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partially straightened by Simple Fracture, during the Second stage.
The two encouraging results mentioned above are: —
" (a) Marked improvement in the General Health.
" (b) Definite increase in Hearing-power, so that the child is
able to attend school with far greater advantage.
" Frequently I have found that the diseased Tonsil on the same
side as the infected Ear appears to be more purulent that the other.
" Many children have suffered with Deafness due to Chronic
Eustacian Catarrh, sometimes associated with Pathological deflection
of the nasal septum to the affected side, and frequently with diseased
Tonsils and Adenoid excess. If, after Tonsillectomy and Adenoidectomy
the tympanic membrane remains retracted, with no improvement
in hearing, then Eustachian Catheterisation. with the help of Ethyl
Chloride general anaesthesia, and injection into the catheter of a
mixture of the essential oils, has generally completed the cure.
" I have thought it wise to advise the mothers of children suffering
with diseased Tonsils and Nasopharyngeal Adenoid excess to keep
them entirely away from all Cinemas, and all Swimming and Bathing,
until the above lesions have been cleared away; else there is much
risk of Acute Tonsillitis, so frequently leading to Mastoiditis.
" A few of the children have shown convincing evidence that
their deafness was due to Aprosexia, rather than to any intrinsic aural
lesion, and improvement has followed the provision of free nasal
airways, and healthy pharynx, followed by a course in the Speech
Clinic.
"The Diagnosis of active Tonsillar disease has not always been
easy, seeing that the surface appearances have proved very deceptive,
but pus has often been detected emerging from the crypts on slight
pressure, whilst Haemolytic Streptococci have been reported in several
cases. This latter class of case has been admitted to the llford Isolation
Hospital at a very early date, and operated on, there being no doubt
that there is much danger of this infection gravely affecting the general
health of the patient, and spreading to his associates. 1 think that,
in the great majority of cases, the absence of Toxaemia and Cervical
Adenitis is strongly suggestive of there being no very active Tonsillar
disease.
" Where there has been recurrence of Adenoid excess in the
nasopharynx after Adenoidectomy, as is very common, and which is
certainly due to lymphoid reaction to fresh invasion of harmful
bacteria, and which often subsides when that invasion has been overcome,
these cases have demonstrated that further operation is unjustifiable
in the vast majority.
" Finally, I should like to add a note on the tragic position of
so large a number of children waiting for Tonsillectomy and
Adenoidectomy, some of whom were entered for operation 3 years
ago, and show positive evidence of deterioration in health, and at the
very period of their lives when the reverse should be the case."
The following table shows the work of the Clinic:—