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are clinically meaningless. Every case is a law unto itself and must be
decided on its own merits. It is important, also, to remember that
adenoids and tonsils differ in their pathological effects. Adenoids can
become, when greatly hypertrophicd, a "mechanical" factor in causing
nasal respiratory obstruction, whereas tonsils can be, when clinically
diseased, a source of "toxaemia". "Unhealthy" tonsils and adenoids
are usually the "sign" of a disease which must be sought elsewhere and
removal of the sign will not cure the disease. There are, however,
instances where removal of adenoids (when they cause nasal obstruction)
and, much less frequently, tonsils (chronically diseased) are clearly
indicated and the results very satisfactory. Nevertheless, the operation
should be limited to those cases where the effect of their removal is
beyond doubt.
In conclusion the standard of general health of the children seen at
the clinics during the year has been very good. In only a few instances
could it be considered as below normal and it is in marked contrast, to
say, 20 years ago.
Audiometry Scheme
Under the present County arrangements a gramophone audiometrician
is shared between this Area and that comprising the Boroughs of
Finchley and Hendon.
Mrs. Perry, whose appointment was reported in my last annual
report, resigned during the year, and was replaced by Mrs. M. Duffy
in October. Due to this change in staff the initial survey in Finchley
and Hendon has taken longer than anticipated, so that the services of
the gramophone audiometrician were not available at all in this Area
during 1954.
Consideration will be given, once the routine audiometry testing of
seven year old children has been brought up-to-date, to testing children
in "C" streams at school to ascertain whether or not their lack of
educational progress may be associated with some degree of deafness.
Orthopaedic Service
Hornsey. Mr. Guy Rigby-Joncs, f.r.c.s.(edin.), reports that the
continuing demand for treatment is a clear indication of its value and
the numbers attending would make it quite impossible for these children
to be transferred to local hospitals for their orthopaedic care. It would
be a great pity if these services were allowed to be taken out of the
hands of the local authorities who control the welfare and school clinics
and have a far better organisation for inspecting the home circumstances
which often play a large part in the postural dcfccts of children. The
great advantage to the child is that minor ailments and defects can be
dealt with outside the hospital atmosphere and the child is never allowed
to think that it is in any way abnormal.