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Skin Lesions.
(1) Infective conditions. Infective skin lesions (scabies, impetigo, ringworm)
were only rarely seen. They were once common and their disappearance
is no doubt a tribute to modern methods of prevention and treatment. Scabies
is possibly overlooked sometimes and in the present series was found to underly
one case of impetigo and one case of urticaria.
(2) Congenital lesions (naevi). Fortunately most of the naevi were of the
superficial type which are pink and not raised, these respond rapidly to freezing
with carbon dioxide snow and this treatment was arranged when there was any
disfigurement.
(3) Acquired lesions. Possibly the commonest skin lesion of the pre-school
child is papular urticaria. Recurrent crops usually occur. Only one case required
specific treatment.
(4) Infantile Eczema. The severe cases of this condition were referred for
hospital treatment.
Tonsils and Adenoids.
Tonsil and adenoid operations were arranged in fourteen cases and only
in the presence of associated symptoms. Enlargement of the tonsils is not usually
of itself a cause for removal. Chronic and recurrent infection is the usual indication
and the small tonsil, adherent to the faucial pillars and associated with easily
palpable tonsillar glands is a greater indication for operative interference than the
presence of a large tonsil. Operation was usually advised only after a period of
observation in cases of recurrent aural discharge, recurrent tonsilitis, very large
tonsillar glands, and persistent mouth breathing. In cases in which the operation
is not followed by a disappearance of symptoms the possibility of chronic sinus
infection must be considered. Sinus infection is probably commoner than hitherto
supposed. The only certain diagnostic method at this period of life is the X-ray.
The prevalence of this condition in the children attending these clinics might well
be investigated at a future date.
Mental Symptoms.
The children displaying mental symptoms fall into three groups : (1) Associated
organic lesions (mongolism, etc.). (2) Gross backwardness. (C) Mental
maladjustments and psychological handicaps (a) enuresis, (b) persistent nightwaking,
(c) undue dependence on parent, etc.). The last group only will be discussed.
The three instances have been mentioned because they constantly crop
up. The underlying cause is no doubt often obscure but in many cases is obvious,
(a) The persistent night waking of many babies is secondary to the discomfort
following enuresis. The cure lies in correcting the habits and not in sedatives.
(b) In older children enuresis is often associated with severe day frequency.
This frequency possibly betrays an anxiety to keep " dry." It unfortunately
promotes bladder intolerance which increases the enuresis. Cure can often be
obtained by limiting this day frequency.
Heart Murmurs and Rheumatism.
Cardiac murmurs are of frequent occurrence in the pre-school children.
In the present series a murmur was heard in 12 per cent, of cases (diaphragm
stethoscope). In the great majority of cases it is the very systolic murmur at the
apex. In a tenth of these cases the murmur is considerably louder, in five cases