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157
ENQUIRY INTO THE INCIDENCE OF ADENOIDS AMONG
CHILDREN ATTENDING THE PUBLIC ELEMENTARY
SCHOOLS IN CROYDON.
During the year an inquiry was conducted in all departments of 31 out of
the 33 public elementary schools in the Borough, for the purpose of investigating
factors bearing on the prevalence of adenoids among children of school
age. The home conditions of children found to be suffering from adenoids
were the subject of systematic reports by the health visitors.
The object of the enquiry, which followed a definite procedure arranged
beforehand and applied to all the schools visited, was, in the first place, to see
if any light could be thrown on the conditions favouring the development of
adenoids, the relation of the condition to age and sex, and its effect on the
child's educability. At the same time, it was felt that—as has, in fact, been
found to be the case—the attention thus concentrated on the subject would
result in the detection of individual cases of mouth-breathing, deafness, eardischarge,
or of other less obvious conditions associated with adenoids, which
would, under ordinary circumstances, have probably escaped attention until
a later period of the child's school career. The trouble involved has, therefore,
even from the purely practical aspect, been well repaid. It is a pleasure to
draw attention in this connection to the close and cordial co-operation effected
throughout the enquiry between teachers, medical officers, and health
visitors.
Method of enquiry.
(a) During the course of routine medical inspection at a school, it is the
practice of the Medical Officer to visit each separate classroom in order to
select any children giving evidence of need for medical examination, and at
the same time to note the condition of the room in respect of ventilation,
hearting, lighting, cleanliness, etc. This procedure was made use of in the
present enquiry, and the medical officers were asked to select all children
showing the "adenoid facies"—open mouth, pinched nose, sleepy eyes, etc.,
suggestive of a marked degree of post-nasal obstruction, bv far the commonest
cause of which is the condition known as adenoids.
(b) The medical officer having made the preliminary selection, the classteacher
was then asked to bring forward all children showing deafness, ear
discharge, or mouth breathing, as well as all others suspected by the teacher
on other grounds to be suffering definitely from adenoids.
(c) The medical cards for the school were searched to ascertain any other
known cases of definite adenoids not included under (a) and (b). The children
in these groups, for whom recent medical reports were not available,
were subsequently examined, to determine, by general medical examination,
but without the use of a faucial mirror and without digital examination,
the presence or absence of definite adenoids, either (1) needing operation, or (2)
insufficient for operation but needing observation. The general standard laid
down in the Report of 1921 of the School Medical Officers to the Board of
Education (p. 56)* was adopted for this purpose. It was anticipated that
thus a reasonably complete census of the definite cases of adenoids attending
school would be obtained. The register of children who had undergone
operation for adenoids was consulted for particulars as to this group who,
had not such operation been carried out (apart from the possibility of
spontaneous cure in a small proportion), would have had to have been added
to the list of children suffering from the condition.
(d) The medical officer, in visiting each classroom, noted the condition in
regard to ventilation, lighting, warmth, and cleanliness, and recorded the
number, sex and age of children on the class register.