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174
Sub-group A (359 Cases).
Only tonsils defective.
Observation Cases.—In this section 31.6 per cent, of the cases
were ultimately recommended operation; but of the children (188)
under observation throughout, 49 per cent, improved, 49 per cent,
remained stationary, and only 2 per cent, became slightly worse.
Operation Cases.—The results of operation were very satisfactory
(over 90 per cent, improved) whether operation was recommended
at the first or at a subsequent inspection. Of the children
not operated on after the initial recommendation for operation,
60 per cent, improved; whereas of those not operated on after
subsequent recommendation for operation as the result of further
observation, 73 per cent, became worse.
These results appear to suggest that the best procedure, in
dealing with children of this type, is to keep them under observation
for some time before recommending for or against operation.
Experience suggests that a year is roughly the length of time necessary
to show what the ultimate condition is going to be. By thus
waiting a number of unnecessary operations will be avoided.
In this group operations were performed in only 34 per cent,
of the cases recommended, an indication that the parents were not
convinced that the children's health was impaired sufficiently to
justify operation.
Sub-geoup B (152 Cases).
Tonsils defective and tonsillar glands enlarged.
Observation Cases.—13.8 per cent, of these cases were subsequently
recommended operation; but of those continuing under
observation throughout, 61 per cent, improved, 37 per cent, remained
stationary and 2 per cent, became slightly worse.
Operation Cases.—Of the cases operated on, 100 per cent,
improved. Of those not operated on after the initial recommendation,
59 per cent, improved; whereas of those recommended operation
as the result of subsequent observation and not carried out,
82 per cent, became worse.
There is a marked similarity between the results in subgroups
A and B, and one is led to the conclusion that, in both types
of defect, operation should not be recommended until the condition