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more easily liable to subsequent infections. Further, by their being infected, they constitute a
septic focus in the nose and throat and so the possibility of infection of surrounding structures is
thereby heightened. Quinsies, discharging ears, infected nasal sinuses, colds, sore throats and enlarged
glands in the neck are among the conditions which can be caused by direct spread of infection, and
some of these troubles, in their turn, may have more serious complications produced by the further
spread of infection, for example, mastoid disease, meningitis or brain abscess. In addition, because
of the presence of these septic foci the child's general health frequently suffers—he fails to put on
weight, he becomes anaemic, dull and listless, easily tired and unable to concentrate.
But apart from the question of spread of infection, trouble may be caused mechanically by
the' enlarged tonsils and adenoids. In this way they can block the internal entrance to the ears
and so cause deafness, or they can block the normal air-way of the nose used for breathing and so
cause mouth-breathing with all its attendant harm on the mouth, nose, teeth and the general health.
In severe cases the tonsils may be so enlarged as to make breathing difficult and this may produce
mal-development of the chest.
Then lastly, the tonsils, if previously infected, are more susceptible to subsequent infections
with other germs, especially important of which are the organisms causing scarlet fever, diphtheria
and possibly rheumatism.
It is obvious, therefore, that all these things must be taken into account in deciding in any
particular case whether removal of enlarged tonsils or adenoids should be recommended. The
procedure under the Willesden scheme is as follows:—
The children, if under five years of age, are discovered either by routine medical inspection at
the Health Centres or by being brought up by their parents in the ordinary way and found to be
exhibiting one or more symptoms of tonsillar or adenoidal disease. If of school age they may be
discovered at one of the three routine medical inspections during school life, or they may be discovered
on attending a minor ailment session at a Health Centre. In any case, however discovered, an
assessment is made of the degree of the diseased process and a decision is taken by the assistant medical
officer as to whether the condition needs present operative treatment or whether it can be treated by
conservative methods and the child observed to see if the symptoms will disappear without operation.
If operative treatment is considered necessary, or if there is any doubt about the matter, the
child is referred to the consultant Throat, Nose and Ear Surgeon who visits the Health Centres in
turn once a month, i.e., each Clinic every third month). Should there be a considerable interval
before the Surgeon is due at a particular Health Centre, and the case a relatively urgent one, it may
be sent to see him at the Centre which he will next visit. The Throat, Nose and Ear Surgeon sees
each case and carefully decides from its history and with the co-operation of the assistant medical
officer, who is present at the examination (a) whether it requires operation for the removal of its
tonsils, or its adenoids, or both; or (b) whether medical measures should be applied instead of operation;
or (c) whether the case should be observed and then re-examined by him at the end of a stated
period.
If the assistant medical officer himself has decided that a case seen at school may safely be
observed he will either see it at a subsequent medical inspection at the school or will refer it to the
Health Centre where a more detailed examination can be made and more intensive observation
on the symptoms exhibited can be kept.
There are few operations which can be more beneficial to a child's health than that for removal
of tonsils and adenoids where removal is indicated. Not only does it have a curative effect in the
majority of cases of mouth-breathing, ear discharge, deafness, sore throats, coughs (when due to the
local condition), nasal discharge and enlarged glands but it appears to have definite preventive value
in such diseases as recurrent sore throat, rheumatic fever (if carried out before the initial attack),
scarlet fever and diphtheria.
To summarise,
1. Tonsillar and adenoidal tissue is primarily protective.
2. When exercising this protective function it becomes enlarged.
3. Should the infection be completely overcome the tissue will again subside to normal.
4. The persistence of enlargement generally means the presence of infection and the
probability of a septic focus.
5. This chronically enlarged tissue will have lost any protective function and in most
cases is a potential source of ill-health.
6. As such it usually requires removal.
The success of the treatment depends on five essentials: the child must be properly prepared
for the operation; the anaesthetic must be given perfectly; the surgeon must be expert at his job;
the child must receive skilled nursing attention after the operation; and, lastly, faulty breathing
and nasal hygiene must be attended to on recovery. If any one of these fail, success may not be
complete.