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118 Annual Report of the London County Council, 1913.
Dr. Wood's
report upon
the relation
between
nasal obstruction
and
superior
protrusion.
Two statements are often made concerning the incidence of protrusion of the upper incisor teeth.
Firstly, that superior protrusion is commonly associated with adenoids; secondly, that where not so
accompanied there is invariably a history of use of the "comforter" or the habit of thumb.sucking for
a long period. With a view to testing these statements an enquiry was conducted by Dr. F. T. II.
Wood with the 11.12 year.old group of children medically inspected in 1913. Children showing
superior protrusion were separated from the lists ; in these nasal obstruction was noted as absent,
present, or previously treated by the removal of adenoids ; the state of nutrition was entered, and
where possible the method of feeding during infancy and the use or non.use of a "comforter" was
enquired into; in addition, the presence or absence of superior protrusion in the parent attending the
inspection was noted.
A summary of the notes made shows that 1,175 children were inspected ; that 88 showed
well.marked superior protrusion, and 172 showed it slightly—a total of 260; enquiry as to method
of feeding and use of "comforter" was made in 47 of these 260. (a) In the 88 cases of marked
superior protrusion there were 39 entered as "no adenoids," 38 as "adenoids," and 11 as "adenoids
previously removed"; while in the 915 cases without superior protrusion there were 825 " no
adenoids," 52 "adenoids," and 38 "adenoids previously removed." In other words, the existence
of nasal obstruction at some period was diagnosed in 55.7 per cent, of children with superior protrusion,
as against 9.8 per cent, in children free from it, (b) In the second place of the 47 cases of superior
protrusion where the mother was present and enquiry was made, 34 were mainly or wholly breast.fed,
13 were bottle.fed, and prolonged use of the "compter" was admitted in 24. (c) Finally, 27 of these
47 mothers showed obvious superior protrusion themselves (and as the sex incidence is not very unequal,
one may assume its existence in some of the fathers of the 20 cases where the mother was free.)
The conclusions that may be tentatively put forward on this matter are:—
1. That superior protrusion is not always associated with adenoids.
2. That the statement as to the invariable use of the "comforter" in cases without adenoids
is not strictly correct.
3. That the presence of superior protrusion in the parent is a more important predisposing
factor than is commonly stated.
4. That some of the cases of nasal obstruction with associated superior protrusion submitted
to the routine operation for adenoids are treated too late to relieve symptoms.
Enlarged
glands of
the neck.
Enlargement of the sub.maxillary or cervical glands was reported in 20,651, i.e. 10.5 per cent, of
the cases examined, but only 708 of these cases were considered severe enough to require treatment.
In Holborn the proportion of children reported as having enlarged glands was 97 4 of the number
examined, but only one case was referred for treatment, a percentage considerably below the general
average for London.
The relationship
of
adenoid
growths and
other
defects.
I he relationship between the presence of adenoid growths and defective hearing was commented
upon in my report for 1912. The neglect of adenoids in early life affects the ability of the child ,to
profit to the full extent by the teaching in school, and renders the sufferer dull and backward
generally. In the borough of Shoreditch the proportion of children aged 12 with defective hearing was
found to be 6.5 per cent, of the number examined,
The records of the children in this age.group in Shoreditch examined during the first term of
1913 have been analysed, and 116 (or about 7 per cent.) were reported to have adenoids. Of these
116, 53 had defective hearing; in 63 cases hearing was normal. Thus of the children with adenoid
growths over 45 per cent had defective hearing against 6.5 per cent, of the children generally in
Shoreditch schools. The presence of adenoids was noted in 53 cases of defective hearing out of a
total of 98 cases of hearing defects ; 18 of the remaining children had enlarged tonsils, 18 suffered
from otorrhea without either large tonsils or adenoids, and in 9 cases neither adenoids, large tonsils
nor otorrhea was present to account for the defect. In Bermondsey, on the other hand, of 51 cases
of defective hearing 30 were noted as having adenoids; there were in all 170 cases of adenoids
reported among children aged 12, and the proportion of children with adenoids who had defective
hearing was 18 per cent.:

In regard to the relation between adenoid growths or enlarged tonsils and the mental condition
of children the following table gives the figures for the children in elementary schools, and similar
figures relating to the children of the same age examined during the year in schools for the mentally
deficient. Included in the table is a column showing "other diseases of nose." as many of the cases