The Tonsils and Nasopharyngeal Epidemics

In a paper on nasopharyngeal epidemics presented to the Section of Epidemiology and State Medicine of the Royal Society of Medicine on 22nd June, 1928, J. A. Glover suggested an investigation into the 'relative incidence of droplet infections upon children whose tonsils have been enucleated and whose adenoids have been removed, compared with children who have not been operated on.'I have attempted this investigation, and by reference to a small part of the literature on the subject, to discuss my observations.The material observed is a public school for boys.A preparatory school is included, so that the ages of the boys under observation range from ten to eighteen years.The enquiry resolved itself into two parts Part 1.The condition of the throat in health.Part 2. The incidence of catarrhal disease.1.-A sample of the school, 289 boys in good health, was examined during the second half of July, 1929, and data rSlative to the tonsil, the oral pharynx, the buccal mucosa and the cervical glands noted.The figures obtained are compared with the results found in Part 2.2,-An analysis was made of my records of the acute, non-notifiable, upper air-passage infections occurring in the same boys during the four preceding school terms.A period of approximately one year of actual observation, but including two summer terms, is therefore dealt with.Ill health during vacations is not considered.Whereas the figures given in Part 1 may be taken as fairly typical of this class of community, those in Part 2 can in no way be looked upon as constant.They are dependent on the epidemic constitution at the time, and in the locality of the observation.Any conclusions drawn from this comparison can relate only to these particular circumstances.The setting during this period was one of epidemic sore throat, but apart from the fact that an epidemic of streptococcal tonsillitis might be expected to bias the figures against the much maligned tonsil, the writer believes his conclusions are reasonably true for all acute catarrhal upper air-passage infections.It must be remembered that this semi-isolated community provides an environment favouring the spread of what, in the present state of our knowledge, appear to be droplet infections.As Glover says ' A school seems to be designed for epidemiological study '1, and Sydenham advises 'To fish out the species of a continued fever choose for your field of observation some large and * Being part of an essay on 'N asopharyngeal Epidemics in Public Schools' awarded the