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5c. Tonsils and Adenoids.— Enlarged tonsils and adenoids
were present in 7.8 per cent. of the children examined; 3 per cent.
causing symptoms necessitating removal, the remaining 4.8 per cent.
requiring watching. In the vast majority of the latter, the enlargement
of the tonsils does not subside, but on the contrary, frequently becomes
more pronounced; secondary symptoms, such as deafness, appear and
removal is considered necessary.
Taking into consideration the relationship between enlarged tonsils
and adenoids and microbic infection, such as diphtheria carrier, acute
rheumatic fever and infective endocarditis, there is a feeling that one
must not necessarily depend too much upon secondary symptoms due
to physical causes when advising as to their removal or not.
Table II shows that a large number of children suffering from nasal
obstruction are sent to the Clinic apart from routine medical inspection.
In the same Table it will be seen that 432 cases of enlarged tonsils
and only 20 cases of tonsils and adenoids were referred for further
treatment. This sub-division is far from being correct; it simply means
that 432 children had tonsils large enough to cause symptoms and that
in the other 20 cases they were not so prominent, and a further
examination had to be made to reveal the cause of the obstruction.
The report of the Surgeons operating on these cases is of interest;
of 361 children, 814 had enlarged tonsils and adenoids, 42 had adenoids
only, and 5 had enlarged tonsils only.
5d. Tuberculosis.—It is rare to come across children with
definite signs of tuberculosis of the lungs. Five such cases, of whom
two were already under treatment, were found during routine inspection,
and 52 were found with suspicious signs. In the majority of cases these
signs clear up within a comparatively short time; in the small minority
they may last for months, with no obvious impairment of the general
health. Of the non-pulmonary tubercular lesions, that of the cervical
glands is the most common. Five such cases were advised to secure
treatment, whilst 16 were kept under observation.
A fair number of children are seen who have fused submaxillary
glands, small and hard, but freely moveable under the skin; it is
probable that this condition represents a healed tubercular focus.
A list of tubercular contacts of school age is furnished by the doctor
in charge of the County's Local Tuberculosis Dispensary, and these
children are regularly seen by Medical Inspectors at the routine
examination.
5e. Skin Diseases were not commonly found during the routine
inspection; the majority of these cases had been found by the teacher
and promptly referred to the Clinic. Scabies is as prevalent as in 1919,
but one rarely meets with such extensive lesions as in that year.
The number of cases of Ringworm is a slight improvement on that
of 1919, but the number of cases of Impetigo has nearly doubled;
many, however, of these cases are of slight extent and are soon cured.