London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1913

[Report of the Medical Officer of Health for London County Council]

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Report of the County Medical Officer—Education.
137
Of the 162 cases examined—
52.46 per cent. were boys and
47.53 per cent. were girls.

The ages of the children ranged from 4 years up to 14 years, and are recorded as follows:—

Sex percentage.
Age.Percentage.Boys.Girls.
410.49.21.2
514.17.46.7
69.23.16.1
78.64.93.7
89.24.94.3
93.71.81.8
103.11.21.8
1116.68.08.6
1216.08.08.0
134.91.83.1
143.71.81.8

This table of age incidence refers mostly to nasal obstruction from adenoids.*
The theory that adenoids tend to disappear at puberty may prove a disappointing one. The
structure of adenoids reveals a fibrous connective tissue framework supporting masses of lymphoid
cells. A contraction of this fibrous tissue causes gradual shrinking of the adenoid mass. This
change, however, is independent of the age of the patient. There is no definite period at which it
must occur; so that it is foolish to wait, for the secondary effects continue to progress.
There is only one sensible method of treatment—removal of the growths. This was done in
75.3 per cent. of the cases considered, as already mentioned, and it is hoped thereby that the chances
of serious middle ear disease, with its many complications and sequelæ — which would eventually, Dr.
Martin thinks, have occurred in many of his cases—will be lessened, and something will have been
done towards lowering the very high percentage recorded in the tables. The Eustachian catheter was
passed in three cases of continued deafness with benefit. These cases had elsewhere been operated
upon for tonsils and adenoids. Several of the cases were referred to the "Minor Ailments"
department of the centre for syringing of the nose and ears.
It will be observed from the table that the percentage of children with enlarged tonsils is 67.9.
Such cases should be treated without delay, as the child is especially liable to all sorts of
affections of the throat, and is more prone than other children to suffer from the more serious
complications of such infectious diseases as scarlet fever and diphtheria. Unless enlarged tonsils are
removed early their evil effects—the nasal speech, the narrow deformed chest—may remain
permanently with the child even after removal of the offending tonsil. If the hygiene of the mouth
were properly attended to, i.e., brushing of the teeth and removing or stopping of decaying teeth,
there is no doubt that enlarged tonsils would be of less frequent occurrence. The percentage of
children with adenoids was 87.03, and other causes of nasal obstruction were as mentioned in the
tables.
Some of the effects produced by the presence of enlarged tonsils and adenoids may be
tabulated in this way:—
(1) The blood not properly oxygenated giving:
(a) Stunted growth.
(b) Heavy and dull mental condition; child cerebrating slowly.
(c) Anæmia.
(2) Breathing interfered with, producing:
(a) Badly expanded lungs.
(b) Malformed chest; narrow, flat, or pigeon-chested.
(3) Greater liability to disease of the respiratory system, e.g.:
(a) Colds, bronchitis, &c.
(b) Phthisis.
(4) Local conditions of the throat make the child more liable to:
Sore throat, quinsy, rheumatism, infectious diseases, and nasal catarrh, which
frequently spreads to the middle ear and causes deafness.
(5) Expression of face:
Mouth always open; dull, heavy, stupid-looking.
(6) Speech:
Nasal and indistinct.
This is a formidable list, and when it is borne in mind that some of the effects of the presence
of enlarged tonsils and adenoids may be permanent, even after the removal of the offending cause, it is
not difficult to appreciate how important a thing it is that enlarged tonsils and adenoids should be
removed as early as possible.
Many of these children are incapable of gleaning the full benefit of their school training,
because they are retarded in their progress on account of these defects; they consequently require a
greater amount of attention from their teacher, which is given at the expense of the other boys and
girls. At the Hackney School Treatment Centre every precaution was taken to reduce the shock of
the operation on tonsils and adenoids to a minimum. The children were made happy and comfortable
* Dr. Martin comments upon the age distribution, but was unaware of the disturbing factor that only certain
age-groups are medically inspected at school. This factor is the probable explanation of the irregular variations of
the incidence at the different ages.
23610 T