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66
yet the parents will not have the tonsils and adenoids removed.
However these instances are now rare, and they are not our
greatest difficulty. We far more frequently come across cases in
which the parents ask for the operation to be done, but there is
no need for operative treatment. The parents belong to the careful
type, who are over anxious about their child, and take him to
a doctor for the slightest ailment. Sometimes removal is recommended
because it is presumed that the tonsils might be the remote
cause of disease, but frequently indiscriminate removal of tonsils
is advised to save the trouble of making a diagnosis.
As far back as 1923, Sir George Newman, in his Annual
Report, issued a warning about the indiscriminate removal of
tonsils and adenoids and laid down certain rules for the guidance
of local authorities.
Such instructions were necessary, and as he foresaw, there was
a danger that tonsillectomy, like many other therapeutical measures,
was apt to be abused and the operation advised indiscriminately
without any regard to the conditions present in the throat and ears.
Mr. Layton, Consulting Otologist to the London County Council
Fever Hospitals, in a recent report laid down the following maxims :
(a) Only under the rarest circumstances should the tonsils
ever be removed in any child under 5 years.
(b) Between the ages of 5 and 10 years the tonsils should only
be removed when it is proved to the hilt that it is the tonsils that are
harming the child, and that the harm they are doing is greater
than the good that is being done by the healthy lymphoid tissue
that these tonsils still contain.
(c) Tonsils and rhinological adenoids (i.e. those in the
midline), should not be removed in children living under conditions
of bad hygiene, in overcrowded houses or in insanitary conditions
without overcrowding. In such circumstances the child needs all
the lymphoid tissue of the upper respiratory tract with which to
combat these disadvantages.
(d) In order fully to consider all these points and to examine
the child, a consultation of at least 10 minutes to a quarter of an
hour is necessary, and only on the rarest occasion should a decision
be come to at the first examination.
Group IV of the Table gives the figures of the children inspected
and treated for Dental Defects, and below is appended
Mr. Slater's report for the year. It is explained earlier in the report
that Mr. Slater is responsible for the figures in the last quarter only,
and, naturally, lie is not prepared to express his views upon dental
condition in general in the district.