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or at least evanescent. At the age of three, the incidence of caries this year
is 19 per cent., compared with 27 per cent. in 1934 and 28 per cent. in 1933;
and at four years 44 per cent., compared with 48 per cent. in 1934 and 45 per
cent. in 1933. On the whole, therefore, there is a minor improvement throughout
the 2—6 period, though the high incidence at the age of four remains
obstinate and is disappointing in view of the facilities for early detection of
defects that are provided and of which the parents, as a rule, take willing
advantage. Analysing the degree of defect now we get further disconcerting
figures. Forty per cent. of all children showing caries are found to have two
teeth or less involved, 8.5 per cent. have three or four, and 51 per cent. have
four or more already gone when they are inspected. Even at the age of two
the percentage of defective children showing extensive defect is not much
less than the latter average figure for the 2—5 period. Hypoplasia as apart
from caries is rioted at that age in 21 per cent.: no doubt caries already covers
a number of additional cases of this. These are macroscopic observations
only, but they go to show that the developmental element in caries is probably
important—as some laboratory research has shown—-and that the majority
of children who are going to have faulty teeth in their first dentition have
the defect already well established by the age of two years. Prevention,
therefore, more than ever is the watchword since it is evident that treatment
cannot overtake the effects of a bad beginning.
The figures for children showing enlarged tonsils and/or adenoids remains
high (50 per cent.), but the operation figure is low, under 3 per cent., a figure
lower than we have shown before and very much lower than the percentage
of operation cases shown by certain other authorities. It must be remembered
that each case is assessed individually on its merits and not from the point of
view of statistics; that treatment also should be not merely therapeutic but
preventive—preventive of further damage that might be incurred should
diseased tonsils remain in situ or adenoids obstruct the nasal airway and
invite infections of the sinuses communicating with the nose or of the ear.
The small rate of operation cases would be no matter for congratulation if
the same children not operated on now were to fall victim after some short
interval—say soon after attendance at school—to symptoms requiring emergency
treatment of the nose and throat. This point of view, naturally, has
to be continually kept in mind when deciding whether enlargement of the
tonsils matters or not; and it is given very earnest consideration in each
case. It is to be hoped, therefore, that the freedom from symptoms and
absence of secondary signs of infection (such as catarrhs, deafness and seriously
enlarged glands) which has led to the great majority of cases being put down
for observation only, will stand them in good stead at a later date.
It should be said further in the same connection that 30 per cent. of
children showed definite enlargement of anterior or posterior cervical glands,