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8
commonly associated with rickets. The three medical observers worked independently
but upon a common plan, which had been evolved in a previous short survey
carried out in concert.

Thus an intensive survey in which attention was concentrated solely upon the
persistence of bony malformations associated with rickets, showed that in the
London schools to.day amongst the children at five years of age, three or more
signs of rickets are found in percentages varying from 25.9 in "fair" schools to
50.2 in" poor "schools. As rickets is pre.eminently a nurture disease, these results
show how much is still required in both improvement of housing conditions and in
training in motherhood.
It may be objected that in the ordinary inspection of entrants only 0.75 per
cent, of the entrants are recorded as having rickets, but these are the children who
have marked outstanding manifestations of the disease calling for notice and for
action, while the signs recorded by the special investigators are minor manifestations
no longer necessarily of any importance except as signs of deficiency or default at an
earlier stage.
Another section of the enquiry consisted in the examination of as many of the
same 1,638 children as possible by the Council's aurist, who made a digital
examination of the naso.pharynx of 1,361 of the children. At the ordinary inspection
the presence of adenoids is inferred from the symptoms and signs shown by the child
and is not confirmed by digital examination. This section of the investigation is
therefore of great importance as the actual incidence of adenoidal over.growth in
unselected London children has never hitherto been established. Of the 1,361
children examined, 174 had already been operated upon for the removal of adenoids.
Of the remainder the naso.pharynx was found normal in only 237 (17.4 per cent.),
tonsillar enlargement with or without sepsis was found in 193 (14.3 per cent.) and
tonsillar sepsis without enlargement and without adenoids in 10 (0.7 per cent.).
Adenoids in some degree, with or without tonsillar enlargement, were present in
747 (54.9 per cent.). Including those whose adenoids had been removed, the
proportion of unselected 5.year.old children in whom adenoids were or had been
found, was 67.7 per cent.
The extent to which resort is now made to operation upon enlarged tonsils
and adenoids is shown by the fact that at age five 12.8 per cent, of the children in the
schools have already had their adenoid growths removed. It is noteworthy that in
contradistinction to the distribution of the signs of rickets, no greater prevalence of
adenoids was found in the poorer schools ; in fact the proportion of children free from
adenoids was highest in the poorest group of schools.
The Committee, in order to be able to compare the results of digital examination
with those of other investigations in which this method was not used, asked the
Council's aurist to re.examine the children and to record only symptoms related by
parent or teacher and those observed by himself without a digital examination ;
490 children were therefore re.examined at a date about a year subsequently to the
first examination, 30 per cent, of the mouth breathers showed no signs of adenoids
on digital examination, while of those showing extensive adenoids on digital
examination only 29.3 per cent, were mouth breathers. It is therefore evident that
the two methods of diagnosis result in the selection of two different series of children
and that the results obtained are not comparable.