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nose and throat are referred for further treatment proves that a careful selection is made of those who
really require special treatment. In fact, the number referred for treatment for adenoid growths, is
only 4,571 or 2.1 per cent., more children being referred with tonsils alone than with tonsils complicated
with adenoid growths and with adenoid growths alone. The probability is, judging from these figures,
that if anything the school doctors err on the side of caution, in referring for further examination or
treatment cases of adenoid growths, and the charge made that there is indiscriminate resort to operations
rests on no sure foundation in fact.
The immediate good results from operation in certain cases are illustrated by a series of cases
where children have been suffering for lengthened periods from serious and painful eye disease, and in
consequence have been proposed for admission to Swanley under the Council's scheme. They have been
seen by Mr. Bishop Harman, with a view to ascertaining their fitness for Swanley, and he has discovered
the presence of unhealthy throat conditions. He has, therefore, directed that treatment should first
be obtained for the throat before final decision be made in regard to Swanley. In some of these cases,
almost immediately after the operation for throat disease, the eye conditions have been spontaneously
cured, and the question of admission to Swanley no longer arose. The notes of two illustrative cases
follow :
Mary B., aged 12, had been suffering from ulcers of the cornea for three years, and was proposed
for Swanley. She was seen by Mr. Harman on the 3rd May, 1921, who noted central depressed ulcers
of the cornea of very long standing ; she also had " huge " tonsils, and Mr. Harman recommended throat
treatment before decision on Swanley. The child was taken to Shadwell Hospital and had her tonsils
and adenoids removed on 25th May, 1921. On 21st June, 1921, she saw Mr. Harman, who reported
that the throat was satisfactory and the eye disease cured. She was able to return at once to the elementary
school.
Esther M., aged 8, was proposed for Swanley for chronic ulcers of the cornea. She was seen by
Mr. Harman on 13th September, 1921, who found that there was a large white ulcer on the left
cornea, with considerable infection. He also found the tonsils verv large and unhealthy. He postponed
decision as to Swanley until treatment was obtained for the throat. The throat was operated
upon on 14th October, and on 8th November Mr. Harman found the eye disease quite cured and sent her
back at once to the ordinary school.
Ear disease
and hardness
of hearing.
Closely associated with the prevalence of enlarged tonsils and adenoid growths are discharging
ears and hardness of hearing. As in the case of enlarged tonsils and adenoids, there is no difference
in the incidence upon boys and girls. Both the incidence of tonsils and adenoids and that of discharging
ears diminish during school life as the result of care and attention, but unfortunately the results of these
conditions—chief among which are hardness of hearing and deafness—remain permanent and so accumulate
that they show a greater incidence upon the older than the younger children. It is therefore
very gratifying to note that not only the percentage of children suffering from the causes here considered
is, as the result of continued medical care, becoming less frequent, but that permanent results also are
becoming rarer. During 1921, 1*9 per cent, of children were found to have ear disease and 0.8 per cent,
were found to have noticeable hardness of hearing, both figures being a slight improvement on those of
1920 which, in turn, showed an improvement on the figures of 1919.
In addition to 3,231 children in the age groups suffering from otorrhœa and otitis, there were 1,792
such children brought forward by the teachers, nurses and care committees at special examinations.
Visual aouity
14,601 children were referred for treatment for visual defect or 10'7 per cent, of those examined
in the eight and twelve-year old groups. This is a distinct improvment upon 1920 when 11 "6 per cent,
were so referred.

Bad cases of defective vision are commoner at twelve than at eight, but the deterioration between
these ages is being diminished and is now much less than it was in former years. The most striking
result, however, is the heavier incidence of visual defect upon girls, and, though this is not so marked
as formerly, it yet appears that the habitual employment and methods of instruction to which girls
are subjected, particularly as regards the teaching of fine sewing, are harmful.
Squint.
3,176 children (15 per cent.; were found to suffer from squint, the percentage is especially high
in entrant infants and grows progressively less throughout school life.
Heart defects
and anfemia.
6,229 children, or 2.9 per cent., were found suffering from heart defects, which is a distinctly
better result than in former years (3.4 per cent, in 1920 and 1919). 7,974 children, or 3.7 per cent.,
were marked with anaemia, again an improvement on the previous year when 4.1 per cent, were found.
The heavier incidence of heart defect and anaemia in the older girls is still particularly noticeable. 4 per
cent, of twelve year old girls have heart defect as compared with 3 per cent, of boys ; and 4.2 per
cent, of older girls suffer from anaemia as compared with 3.4 per cent, of boys of the same age. The
remarks upon the heavier incidence of visual defect upon the older girls need to be repeated here.