London's Pulse: Medical Officer of Health reports 1848-1972
View report page
Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1930
[Report of the Medical Officer of Health for London County Council]
This page requires JavaScript
Downs
Hospital.
19
"The third table gives a detailed analysis of all cases of otorrhœa requiring treatment
and shows the various conditions of disease responsible for the ear discharge
and the numbers suffering from each condition. It shows further the number of
cases cured as the result of ionisation or other form of treatment; the number which
had to be referred for mastoid operation; the number lost sight of and the number
still under treatment at the end of the year. Study of this table shows that about
half the total number of ears, viz., 1,539, are classified as 'tympanic sepsis' (uncomplicated).
Further, the table shows that 29 of these were referred for mastoid
operation.
"Another point to be noticed is the large number of ears that had already had a
mastoid operation at the time of presentation for treatment at the centre. A certain
proportion of these had never healed since being operated on, but some of those
enumerated had at some time cleared up and subsequently became re-infected. The
two main causes of re-infection have already been pointed out and what was said
concerning ears untreated by operation applies equally to ears which have been
surgically treated.
"Many children with (a) discharging ears, or (b) ears which at one time were
discharging and have subsequently cleared up, are allowed to go to the swimming
baths. In the case of discharging ears this should not be permitted, since in the first
place it is objectionable and even dangerous to others, and secondly, it is adding
further infection to an already infected ear; while in the case of ears that have
recovered from their disease, water from swimming baths is almost certain to give rise
to re-infection. Notifications are sent to head teachers in this matter, but notwithstanding
this, cases frequently come under notice showing re-infection from this
cause.
These 180 operations are in the table classified under eleven headings. The records of these cases have been followed from the day of their operation at the Downs Hospital through their 'after-treatment' periods, whether at the after-care clinic at Kentish Town or at the special aural clinics, and the following table shows the number (a) of each type of operation where complete healing took place during the year, and also (b) the number of each type of operation where the patient was still under treatment at the end of the year, together with the average length of treatment per case.
| Type of operation performed. | Number of cases | Average time per case in weeks (Healed). | Number still under treatment at end of year. | Average time per case in weeks (Unhealed) | |
|---|---|---|---|---|---|
| operated upon. | healed. | ||||
| 1. Radical mastoid operation (without flap | 74 | 43 | 25 | 31 | 313/4 |
| 2. „ „ „ (with flap) | 20 | 18 | 201/3 | 2 | 21½ |
| 3. „ „ with muscle graft | 38 | 18 | 14 | 20 | 27½ |
| 4. „ „ with skin pedicle | 2 | 1 | 16 | 1 | 8 |
| 5. „ „ with wolf skin graft | 1 | 1 | 26 | — | — |
| 0.*Heath conservative mastoid | 6 | 3 | 151/3 | 2 | 25½ |
| 7. „ „ type (without flap] | 14 | 13 | 21 | 1 | 40 |
| 8. Schwartz type with muscle graft | 17 | 6 | 11½ | 11 | 14½ |
| 9. Epitympanic with muscle graft | 5 | — | 5 | 5½ | |
| 10. „ | 2 | 2 | 20½ | — | — |
| 11. Heath conservative type with skin graft | 1 | — | — | 1 | 67 |
*There were six cases of this type done, but one case was lost sight of and therefore
only five are shown in this table.
"These 180 cases had this in common, they were all cases of chronic disease of the
mastoid bone. In certain cases the indications for a particular type of operation
were obvious, but in others it was not always easy to decide whether or not any form
of radical operation should be performed. The fact, however, of these cases being of
a fairly uniform type renders it possible to make some sort of comparison of the
results of the various types of operations performed.
o1