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referred for treatment in 1932, no less than 6,587 were referred for enlarged tonsils
only. It is clear therefore that, as conservative and waiting methods are likely to
be adopted in still greater measure for those children who have enlarged tonsils but
none of the stigmata of adenoid growths, there may in the immediate future occur
a considerable diminution in the number of operations performed.
With a view to securing uniformity of practice amongst the staff a memorandum
on the indications for operation has been issued to the school medical staff, including
both those engaged in medical inspection in schools and those carrying out operations
at the treatment centres.
Otorrhœa
and hardness
of hearing.
Otorrhoea was noted in 1,493 children, or .8 per cent. of those examined, compared
with 1 per cent. in 1931 and 1930. The highest proportion of these cases
was found in the entrant group. In no year prior to 1930 was the percentage of children
with "running ears" less than one; and the result this year in this respect is
therefore the best yet obtained. In 1927 the percentage was 1.3, and in 1913 it
was over 2 per cent. The institution of special ear centres for specialist examination
of children with discharging ears has produced a considerable improvement. Consequent
upon the attention paid in the early stages to conditions which, if neglected,
produce deafness, there has been a considerable reduction of the numbers suffering
from this defect. Hardness of hearing was found in 446 children, or only .2 per cent.
of those examined. This compares favourably with 453 in 1930, 696 in 1929, and
868 in 1927, and again is the best result yet obtained.
The apparent improvement in the number of cases of discharging ears found
must, however, to some extent, be discounted owing to the larger number of 12-year
old children inspected.
Mention is made in another part of the report (page 25) of the use of the audiometer,
which brings to light many minor degrees of hardness of hearing and cases of
unilateral deafness.
Defect of
vision.
Children in the 8- and 12-year age groups have their visual acuity tested by means
of the Snellen cards, those whose defects have been corrected having their vision
tested wearing their glasses. In the 8-year old group 41 per cent. boys and 43.2 per
cent. girls, and in the 12-year old group 34.6 per cent. boys and 38.2 per cent. girls
were unable to pass the normal vision test. These figures show a very considerable
improvement on the results obtained in 1931, when 45.6 of 8-year old
boys, 46.1 per cent. of 8-year old girls, 38.4 per cent. of 12-year old boys and 40.6
per cent. of 12-year old girls failed to pass the tests.
The improvement year by year in the condition of the children in this and in
all other respects is very gratifying and encouraging to the service.
Defects of a more serious character (i.e., vision of 6-12 or worse in either eye)
occurred in 15.1 per cent. boys and 15.8 per cent. girls in the 8-year old group, and
in 17.1 boys and 18 per cent. girls in the 12-year old group. This again shows steady
improvement which has been going on for several years—in 1925 the 8-year old group
showed 18.4 per cent. with serious defect, in 1927 the percentage was 18, and in 1929
and 1931 16.8 and 16.9 respectively; the 12-year old group in 1925 showed a percentage
of 20.6, in 1927 it was 20.9, in 1929 this percentage was 19.3, and in 1931
it was only 18.5. The improvement is most marked among the 12-year old girls,
and there is little doubt that the importance of the early correction of visual defect
is becoming more widely recognised among the parents.
Heart and
anaemia.
Heart defect (functional or organic) was reported in 3,356 children or 1.9 per
cent., compared with 1.8 per cent. in 1931, and 2 per cent. in 1930. As usual, older
girls presented a percentage (2.4) in excess of older boys (1.8), and the slight set
back is entirely due to the increased number of heart cases reported in elder girls.
In studies of rheumatism in the metropolis it is found that girls suffer to a greater
extent than boys in the proportion of about 3 to 2. It is reasonable to deduce that
the figures for heart defect reflect this excessive incidence of rheumatism. Anaemia
was found in 1,989 cases, or 1.1 per cent., the same as in 1931, compared with 1.2 per
cent. in 1930. This is less than half the proportion found in 1926 and corresponds
with the general improvement in nutrition.