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shows a further increase this year. The number of cases found
must, of course, go up with the increased school population, but I
think there is an actual increase as well as a relative increase.
This is an increase which has to be watched, because it might
mean that the circumstances under which children are being educated
are likely to produce eye strain. I do not think, however, that the
evidence is sufficient to warrant such an opinion being held.
(h) Ear Disease.—The number of cases of ear disease, too,
shows an increase on last year. This is also being watched.
(i) Tonsils and Adenoids.—Last year you were advised that
the number of cases of tonsils and adenoids showed then an increase.
It is my duty to report this year a further actual and relative
increase in the number of these cases.
The time is fast approaching when children having their
tonsils out will become almost a routine.
For my part, I want to make it perfectly clear that these cases
are seen by at least two doctors before the operation is performed,
in which circumstances it must be admitted that the operations are
not lightly undertaken. Thus your School Medical Officers find out
that a child has enlarged tonsils and they decide as to if and whether
they think it will be right for the child to be operated on. Our
routine practice is then to send the child up for interview at the
Queen Mary's Hospital, Stratford, where the child is examined by
a specialist before an appointment is made for the operation to be
carried out.
In addition to this, the children are often seen by a third
doctor, because a large number of children have been observation
cases before they become cases which are put down for treatment.
It seems therefore that you are taking every possible precaution
against this operation being carried out unnecessarily.
My own opinion, as I have told you, is that these enlarged
tonsils are due largely to errors of diet. There is too much sameness
about children's food; they want more brown bread and fresh