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104
"These figures suggest that the large tonsil tends to atrophyjust
like the normal one.
"As many as 5.4% of all the children had had their tonsils
removed by outside practitioners, but in only about half of these
was any history of symptoms to be obtained. As a rule the family
doctor had been called in to deal with some other complaint, and,
seeing large tonsils, had advised their removal.
"Children showing symptoms and, therefore, set down for
further observation, comprised 17.5%, 14.6%, and 10.3% of the
respective age-groups, entrants, age-8 group, and leavers, the
operation cases being 5.9%, 3.8%, and 2.0%. Assuming that
one-half of the tonsils removed by outside practitioners actually
showed symptoms before operation, this gives us a total in the
age-groups of 27.6%, 21.3%, and 12.4% with symptoms, of whom
only 10.1%, 6.7% and 4.1% had the symptoms so far developed
as to require or justify operation. In other words, had common
practice been followed with these 1,092 children, over 1,000 of
them would have had their tonsils removed without need and
without the likelihood of benefit.
"There is neither reason nor excuse, at the present day, for
wholesale removal of large tonsils. In the School Medical Service
we have an organisation admirably adapted for keeping under
observation those children who need it and for ensuring that, if
operation becomes necessary after a time, it can be carried out.
I would suggest, as a practical policy, that the classification of
enlarged tonsils into these four groups should be followed as a
routine and that this suggested arbitrary scale for operation or
observation should be used, with, of course, the observance of
discretion in individual cases.