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No question of personal equation between examining officers arises on these figures, which are
also free from any disturbing influence caused by age. They appear to indicate cœteris paribus that
either the presence of adenoid growths and enlarged tonsils tends to produce mental defect or backwardness
in school, or that the conditions which favour the development of adenoid growths also bring about
a lowering of mental capacity.

The children in central schools are selected from the brighter mentally of those in ordinary schools.
Other conditions associated with adenoid growths and enlarged tonsils.—The records of medical
inspections were scrutinised wth a view to finding out if any other conditions noted in the children
bear any constant relationship wth the throat conditions under consideration. Teeth, cleanliness,
vision, eye diseases, and malnutrition in turn were examined without any result
Symptoms of adenoid growths and treatment.—Dr. A. G. Wells has collected information in regard
to the symptoms present in a number of school children examined by him before and after treatment
for adenoid growths with the following results, the numbers after performance of operation being given
in brackets:—
Snoring 321 (70)
Mouth breathing 328 (95)
Frequent colds 293 (127)
Deafness 134 (45)
Frequent sore throats 156 (51)
Defective speech 24 (8)
Ear discharge 114 (46)
Nose bleeding 23 (5)
Enuresis 37 (24)
Nasal discharge 110 (38)
Enlarged glands 30 (10)
Mental dulness (marked) 28 (9)
Frequent sickness 7 (2)
Night terrors 84 (26)
Miscellaneous 11 (2)
Total 1,700 (558)
These results show that very considerable relief is obtained by the operative treatment as generally
performed. He points out, however, that although the majority of operations are very successful there
is a residue of less satisfactory results varying from 15 to 39 per cent., at one or other of the institutions
at which the operation was carried out.
Dr. Wells points out that much can be done towards ensuring satisfactory results by careful
attention to details. There is no doubt that the Council's arrangements by which the homes of the
children are visited by district nurses after operation have made a great difference to the results of
operation for adenoids in the case of London school children, and Dr. Wells instances the example of
one of the centres included in the Council's scheme, where every detail was considered which might aid
in producing a satisfactory result and where the results were such that great benefit was obtained in
every case.
The general opinion is that open air treatment, breathing exercises and similar measures
cannot take the place of operative removal of the obstruction, although they are very desirable in all
cases in the after treatment of children who have been operated upon. Thus, for example, Dr. Birmingham,
in a report on the playground class at Gordonbrock-road School, remarks that " the results are
so unsatisfactory in the cases of children suffering from enlarged tonsils, adenoids, mouth-breathing or
enlarged cervical glands, that I would advise they be not sent to the playground classes but placed under
operative or other treatment more likely to give quick and certain benefit."
External
diseases of
the eye.
The amount of external eye disease recorded is largely dependent upon outbreaks of infective
ophthalmia, and although some districts of London, e.g.,Wapping, especially suffered in the latter respect,
the year was on the whole a good one, and only 3 5 per cent. of the children examined were reported as
suffering from external eye disease, as compared with 4.2 per cent. in 1914, and 41 per cent. in 1913.
The records of the testing of the children's eyesight show how materially the extension of care
activity during school life is benefiting the children themselves and improving the general fitness of the
population. It is still unfortunately true that serious defects of vision increase during school life, and
that this affects girls to a greater degree than boys. But it is satisfactory to note that the excess of
serious defects in the girls is less this year than last. On the other hand, the percentage of leavers
recorded with normal acuity of vision has increased from 51.1 per cent. in 1913 to 57.4 per cent. in 1915
amongst boys, and from 43.8 per cent. to 51 per cent. in the case of girls ; so that the acuity of vision
of the leaving girls in 1915 has reached that recorded in the leaving boys two years ago.
Diseases
of the ear
and hearing.
Much attention has been paid to the question of discharging ears during the year. Chronic ear
discharge is the despair of hospital out-patient treatment, and a final solution of this difficulty has still to
be found. Nursing treatment centres have done much to improve matters, but co-ordination between
specialist examination, such as is only in general to be obtained at a special hospital or special department
of a great hospital, and the ordinary tedious routine treatment which must in general be followed, is
difficult to effect. A centre for special inspection of ear cases has been established under the direction
of Dr. A. G. Wells at Paradise-road, Stockwell, with very encouraging results.
The year's inspections show a slight reduction in the number of children found at routine examinations
to have ear disease, viz., 2.2 per cent. compared with 2.5 per cent. in 1914.
Children with defective hearing also happily show a slight reduction, viz., 1.3 per cent., as compared
with 1.5 per cent. in the previous year, and 1.7 per cent. in 1913.