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whom the condition was causing definite symptoms. The cases
referred have all come within the terms of the three definitions
given below. In 50 cases detention in the hospital was necessary ;
233 were conveyed home by ambulance a few hours after the operation.
Where possible it is preferable for all children to be kept in
hospital for one or two nights after this operation. In all there
were 137 non-attendances.
Of the 287 children operated on 163 attended the Remedial
Exercises Clinic for post-operative breathing exercises. This is a
very important complement to the operation. The percentage of
children operated on, who attended for exercises, was 57 per cent.,
compared with 59 per cent. in 1931.
75 cases came to the knowledge of the department for whom
the parents had obtained treatment from another source; the
majority at a London hospital. In these cases the expenses are
defrayed by the parent and not by the Local Education Authority.
Only the following conditions are considered to warrant the
reference of a child for operation:—
(a) Tonsils which are enlarged and septic, especially if in
conjunction therewith the tonsillar glands are also
enlarged.
(b) Obstruction to breathing through one or both nostrils.
(c) The presence of mouth breathing.
Strict adherence to these standards obviates the unnecessary
removal of tonsils. Provided the tonsils are not interfering with
any normal function and are not a focus of septic poisoning, there
is no proof that their removal is of any benefit to a child.
The Inspection Clinic.
This is held on Wednesday and Saturday mornings. The
object of the Inspection Clinic is (a) to examine children referred
by parents or teachers for special examination; (b) children sent
by school attendance officers for an opinion as to their fitness or
otherwise to attend school; (c) children referred for examination
under the provisions of the Education Act, 1918, Sec. 15 ; (d) cases
in whom a further examination is desired after routine medical
inspection ; (e) children referred under the Juvenile Employment
regulations 1,181 attendances were made by children during the
year.