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21
pharynx. In such cases advice is given as to the carrying out of
proper nasal hygiene, and to improving the general health of the
child. "Sneezing" has been tried with success in a few cases,
but without the intelligent co-operation of the mother it is useless.
A clinic where such treatment and instruction could be given
would undoubtedly save some of the earlier cases from the need
of operation. It would also be useful in helping to establish
nasal breathing after operation. Unfortunately the establishment
of such a clinic is at present impossible owing to the Nurses' time
being fully occupied with other work.
The results of operation have been in the main very encouraging.
Improvement is not seen immediately, but at a subsequent
inspection, months or even a year or two later, general improvement
has been noted in physique and nutrition, and in the absence
of enlarged glands of the neck.
Mothers often volunteer the statement that the child has been
much better since the operation, eating and sleeping better, and
Head Teachers usually report improvement in school work.
An essential feature in the success of operative treatment of
Tonsils and Adenoids is the after treatment. This consists in
giving the child a good environment, fresh air and good food,
and—most important—in establishment of nasal breathing. Alas
in many cases poverty and overcrowding make it difficult to obtain
the first two, and the ignorance or carelessness of the parents
prevents the latter. It is in these cases that there is little
improvement noted after the operation, and it is here that a Clinic
as mentioned above would do good work.
Vision.
Dr. Roberts, the Assistant Medical Officer, continues in charge
of the Refraction Clinic, which is held weekly. From time to time
extra clinics have been necessary in order to keep the work up to
date. The attendances at the Clinic remain satisfactory.
There has been a very definite improvement in the way in
which the Eye cases are followed up, and kept up-to-date.
I his is mainly due to the fact that the Assistant School
Medical Officer has charge of the work and sees the children from
two points of view; not only as medical inspector in the schools,
but also as the Medical Officer in charge of the Eye work.