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18
"The last table relates to cases of otorrhœa only, all of which, needed treatment
and shows the cause of the discharge in each case, the number cured, those referred
for mastoid operation, those lost sight of and the number still under treatment at
the end of the year.
"The disparity in the numbers in the various divisions is due to the fact that
more sessions are given in certain divisions than in others.
"The percentage of 'cases' cured was 67.2. This is obtained by deducting
both those which required no treatment and those lost sight of from the total number
of ears examined and treated, and comparing the number 'cured' with this
remainder. The average number of attendances 'per ear' works out about five
throughout. The average number of examinations per session throughout the year
was approximately twenty. The proportion of 'relapsed' cases was about one in
every 51/2 ears. There are two main causes for relapse. Firstly, water, if allowed
to get into the ear of a healed otorrhoea case, is most likely to be followed by a reinfection,
whether the water is from a swimming bath or other source. Although
parents and children are warned of this as a routine, nevertheless great carelessness
seems to persist in this respect and many re-infections are directly traceable to the
accidental or careless introduction of water into the ears. The second main cause is
the condition of the nose. It is comparatively rare to find a child without some
degree of nasal catarrh or rhinitis. This is due to persistent neglect of attention, over
long periods of time, to nasal toilet. Large numbers of children from early years
are not given handkerchiefs, and many of those who are in possession of one, do not
use it properly. Not infrequently a child is found who not only does not know how
to use a handkerchief but even how to blow the nose. This is, directly or indirectly,
responsible for much suffering sooner or later, from various diseases of the upper
respiratory tract and its appendages, e.g., nasal catarrh and rhinitis, adenoids and
disease of the ears, including deafness and otorrhoea. Often in addition to these there
are chest complaints. Here is a large field in which it is possible to improve the
condition of affairs in a marked degree.
"It would be a useful part of the school routine if teachers of all school classes
occupied five minutes at the beginning and at the end of every session in instructing
children in the use of the handkerchief (or its substitute), and in the correct way of
blowing the nose.
"Part of the five minutes should be used in instructing the children in correct
nasal breathing, and an extension of breathing exercise time up to twenty minutes a
day would be well worth the effort and time.
"There would no doubt be a certain percentage of children who would be more
intractable than the rest. For these it would be perhaps an advantage to institute
special clinics where the children could attend for a course of diastolisation. This
treatment was introduced in Paris about 1924 by Gautier; clinics were established
where large numbers of school children are treated and great success is claimed by
this pioneer. The method was introduced in London in a small way in 1925, and the
results were sufficiently encouraging to justify a considerable extension. Dr. Clarke
of the public health service in Liverpool and Dr. Bernveld of the public health
service in Reading came to see this mode of treatment and, being impressed, introduced
it in their own services with successful results. Attention in previous annual
reports has been drawn to this method of treatment and the results obtained therefrom.
"The second table details cases of deafness unaccompanied by otorrhoea. Of the
267 cases, only 92 were restored to approximately normal hearing, 26 had some
degree of relief, 26 had no relief at all and 100 were still under treatment at the end of
the year. If the above recommendations concerning nasal hygiene and treatment
had been earlier in force many of these children would have escaped deafness, to their
own advantage and to the advantage of the community upon whom they are a.
burden.