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99
"Now let us pass to the commoner reasons for tonsillectomy;
those for which the vast majority of the enormous number of
operations carried out at the present day are performed. First
among them we can place respiratory affections. I do not propose
to draw any fine distinction between those of the upper respiratory
tract—colds in the head—and those in the lower respiratory tract,
since in children the difference is one of degree rather than of kind.
Second should come the recurrent sore throat, with which I couple
frank tonsillitis. Third place (this is not intended as a ranking in
order of gravity) is taken by mouth-breathing and fourth by affections
of the ear, including deafness, otalgia, and otorrhoea, while
last, but by no means least, I place enlargement of the tonsil
without noteworthy symptoms.
"In endeavouring to evaluate the indications and end-results
of the operation I took these indications and tried to find how far
they satisfied my second postulate, i.e., if they were constantly
relieved by the performance of the operation. I examined all those
children in Ealing who had been subjected to the operation during
the last three years and have here the results of investigation of
416 of them.
" Owing to changes in personnel and variations in individual
standards, the only possible source of a history in these cases was
the parent. An initial series of some fifty cases, not included in
these results, was therefore investigated, in order to see if the
parents were, as a rule, able to give a satisfactory history and in
order, also, to develop a technique of questioning which would not,
in any way, influence the replies and, therefore, the results. At the
close of this preliminary work I was convinced that satisfactory
histories could be obtained and I was able to standardise the
questions which were to elicit them. Moreover, during the investigation
proper, any history which was at all vague or which required
leading questions for its elicitation, was summarily rejected.
" Three hundred and fifty-three children had suffered from
frequent cold or coughs, before operation. Two hundred and
ninety-five, or eighty-four per cent. of these had improved after
operation. The remaining sixteen per cent. were unimproved.
"Two hundred and nineteen had suffered from recurrent sore
throats. Of these, two hundred and nine were better (ninety-five
point five per cent.).