View report page

Annual testing of vision of all children would be a step in the direction of discovering
early myopia which requires treatment—it would mean a considerable increase of work, but
certainly much less than the general refraction of school children. Meanwhile, the use of + 1
sphere in the routine vision testing is a practicable addition to the work. In the light of
further knowledge it may prove of great utility, and for the present the following up of children
showing a decrease of 5 Snellen lines seems a useful procedure.
(g). Ear Disease and Hearing.
Two hundred and twenty cases of deafness or ear disease were dealt with at the School
Clinics, and 10 were treated by private arrangement of the parents.
I am indebted to Dr. Roberts for the following report on the treatment of discharging
ears: —
REPORT ON THE USE OF B.I.P.P. IN THE TREATMENT OF DISCHARGING EARS IN
A SCHOOL CLINIC.
Treatment of discharging ears in school children at the Clinics has long been one of
the least successful of the many conditions treated here, and it is generally acknowledged
that this condition is very difficult to treat successfully.
In this district there is no Ear Clinic, and discharging ears have to be treated at the
Minor Ailment and Daily Treatment Clinics, and supervised by the Medical Officer of the
Clinic, and they are not usually seen by an Aural Specialist. Consequently treatment is
restricted, and consists mainly of cleansing the ear, which after a varying time heals, often
breaking down again subsequently.
Hydrogen Peroxide is most frequently used and Rectified Spirit with Boracic insufflation
in suitable cases. Other agents such as Neo-Protosil and Antivirin have been tried,
but did not seem to procure better results than Hydrogen Peroxide, and this has become the
routine treatment.
Ionisation has been obtained in a few cases with good results, but it is not available
at the School Clinic, and it is difficult for children to be sent up to a London Hospital, as,
•even when such treatment can be arranged, parents cannot often afford either the time or the
money, and in some cases do not want to take the trouble. A few cases have been treated at
the West Middlesex Hospital by arrangement with the Medical Superintendent, but the
School Clinic has to treat the bulk of the cases. Such cases are chiefly those of middle ear
suppuration or discharge after mastoid operation, often of long duration before seen or cases
which have had previous trouble and broken down again. No acute cases are treated—a few
are seen and referred at once for hospital or private medical treatment.
Some have only the External Auditory Canal or Meatus affected such as with boils or
eczema—these are in the minority and clear up quickly. In all cases where enlarged and unhealthy
Tonsils or Adenoids are present an endeavour is made to have these removed. Advice
is also given as to the general health of the child, though often this appears to be good.
In April, 1932, B.I.P.P. was first tried. This was used with great success
by Mr. Rutherford Morrison of Newcastle during the war for the treatment of septic wounds.
It is a paste comprised of:—
I had personal experience of its use for 2 years at the Military Hospital, Endell Street. The
procedure was then to open up and thoroughly clean the wound under anaesthetic removing all
dead tissue. B.I.P.P. was then rubbed well in to all parts and the wound stitched up.
Results were extremely good, the whole process of healing being accelerated and, a most
important point, dressings were reduced to a minimum, the wound being left untouched for
one week after operation unless there was a rise of temperature, in contra-distinction to the daily
or twice daily dressings of other treatments.
An adaptation of this procedure is made when used in the ear. The ear is
first thoroughly cleansed with Hydrogen Peroxide, dried with wool, and then the paste
applied on a swab. Naturally this is not done under anaesthetic, and the restricted area of
the outer and middle ear make it difficult to apply the paste to all parts—which difficulty is
increased where the surface is pocketed and the opening of the canal small. Therefore the
method is not as successful as when applied to open wounds. In cases where it is very difficult
to apply, the paste can be diluted with more Liq. Paraffin and dropped into the ear, but
it does not appear to act so well, as the tissues are inclined to become sodden. It is not necessary
to plug the meatus with wool, and the child is not seen again for 3 or 7 days—usually
3 days after the first application. The ear is not touched in the interval. Fresh applications
are made as considered necessary with a 3 or 4 day interval—often longer.
E. L. ROBERTS
Assistant School Medical Officer.
Bismuth Sub Nitrate
Iodoform
Liq. Paraffin ...
1 part.
2 parts.
1 part.
21