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improvement noticed was due to the fact that children began to leave school
who from an early age had come under dental inspection. That the improvement
has continued in 1923 is shown both by the figures in the first and the third
column, for not only is there a larger proportion both of boys and girls who have
teeth which appear sound on inspection, but there is a diminished number oi
children with very extensive caries.
Between 1913 and 1923 the proportion of twelve-year-old boys with apparently
sound teeth has increased from 50 per cent, to 67.7 per cent., while that of those
with extensive caries has diminished from 10 per cent, to 2.7 per cent., and a
corresponding improvement is shown by the girls.
A remarkable feature of the dental tables is that the girls in every year and
in every column show a higher degree of resistance to caries than do boys.
21,656 children were found to have some degree of enlargement of tonsils or
evidence of adenoid growth. This number represents 11 per cent, of the children
in the age-groups compared with 12.8 per cent, in 1922, 16.5 per cent, in 1921, and
still higher figures in previous years. It appears, therefore, that the children are
growing healthier from this point of view. Oral sepsis due to neglected and decaying
teeth is often the precursor of attacks of tonsilitis, and as the greater number (16,533)
of the above children have simple enlargement of the tonsils, it may be that the
improvement is a secondary effect of the greater attention to dental hygiene and
the undoubted gain resulting from treatment of dental decay. Although fewer
children were recorded with unhealthy throats a somewhat larger number were
referred for treatment, viz., 7,680 or 3.9 per cent., as compared with 3.6 per cent,
in the previous year. This is still a considerable reduction upon the proportion
referred a few years ago (6.1 per cent, in 1919).
It is very generally held that the presence of enlarged tonsils in a child increases
the risk of contracting infectious diseases and that removal of the tonsils (and
adenoids) diminishes this risk. At the request of Sir James Dundas-Grant some
observations were made with a view to testing the truth of this opinion. A large
Islington elementary school—The Forster—was taken at which there had been
during the year an excessive number of cases of scarlet fever. The number of
children on the roll of the school is 1,000. A list of those scholars, 43 in all, who
had suffered during the year with scarlet fever was made, and another list of children,
numbering 99, who had been reported as having enlarged tonsils and adenoids.
Ten names were common to both, i.e., out of 99 children with enlarged tonsils,
ten, roughly one in ten, suffered from scarlet fever ; of the remaining 901 children
33 only suffered from scarlet fever, or one in 28. Dr. E. O. Lewis visited the school
and elicited the information that nine children of the 99 had been operated upon,
and not one of those who had been operated upon suffered from scarlet fever, though
in one instance the child had twice been exposed to scarlet fever in the home subsequent
to operation. Subtracting the nine children from the 99 it transpires that
one in nine children with enlarged and untreated tonsils suffered from scarlet fever
as against one in 28 of the others. These figures were very suggestive and show
the heavy incidence of infectious disease upon those with already enlarged tonsils,
but the number of cases that had been operated upon was too small to warrant
any conclusions being drawn. Dr. Lewis therefore took another school (Addison
Gardens, Kensington), where there had also recently been an excessive incidence
of infectious diseases, both scarlet fever and diphtheria. Every child who had
been operated upon for tonsils and adenoids was sought out and the history of
infectious disease before and after the operation was obtained. The total number
of children present at school during the investigation was 1,367. Of these, 292
children had been operated upon for tonsils and adenoids. The total number of
children who had suffered from infectious disease (scarlet fever or diphtheria) was
385. The number of children who suffered from infectious disease after operation
was 14. The incidence of infectious disease upon the school population generally
Tonsils and
adenoids.