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48
Ear, Nose and Throat Clinic.—Enlarged or infected tonsils and adenoids
are, excluding dental disease, the most common defects found among school entrants.
There is much difference of opinion regarding the correct treatment for enlarged
tonsils and adenoids occurring in young children. Some cases obviously require
operative treatment, some obviously do not; but there are a number of border line
cases where one doctor would state an operation was necessary and another would
say not. A rational view with regard to operation for enlarged tonsils and adenoids
may be expressed in this way. Children should only be operated upon when there
is no satisfactory alternative and this applies particularly to children under five.
Operation is a last resort in treatment and should only be made use of in dealing
with gross enlargement or definite infection of tonsils and adenoids when other
methods of treatment have failed. The presence of complications, e.g., ear disease,
may of course modify what is written above, but the younger the child the more
important it is to adhere to conservative methods of treatment.
In these circumstances it would appear that the most satisfactory way to arrive
at a proper opinion in the matter is by making arrangements to provide a specialist
who can be consulted upon individual cases. Much can be done for the toddler
suffering from throat, nose and ear abnormalities without operation. His general
health can be improved; the catarrh which so often accompanies these conditions
can be dealt with and the ear passages made more healthy by simple medical methods.
Breathing exercises are helpful to improve the airway through the nose and the child's
chest capacity. To these may be added, if the circumstances so warrant, some
simple medical treatment.
The Council decided to establish an ear, nose and throat clinic where the above
principles and methods would be given effect and this was started in May, 1937.
Mr. Myles Formby, consultant Laryngologist to the Woolwich War Memorial
Hospital agreed to act as Consultant and Dr. Frances Smith, one of the Council's
medical officers, took charge of the routine work in the clinic. Before doing so,
Dr. Smith, along with one of the Council's Health Visitors, attended Mr. Formby s
clinics elsewhere in order to acquire an adequate knowledge of the methods to be
followed. These methods have since been in use at the Council's clinics. Briefly,
they involve a careful examination with suitable light and instruments of the child s
ears, nose and throat, a survey of its general condition and an enquiry into its previous
history. In the majority of cases an attempt is made first to remedy any abnormal
conditions by the simplest means, such as the use of drops for the nose, lavage of
the nasal sinuses, attention to dental caries, giving of general tonics, or a course of
ultra violet light treatment. In many cases improvement is obtained by these
methods, but, if not, the question of operation is considered and if this be necessary
arrangements are then made for admission to one of the Council's beds in the War
Memorial Hospital. Unfortunately it sometimes happens, the first time the child
attends, that operation provides the only suitable remedy.
During the period in which the clinic has been open, 218 children in all were
seen suffering from the conditions set out in Table No. 14. The Table also shows
how they were dealt with.