View report page

(f). Ear Disease and Defective Hearing.
I am indebted to Dr. Denham who is in charge of the Isleworth School Clinic for the
following report.
His general remarks apply to the conditions found at all our Clinics. All treatment is
of a simple kind and is left to the discretion of the medical officer in charge. We have no
Ionization Clinic and any cases thought to benefit by this form of treatment are referred to the
West Middlesex Hospital.
" Otitis Media.
The discharging ear continues to be one of the most troublesome conditions met with in
school medical work.
The attitude of the parent to this is always interesting as in most cases the fact that the
child has a running ear is regarded as a more or less natural state of affairs, but the possibility
of the development of a dreaded mastoid is usually the reason which prompts the child's attendance
at the clinic for advice.
As many as five out of every hundred children attending elementary schools suffer from
otitis media and with the possibility of their being subjected later to grave social and economic
handicaps the early treatment and possible prevention of hearing defect is a matter of the
greatest importance.
Unfortunately, one is only too often presented at School Clinics with an already established
disease for much to be done in the way of early or preventive treatment as, in at least fifty per
cent, of the cases the onset occurs whilst the child is of pre-school age. This would suggest that
more careful supervision of the ears should be undertaken at Infant Welfare Centres and more
children referred for expert advice regarding the advisability of surgical treatment during the
acute stage of the disease. Any child attending the Maternity and Child Welfare Clinic with
any ear complaint should be examined with the auriscope and if any defect or other acute condition
is found the child should be referred to its own doctor for treatment. It is very
important for mothers to be educated to recognise and report the onset of earache as soon as
possible after its commencement as it is so often looked upon merely as a symptom of teething
which requires no particular treatment. It seems more than probable that if a larger number
of these children had their drums incised, less disability would result than is the case when the
membrane is allowed to proceed to the stage of spontaneous rupture.
In the School Clinics a different state of affairs usually prevails. Here, as previously
stated, one is usually presented with an already established disease which presents itself in the
form of a monotonous succession of acute exacerbations of a chronic condition. The hearing
of these children is tested, the drums thoroughly examined and the quantity and character of
any discharge noted. The nasopharynx is then examined for the presence of any septic focus
such as septic tonsils or adenoids and attention is also given to the teeth and accessory sinuses.
Where the removal of tonsils and adenoids is considered necessary the children are referred either
to their own doctor, or, if the parents prefer it, arrangements for the operation are made directly
with the local hospital.
When treatment at the clinic is considered sufficient the child is usually given the routine
one which consists of daily irrigation with a warm solution of Eusol and subsequent insufflation
with boracic and iodine powder. It is essential to get the ear as dry as possible before the
insufflation of the powder and this is done by dry mopping with pledgets of cotton wool after
gentle irrigation with the eusol solution. To ensure thorough drying the swab may be dipped in
ether.
This treatment has proved very satisfactory and most cases show definite improvement in
a very short time. Any case which resists treatment for more than three weeks is referred to
hospital for the opinion of an ear, nose and throat surgeon."
R. H. G. H. DENHAM.
(g). Dental Defects.
In taking leave of the orthodontic work there is one thing I should have liked to have
seen before I finished and that is that the fee for orthodontic work should be abolished and the
work included in the 1/- paid for dental treatment.
In a number of these cases the orthodontic deformity is of far far greater importance to
the individual, particularly if it is a girl, than any condition of carious teeth which can be replaced
by artificial dentures later on. The orthodontic deformity, if it i^ bad, can never be
remedied in after years, and the affliction of an inferiority complex which makes a woman's life
miserable by reason of a hideous mouth, bears no comparison whatever to the fact that she has
lost a tooth or has a gap or that she has twenty teeth filled or that she has lost her molars and
that they have been replaced by an artificial set on a partial plate or even that she has a complete
artificial denture. I feel that the perspective in these dental matters is not correct and must be
re-orientated and these cases must be dealt with on the same basis as the other medical needs
by sympathetic treatment in the matter of payment.
25