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nervous child is even alarming. For these reasons its general use is unsuitable under conditions of school
medical inspection and must be reserved until the time of the further examination carried out at the
school treatment centre or hospital.
The diagnosis of the existence of adenoids in school practice rests entirely upon interpretation of
symptoms exhibited by the child; one observer will record the suspected presence of adenoids where
the symptoms are slight, while another will only do so on discovery of the presence of very pronounced
effects. The differences in prevalence recorded in various localities, therefore, are often to be attributed
rather to the idiosyncrasy of the observer s than to any actual differences in the prevalence of the disease.
In London, however, it is the practice to record separately the children who have symptoms so
pronounced as to be referred for medical treatment. When attention was limited to these cases it was surmised
that there would be greater evidence of standardisation of individual idiosyncrasy, and that very
wide variations would be apparent no longer.
Dr. C. J. Thomas has analysed the figures of entrant children referred for treatment for adenoid
growths over a series of three years for each borough of London, and finds that three groups of boroughs
can be distinguished; six boroughs, Battersea, Lambeth, Shoreditch, Southwark, Wandsworth and
Woolwich are much above the average in incidence ; twelve are average, Bermondsey, Chelsea, Fulham,
Hackney, Hammersmith, Holborn, Islington, Kensington, Poplar, Stepney, Stoke Newington, Westminster
; and ten are below average, Bethnal Green, Camberwell, Deptford, Finsbury, Greenwich, Hampstead,
Lewisham, Paddington, St. Marylebone and St. Pancras.

It is quite clear from this return that a new disturbing factor has appeared ; the areas in which
the largest number of children are returned for treatment are those in which facilities for treatment
were earliest established and better known; indeed, in the case of three of them the school treatment
centres were actually the first to be instituted in London. In the light of these results, it will be more than
ever clear that great caution is necessary in drawing deductions with regard to local incidence. The differences
exhibited by two poor boroughs like Shoreditch and Bethnal Green, for example, are particularly
instructive, and they are no doubt to some extent explicable as being due to differing facilities for
obtaining treatment in these two boroughs. Another point deserving of note is that an expectant
attitude is followed by some school doctors, and this hesitation in recommending operative treatment
on the part of particular doctors may explain the great difference to be noted in the small number
of children referred for treatment in Bethnal Green as compared with Shoreditch.
Association of the presence of enlarged tonsils and adenoid growths with deafness and discharging
ears.—The close association of the unhealthy conditions of the nose and throat with ear discharge and
deafness has frequently been pointed out in previous reports. The figures available have been obtained
from researches of individual observers directed to this specific question and based upon single examination
of children at a definite point of time.
There are now, however, available completed records of the medical history of children who have
left school. These records are forwarded from the schools to the public health office and are there
accumulated. It is now possible, therefore, to ascertain how far the association of deafness with the
throat troubles under consideration is reflected in the medical histories of children resulting from ordinary