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arrangement has been a great boon, and has enabled the Council to deal with a large number of children
who were under supervision, though out of school for interminable periods, owing to painful and distressing
eye disease. Previously nothing could be done in these cases, except watch them month after
month struggling in unhygienic surroundings with palliative treatment. The number of children sent
to Swanley under this arrangement from its commencement in May to December was 108.
(b) Aural defects (including enlarged tonsils and adenoid growths).—Attention has been continuously
directed to this sphere of the Council's remedial work. Greater interest and solicitude are now shown
generally in all questions relating to the care and treatment of children and public criticism, welcome
and sometimes well informed, is now readily forthcoming. The arrangement at the Cyril Henry centre,
whereby children are kept in for two days following minor operations upon the throat, has been greatly
appreciated. The consent of the Board of Education has been obtained to the use of an ambulance
in the case of other centres, and it is hoped before long that a centre may be established in Highgate
New Town whereby the benefits at the Cyril Henry centre may be extended to children living north of the
Thames. As has been shown in the section on inspection, an undue number of children has by no means
been referred for further examination and treatment for nose and throat disease, and there can be no
doubt that operation is advised only where the child's health is seriously threatened. Dr. A. G. Wells,
who has made a series of visits to the treatment centres, has drawn up the following statement in regard
to the indications for operation for tonsils and adenoids :—
Tonsils should not be removed simply because thay are enlarged. Generally speaking, no operation
for tonsils and adenoids should be performed unless there are very definite symptoms present, the
persistence of which would be likely to act prejudicially upon the health of the child, and the treatment
of which by more conservative means would be likely to be ineffective.
Each case must be judged on its merits, and while the following recommendations are not
exhaustive as to when operation is indicated, they are meant to serve as a general guide in arriving at
a decision at the Council's treatment centres.
Indications for operation in cases of adenoids :—
(1) In cases of recurrent attacks of earache.
(2) In cases of recurrent attacks of deafness.
(3) In cases of otorrhcea.
(4) Marked snoring, mouth breathing and restlessness at night, when the cause can be
attributed to adenoids.
(5) Frequent repeated colds and coughs not due to other factors.
(6) General malnutrition where other causes can be excluded.
Indications for operation in cases of tonsils:—
(1) Frequent sore throats, not prevented by conservative treatment.
(2) Cases of diseased tonsils—e.g., fibrosis of the tonsils; tonsils in which small yellowish
plugs are extruded into the throat, or those in which secretion from the crypts can be
expressed by pressure on the tonsil.
(3) When there is enlargement of the tonsillar glands.
Dr. Wells has also drawn up the following recommendations in regard to immediate treatment
after operations:—
In order to minimise the risks of untoward results in operating for tonsils and adenoids, operators
are recommended as follows:—
(1) Take the precaution of inspecting thoroughly the area of operation in order to see that
no " tags " of adenoid tissue remain after operation or other condition- exist which might
detract from the success of the operation. (This necessitates inspection of the throat under
complete illumination by direct or reflected light.)
(2) See that the patient is not allowed to leave the operating table until all bleeding has
ceased. (This usually takes place within three to five minutes of the completion of the
operation.)
(3) See that the child is placed in bed in the most suitable position after operation. (A
lateral position with the head slightly extended ; the upper leg well flexed at the hip
and knee and the arm so tucked against the chest that the upper shoulder is propped up
to allow free respiratory movements of the chest.)
(4) Nurses on duty in the ward or recovery room should see that the above described
position is maintained. If much oozing escapes from the mouth, the nurse should acquaint the
doctor at once. She should watch the movements of the larynx to see if any appreciable
quantity of blood is being swallowed.
If the child is restless, pale, has irregular, shallow, sighing respiration and rapid pulse, the .
doctor should be immediately notified.
Dr. Wells has continued to devote a session on one day in the week in each division to the oversight
of cases of discharging ears. He saw during the year 924 children. The treatment of these cases
by Dr. Friel by the method of ionisation has been continued at the Almeric Paget treatment centre,
and has been extended to the Lissonia centre. At the Almeric Paget centre, 124 children were examined,
and of these 86 were considered suitable for ionisation ; of these, 49 were cured, 11 referred for operation
10 still remain under treatment, and 16 ceased to attend. Of the 49 cases cured, 43 had one ionisation
only. In suitable cases, therefore, ionisation appears to succeed far more often than any other form of
treatment, and not only this, it effects a cure at once, whereas all other methods must be almost indefinitely
prolonged.
The arrangement with the Metropolitan Asylums Board for the admission of children needing
mastoid operation to Cleveland-street infirmary has been continued ; 158 operations were there