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9
and 12-year groups the proportion has fallen in 1932 to less than half of that recorded
in 1924.
These figures do not necessarily mean a lessened incidence in dental disease,
but reflect the efforts of the school dentists and treatment centres to remedy the
deplorable conditions which formerly prevailed, and to a lesser extent still prevail. As
stated in previous reports, the heaviest burden the school medical service has to bear is
undoubtedly the poor condition of the children's teeth, and this is one of the gravest
problems that those whose business it is to study the national health have to consider.
It is, however, gratifying to note that year by year there is a substantial improvement
in the dental condition of the school children. This improvement is also shown
in the results of the inspections carried out by the Council's dental inspectors which
appear on page 26.
In the statutory age groups 9,336 children were referred for treatment of enlarged
tonsils or adenoid growths; this is 5.1 per cent. of the children examined, compared
with 6.6 per cent. in 1931, 6.7 per cent. in 1930, and 7 in 1929. These nose and throat
conditions are found chiefly among the entrant group, many of the children in the
older groups having already been dealt with before their examination in those age
groups. The percentages requiring treatment for these conditions were:—entrant
boys 9.4, girls 8.7; 8-year boys 4.3, girls 4.7; 12-year boys 2.2, girls 2.8.
There has been in the past year a considerable drop in the percentage of children
referred for treatment for enlarged tonsils and adenoid growths. This is a continuation
and accentuation of a tendency which has been apparent for the last three or
four years. The very high proportion of children referred for operation during late
years is partly due to the overtaking of arrears which accumulated owing to the
reluctance of parents to submit their children to operation under the out-patient
procedure which was formerly their only choice. The policy of the Council, which
was to substitute in-patient treatment for out-patient treatment in respect of these
conditions, removed this reluctance.
There is, however, also an alteration going on in the attitude of the medical
profession with regard to performance of the operation as a precautionary or preventive
measure. It is now thought by many that, provided that the tonsils are
healthy, mere enlargement should not be regarded as a reason for operative treatment.
Careful observation has shown that the removal of simply enlarged tonsils does not
exercise that preventive influence on subsequent attacks of disease to the extent
which was expected. Although the performance of the operation in cases where the
tonsils and throat are unhealthy, or actual obstruction exists, is undoubtedly most
necessary and, in the great majority of such cases, brilliantly successful, there is now
developing a reluctance to submit cases for the operation which were formerly referred
on purely preventive grounds, and a greater reliance is being placed in the latter group
of cases on a waiting policy.
A consideration of the figures for the two years suggests, however, that it is the
former reason (viz. the overtaking of arrears), which is chiefly responsible for the drop
in the number of cases referred for treatment. The figures given above relate to the
cases referred for treatment only. Many more cases of tonsils and adenoids are
recorded for observation than are referred for treatment, and it has never been
the custom in the London school medical service to refer cases indiscriminately
for operation.
In 1931, 15.1 per cent. of the children examined were recorded as having
enlarged tonsils and adenoid growths, and 6.6 per cent. of the total examined were
referred for treatment. In 1932, 11.9 per cent, of those examined were recorded as
having enlarged tonsils and adenoids, and 5.1 per cent. of the total examined were
referred for treatment. The proportion referred for treatment of those found with
enlarged tonsils and adenoids was the same in both years, viz., 43 per cent.
A distinction should be drawn between the operation for enlarged tonsils and
that for adenoid growths. The indications for treatment by operation in the two conditions
vary fundamentally, and there is complete agreement by all authorities that
where there is diminution of hearing capacity, or obstruction leading to mouth
breathing, adenoid growths should be removed without delay. Of the 9,336 children
b
Enlarged
tonsils and
adenoid
growths.