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to it, and it is relatively more common in the milder cases of tonsillar
enlargement. The connection between otorrhcea and an unhealthy
naso-pharynx is certainly not established in this group of cases.
With regard to the results of operation in the cases with the
above defects, catarrh, tonsilitis, debility and colds benefit markedly
from the operation. Bronchitis, rheumatism and deafness show
nothing conclusive, as equally good results were obtained from
both operative and conservative treatment. Otorrhcea is not
influenced by the operation, except in a very few cases. Indeed,
in some cases it was considered to be the result of operative treatment.
Of 30 cases coming under observation after the operation
had been performed, seven were found to have developed otorrhcea
and five were still suffering from otorrhcea some years after the operation
which had been performed as a curative measure. The removal
of tonsils and adenoids should not, therefore, be hastily recommended
in children with otitis media, as its efficacy is doubtful.
Conclusions.
As already explained, this investigation was undertaken
with a view to supplying answers to four questions. The subsequent
analysis of cases appears to furnish answers to these questions
as follows:—
1. Which type of defect is most permanently harmful to the
child?
Only one type of defect did not clear up without operation,
viz., tonsils enlarged to the third degree with tonsillar glands
defective and mouth breathing. If one considers the percentage
of defects (34.5 per cent.), nasal obstruction is relatively harmful
and in a slightly less degree septic tonsils. At least 33.3 per cent,
of all other cases cleared up without operation, the proportion of
recoveries becoming progressively greater as the defect became
less marked.
2. Which type of defect is most likely to clear up without surgical
operation?
The cases in Group I and sub-groups A and B of Group II show
the most favourable results. Sub-group A of Group III shows a
fairly high percentage of recoveries and suggests that all cases of
tonsillar enlargement, no matter to what extent (if there are no
allied defects) should be put under observation for an appreciable
period of time before advising operation.
3. To what extent can the condition of the tonsils be regarded as
the cause of the other defects?