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68
Ionisation
treatment
for otorrhœa.
Treatment by ionisation of cases of suppurating ears was commenced at the Almeric Paget centre
at the beginning of the winter term, 1920, under the direction of Dr. Friel. One ionisation apparatus
was installed in the first place, but subsequently towards the end of the term a second apparatus was
added. Cases of suppurating ears which resisted the usual conservative treatment, were referred from
the various centres in the Eastern Division, but an arrangement has recently been made whereby one
centre is being dealt with at a time. The object of this plan is to find out which cases at the particular
centre are suitable for ionisation, and to treat these, referring those which are not suitable to Dr. Wells
in order that he may advise as to other methods, such as mastoid operation, etc., as opportunity permits.
In this way, the cases attending a particular centre are separated into two groups, viz., those suitable
for ionisation and those not suitable, and thus a more comprehensive way of dealing with the cases is
assured. During the winter term the total number of cases seen at the Almeric Paget centre was 61,
of which 52 received ionisation treatment, and 9 were considered unsuitable. In 25 cases the discharge
ceased as the result of treatment. There were 11 failures for the following reasons—mastoid disease, 3;
granulations, 3; attic disease, 1; polypi, 3; cause unascertained, 1. One case gave up treatment
and 15 cases still remain under treatment.
There is no doubt that ionisation is an excellent method of treatment in certain cases of suppurating
ears, and the above results fully justify this opinion.
Since the beginning of the winter term of 1920 an ionisation apparatus has also been installed
at the Children's Infirmary, Cleveland-street. The cases dealt with here were of two kinds, viz., (a)
cases upon which a mastoid operation had been performed, (b) cases on which no operation had been
performed. The object of ionising cases of class (a) was to endeavour to cut short the after-treatment
of mastoid operation cases, and the details below will show the results obtained. Dr. Wells reports
that ionisation expedites the healing process, but it is not yet determined how soon after the operation
ionisation can be performed with best advantage.
Cases in class (b) were similar to those dealt with by Dr. Friel at Cable-street. Of 17 cases ionised
in which no operation was performed, in 9 the discharge ceased, clearing up within two weeks in 7 cases,
and within four weeks in the other 2 cases. In the 8 unsuccessful cases, failure to clear up was due to
mastoid disease, as was afterwards proved. Of 118 cases ionised in class (a) in which mastoid operation
had been previously performed, 80 were successful, and 38 were apparent failures. Of the successful
cases, 64 cleared up with one ionisation, 15 with two, and 1 with four ionisations.
Mastoid
operations.
During the past year 125 mastoid operations have been performed at the Cleveland-street institution,
under the arrangement made with the Metropolitan Asylums Board, with the consent of the
Ministry of Health. Of these, 16 cases were lost sight of after the operation, owing to the children having
left school or for other reasons, before their treatment was completed.
Of the remainder 76 per cent, of the cases healed and were discharged as " cured." This is a
very excellent percentage of successes, but particularly is it so when one realises the material which has
been dealt with. The cases that have been operated on have been almost entirely of the very worst
type possible. If it had been possible to pick out cases with a view only to obtaining the best results,
no doubt the percentage of successes would have been even higher than 76 per cent. But, owing to
the fact that only a limited number of operations can be done, those that have appeared to be the most
urgent and the most diseased have been selected. The result of this work is proof of what can be done
for some of the bad cases of chronic mastoid disease, which have in most instances existed for many
years, and for which conservative treatment has been of no avail.
(c) Ringworm.—Of the 1,840 children referred under the Council's arrangements for treatment
of ringworm of the scalp, 1,758 received X-ray treatment, and 1,593 were discharged as cured. Only
44 children were treated with ointment.
(d) and (e) Vision.-—The number of children attending the Council's centres for defective vision
was 29,887, an ncrease of 1,876 on the figures for the year 1,919. Spectacles were prescribed in 22,827
cases, and in 19,882 cases they were obtained.
(f) Dental defects.—Mr. C. Edward Wallis reports that the great difficulty in obtaining suitable
premises for dental centres has to some extent been met by increasing the number of sessions devoted
to dental treatment, and facilities are now available for nearly 100,000 cases. The total number of
dentists engaged is 70, of whom four are whole time and 66 are on a part-time basis. The only new
centres have been the Battersea (" Gonville ") centre and that at Bushy Park Camp School, for which
the dental equipment was presented by the Canadian Government.
The cost of dental equipment has risen greatly, for example, a clinic operating chair, which formerly
cost £17, now costs as much as £50. In the latter part of 1920, the opportunity was taken of obtaining
six surplus army dental chairs and other apparatus at a greatly reduced cost for the use of prospective
centres.
It has now been decided that in connection with all centres children below the age of six shall
be dealt with. For some years past the age of children inspected has been extended fiom the age 6-8
upwards by one year at each succeeding re-inspection, so that in course of time the scheme will deal
with the whole of the school population.
In order to co-ord nate the work of the various inspecting and treat ng dentists two series of rules
have been drawn up and supplied to all concerned.
Bushy Park
Camp School.
The need for opening a dental centre at Bushy Park is proved by the statistics obtained by the
dentist in charge, Mr. W. D. McDonald, who lound that 78 per cent. of the admissions required dental
treatment, and that 27 per cent. were suffering from septic inflammation of the gums associated almost
invariably with enlarged lymphatic glands. The fact of the children being actually resident enabled
Mr. McDonald to institute a special scheme of gum treatment and massage, to be supervised by the