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(a) A larger proportion of adenoids, both slight and severe, is found in
public elementary schools receiving children of relatively poor circumstances
than in those receiving children from somewhat more prosperous homes;
(b) This is true of both sexes and throughout the whole period of elementary
school life; and
(c) On the whole, this difference is at least as marked, at the age of
entry—5 years—as at subsequent ages.
This difference between the two groups of schools might conceivably be
due to conditions within the schools, on the hypothesis that one group of
schools was structually less satisfactory in respect of space, light, ventilation,
etc., than the other. Comparison of the data collected on these points bv
the medical officers gives no ground for suggesting any such difference. It
mav be inferred that the difference is one which existed before admission
to school.
It might then be explained either by a more ready recourse to operative
treatment before school age in the more prosperous homes—there are no
data by which this can be checked—or to varying factors in the home environment
of the young child in the two groups. Subsequent paragraphs deal*
further with this point.
Age of onset of adenoids.
The marked prevalence of adenoids at the age of five years, when the
average child first enters the public elementary school, suggests that the
disease may in considerable part have its origin before ever the child enters
the school; while the excessive proportion in schools attended by the poorer
children further suggests that the incidence may, in part, depend on circumstances
in the home associated with poverty, though obviously not limited
to such circumstances.
An attempt was made, with the willing co-operation of the health visitors,
to investigate the home circumstances of 156 unselected cases in which children
had been found during the enquiry to need operation for adenoids.
These enquiries were directed towards obtaining a rough impression of the
age of onset of the various complications found in the children in question ;
their susceptibilty to catarrhal infections; the method of feeding in infancy ;
the use or avoidance of a "comforter" in infancy; and the home conditions
in regard to accommodation, adequacy of light, ventilation, and cleanliness,
and the presence or absence of serious dampness—all factors which
have had varying degrees of stress laid on them as possible factors in the
production of adenoids.
The following table sets out the age of the children in this group found
in school to be suffering from adenoids, and the ages at which parents had"
first noticed the onset of certain specified symptoms or signs affecting the
children, and known to be associated with adenoids. In the case of mouthbreathing,
deafness, and ear-discharge, it would probably be justifiable to
conclude that in the great majority of cases adenoids were definitely present
when these conditions first became noticeable. While it is obvious that data
depending on the recollection by parents of the past history of their children
must be far from exact, and while the data here set out are numericallv
small, they are sufficient to indicate the early age at which significanl symptoms
of an unhealthy condition of the nose and throat may arise.