View report page

81
(d) Ear Disease and Hearing.—Of the 153 children with
ear defects who received treatment, 120 were treated at the Health
Centres.
(e) Enlarged Tonsils (Chronic Tonsillitis) and Adenoids.—
It is shown in Table IV, Group III, that 84 cases of enlarged tonsils
and six cases of enlarged tonsils with adenoids were submitted
for operation at the Mattock Lane Health Centre, and that 72
cases were dealt with at hospitals or by private practitioners.
Much attention has recently been directed by medical men
to the value of the operation of tonsillectomy and particularly
to the question of defining what amount of enlargement or pathological
condition of the tonsil justifies operation. Since the early
days of medical inspection when it was assumed that even a
moderate degree of enlargement indicated a pathological condition
and justified operation, there has been growing up a decided change
of opinion which has been brought about by various circumstances.
One circumstance noted in Ealing was that some children recorded
when attending a public elementary school as having enlarged
tonsils and deemed to require operation were later found on examination
in the Secondary School to have normal tonsils even though
no operation had been carried out in the meantime. This itself
caused much thought, so much so that a definite policy was laid
down regarding the giving of advice in cases of enlarged tonsils.
In the Annual Report for 1922 it was stated: " The cases
in which operation for enlarged tonsils is recommended are those
which suffer from {a) repeated attacks of sore throat, (6) repeated
colds, (c) chronic enlargement of the tonsils causing more or less
obstruction, (d) deafness or earache, (e) otorrhoea or (/) " winter
coughs," as they are often called by the parents. In 1922 there
was a distinct fall in the number of cases recommended, and
consequently submitted, for operation, and this reduced number
was maintained for four years but afterwards as a result of changes
in personnel, apart from the increase in the school population,
the number gradually increased until it was felt that some clear
and definite guidance to the medical staff was required. It must
not be assumed that the numbers recommended for operation had
reached an excessive figure compared with other districts. The
number had increased simply in relation to previous numbers