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any conclusions as to the normal prevalence of adenoids, if measured by the
proportion of children picked out in school as now suffering from this condition.
1.8 per cent. of the children throughout all departments were found
to be suffering from adenoids in a degree needing operation, and a further
1.4 per cent. from a slighter degree of adenoids needing further observation
before operation is advised.
These numbers are no doubt, to some extent, an under-statement of
the incidence of adenoids under existing conditions, and they by no means
represent the normal incidence, which is disturbed by the activities of private
and public medical service. If to these there are added the children of
school age who have undergone operation for adenoids at the Education Committee's
throat clinic, and who, except for this, would no doubt still be
suffering from this defect, the number of school children with severe degrees
of adenoids would amount to about 5 per cent.* of the whole, together
with the 1.4 per cent. with slighter degrees of adenoids already noted. This
makes no allowance for children who have undergone operations at general
hospitals or at home, so that the estimate of 5 per cent. is still below the
prevalence of adenoids which would exist in the absence of surgical interference.
*This figure is to be regarded only a.s a somewhat rough approximation. The
data in regard to children who had previously undergone operation for adenoids
at the Throat Clinic are complicated by uncertainty in many cases as to Whether
the child was referred primarily for enlarged tonsils or for adenoids. In Croydon
the records of medical inspection show that on an average about 50 per cent. of
children referred far tlhraat operations are sent on account of adenoids, and 50 per
cent. on account of enlarged tonsils. It has, therefore, been necessary, in the absence
of mare exact information, to assume that 50 per cent. of the operations conducted
year by year at the Committee's throat clinic (which deals only with cases of
adenoids or of enlarged tonsils) have been on account of adenoids. It is very
unlikely in any case that this is an oveir-estimate of the number of adenoid cases
undergoing operation at the clinic. Further, any variations in the relative proportions
of adenoids and of tonsil cases deait with in successive years are likely to
have been haphazard; there is no evidence or likelihood of an orderly increase or
decrease in the proportion of adenoids to tonsil oases treated, so that there is no
reason to think that conclusions drawn in the next paragraph as to age incidence are
invalidated on this account.
It can be concluded that:—
Had the Education Committee made no provision for the operative treatment
of adenoids, not less than 5 per cent, of elementary school children
would be suffering from definite adenoids with symptoms calling for operation
;
and further that
The effect of the continued work at the Committee's throat clinic has
been to reduce the number of children with grave degrees of adenoids to about
one-third of the level which would otherwise have been attained; so that
somewhat under 2 per cent, now require operative treatment for the condition.
The effect produced by operative treatment obtained through other channels
cannot be ascertained.
(b) Age incidence.
For the reasons given above, the data as to children now suffering from
adenoids in school give an entirely wrong impression of the age incidence.
These figures, as can be seen in the table on page 47, Section C (lines
numbered 3 and 5), might suggest a rapid drop in prevalence after the age
of five years.
When, however, allowance is made for the children who have already
undergone operation for adenoids in past years at the throat clinic (apart
from those treated elsewhere, or for whom data are not available), it becomes