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82
Many of the children are referred to the clinic on account of
frequent colds. Some of these children are found on examination
to have wide anterior nares and a larger airway than usual. Have
again, removal of adenoid tissue is particularly apt to aggravate
the condition.
Deafness is another symptom for which operation on the
nose and throat is often demanded, and this again is a condition
which may be made worse by indiscriminate removal of tonsilk
and adenoids. If the child is deaf, and physical signs such as
retraction of the drumhead are present, then a digital examination
is necessary in order to find out whether adenoid growth is causes
obstruction to the Eustachian tube. If this is found, the condition
is usually improved if the otological adenoids only are removed
leaving behind any adenoid tissue which is present in the mid line
The same consideration must be exercised over the question
of the removal of the tonsils. If the tonsils are a source of sepses
they must be removed, but working on the principle that swelling
of lymphoid tissue is a protective mechanism, tonsils should never
be removed for enlargement alone, except in the very rare event
of their causing mechanical obstruction.
The explanation of the reduction in the number of cases
operated on this year therefore, lies in our recognising that enlargement
of tonsils and adenoids are due to many different causes
that enlargement may be beneficial to the child temporarily, and
removal detrimental.
The number of cases remaining where the operation is needed
are necessarily greatly reduced, as tonsils are only removed when
diseased, and thus the lymphoid tissue of the upper respiratory
tract is conserved during those years when the child most needs it
A return of the defects found at medical inspection will be
found on Table 2 at the end of the report. A full report
Malnutrition and Otorrhoea appears below.
Provision of Meals.
Early in the year, the question of feeding necessitous children
in. the Borough was considered. A list of children who were considered
necessitous was submitted, and the children were examined
at the School Clinic. Although only a small percentage of children
on the list was found to be malnourished, it was decided to extend
the investigation and to consider the question of malnutrition
all school children, whether necessitous or not.