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It is seen that the incidence of tonsils and adenoids is much higher upon the
younger children and the excess of 17,000 entrant infants (in 1925 over 1924) alone
accounts for over 1,000 additional children referred for treatment. But this alteration
in the age distribution of the children only explains one-fourth of the total increase
which has occurred.

Not only were larger numbers of children recorded with unhealthy throats during
the year, therefore, but a larger proportion at each age was referred for treatment.
There are only two explanations possible.
Either there must have been an increase in the prevalence and the severity of
cases of tonsils or adenoids or there must have been an alteration of average standard
on the part of the individual medical officers inspecting the children. Whether a
child, with some degree of tonsillar enlargement and obstruction to nasal breathing
from adenoid growths, shall be referred for operative treatment or not, depends upon
the individual experience of the examining doctor, and there is necessarily a rather
wide margin for individual difference in this respect.
Owing to the change over, which has taken place in the London school medical
service, from the whole time to the part time principle, there has recently been a
large infusion of new blood into the service, and the newly-appointed part time
doctors are on the whole younger and perhaps more disposed to favour active
interference with conditions of disease, while the older and more experienced officers
are more likely to assume a waiting attitude in regard to the border-line case.
Then, in such a case, the attitude of the parent is to be borne in mind. Three
or four years ago a prejudice against operation was artificially fostered, unhappily
with temporary success, many parents becoming reluctant to give their consent.
That prejudice has now disappeared and parents are more willing. As in many
border-line cases the decision, either to refer for treatment or to wait, will be the result
of a discussion with the mother, this circumstance alone may account for some
increase in the numbers referred.
On the other hand, there are definite reasons for thinking that there has been
an actual increase during the past two years in the incidence of enlarged tonsils
and adenoids. The weather conditions have been such as to foster repeated attacks
of catarrh, and reports from residential schools and other quarters generally indicate
a somewhat higher prevalence of unhealthy throat conditions. As will be seen
presently there has been a concomitant though slighter increase in other diseases
closely associated with the presence of enlarged tonsils and adenoids. The increase
in the number of "cases noted, apart from those referred for treatment," also points
in that direction.