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is usually unreliable. Chronic deafness, too, can be due to abnormal
conditions left untreated in the nose, such as "nasal obstruction", sinusitis,
rhinitis, whose early symptoms are quite common in young children.
They act by interference with the necessary aeration of the middle ear, or
by the extension of infection into the middle ear and set up a suppurative
otitis media which may progress to the chronic form and permanent
deafness.
The normal functions of the healthy nose owing to their controlling
influence over the fine working of the chest organs, lungs, heart and
circulation, certain abdominal organs, and the brain are of special importance
in the maintenance of the health of body and mind. Many of the
early signs of defects which interfere with and upset these normal functions
in later life are clearly discernible on close examination of the nose and
naso-pharynx during school age.
"Nasal obstruction" on account of its far-reaching and serious effects
is perhaps one of the most frequent and important nasal defects to look out
for during a school child's medical examination. It is very common and
is, unfortunately, only too frequently overlooked.
It is surprising how little understood are and how little attention is
given to the widespread detrimental effects of defective nasal breathing;
and it is all the more so when it is realised that a large number of the
symptoms of nasal obstruction and impaired hearing originate during
childhood and if at this stage were detected and correctly treated the
whole train of widespread ill-effects and disease set up by their progressive
development could be eliminated.
It is well to emphasise here the importance and urgency of 'following-up'
the very earliest symptoms of ear trouble, otitis media and impaired
hearing.
Orthopaedic Service, Hornsey
I am indebted to Mr. E. Palser, M.R.C.S., for the following report:—
"During the year attendances at the Orthopaedic Clinic have been 698
for examination and 1,281 for treatment by the physiotherapist.
The number of new cases was 283, and the number of discharges was a
comparable figure.
This represents an increase in the total work of the clinic, but a reduction
in the number of new cases seen during the year.
The running of the clinic in its present form with the help of the Hornsey
Central Hospital in taking X-rays and carrying out some pathological
investigations has been smooth and without complications which could
not be dealt with under the present set-up.
The variety and degree of severity of the cases which the school medical
officers have referred to this clinic shows an acute appreciation of the type
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