were the thyroid enlargement, the
tremor and the tumultuous action of the heart. Emotional disturbances were present in 16 of the 18.
Of the 52 children no less than 42 presented definite evidences of septic absorption. Carious
teeth and oral sepsis were present in 28, septic tonsils in 6, otorrhœa and other septic conditions in the
remainder.
Dr. Leipoldt is convinced that the conditions he has found are due to inflammation of the thyroid
gland set up by septic absorption. He states that the improvement in some of the children consequent
on thorough dental treatment has been striking; the thyroid enlargement has disappeared and
the palpitation, tremor and nervous symptoms have been much diminished or altogether abated.
Dr. Leipoldt's observations are interesting, suggesting as they do that the early stages of Graves'
disease are more often to be detected in children than is usually supposed, that they are connected
with inflammation of the thyroid gland, and that with continuance of septic absorption from the mouth
or other organs, the condition may become established, and lead either to the development in the adult
of exophthalmic goitre on the one hand, or of atrophy of the thyroid gland (myxœdema) on the other.
These observations go to show that undetected or unheeded septic conditions in childhood may
produce far-reaching effects in those predisposed to certain complaints; they form an additional reason,
if any were needed, for redoubling the efforts already vigorously being made to induce parents to
obtain treatment for all children found defective at medical inspections.
Eye diseases.

The above figures give the percentages of children in each age and sex group found with external
eye diseases and those referred for treatment. They are practically identical with the figures for 1913.
They include, in accordance with the schedule of the Board of Education, both inflammatory
conditions and squints. It should be borne in mind that the two classes of conditions depend on totally
different causes, and fall on quite different types of children. The figures for 1912 gave each type
separately.
Vision.