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(c) Skin Disease.—During 1932, at routine and special medical inspections, 1,607 cases of skin
disease were detected, as compared with 1,807 in 1931, 1,888 in 1930, 1,809 in 1929, 2,241 in 1928.
(id) Enlarged Cervical Glands (non-tuberculous).—During 1932 at routine and special medical
inspections 285 cases of this defect were noted as compared with 302 in 1931, 505 in 1930, 380 in
1929, 315 in 1928.
Infectious Diseases.—The action taken to detect and prevent the spread of infectious
diseases was as set forth in my Annual Report for 1925.
Following Up.—All defects found requiring treatment at medical and dental inspections
are notified to the parents, and it is the duty of the Health Nurses to follow up these cases in their
homes as may be necessary, in order to ascertain if the treatment has been obtained. If nothing
has been done the Health Nurse again explains the necessity for treatment to the parent, and advises
as to the best method of obtaining such treatment.
Medical Treatment.—During the year 1932 school children were followed up by the Health
Department on account of 17,371 medical defects and 8,839 dental defects. Of those defects found
to require treatment, medical or dental treatment was obtained for 16,361 and domestic treatment
was obtained for 3,566. 87 per cent. of the medical defects were treated, 65.6 per cent. receiving
medical treatment and 21.4 per cent. domestic treatment, 62 per cent. of the dental defects followed
up were treated. No record is available of defects requiring treatment which were not followed up.
90 per cent. of the total medical defects treated and 99 per cent. of the total dental defects treated
were dealt with by the Education Committee. The remainder, or 10 per cent. of the medical defects
and 1 per cent. of the dental defects treated were dealt with by private practitioners, voluntary
hospitals, or other charitable institutions, or the Poor Law. In connection with the defects treated,
the children concerned made 99,542 attendances at the Health Centres in 1932, as compared with
92,231 in 1931.
Removal of Enlarged Tonsils and Adenoids.—Considerable reference has been made
to the necessity for this operation in the medical and lay press. In these circumstances it may be
interesting to state the practice in Willesden.
The tonsils, which are placed on either side of the palate at the back of the mouth, and the
adenoids, which are placed above the palate at the back of the nose, are concerned, in common with
all lymphatic gland structure, in preventing the spread of infection. They may be looked upon as
a line of first defence. If they are infected they usually become enlarged and thus enlargement
may be looked upon as evidence that they are, or have been, infected.
The proportion of children suffering from enlargement of their tonsils and adenoids will vary
with their exposure to infection and their powers of resistance. It is not surprising, therefore, that
the numbers of children so affected are found to be greater in urban than in rural communities, since
in the latter there is less exposure to infection and living generally is more healthy. The numbers
of school children in Willesden, found to have enlarged tonsils or adenoids or both in the last six
years, together with the numbers operated upon, are shown in the following table. An additional
column is added to show the number of children under 5 years of age who also were operated upon.

Mere enlargement by itself however, is, if of moderate dimensions, an insufficient indication
for removal of tonsils and adenoids. Enlargement, as has been pointed out, is a reaction to infection
and it may be expected that, as with other glandular structures, when the infecting element has been
removed the gland will return to almost normal size. This state of affairs does, in fact, occur in some
cases of enlarged tonsils or adenoids, in which event no further treatment is necessary. In the
majority of cases, however, the structures remain enlarged and, what is more important, they become