THE rise in the incidence of tonsillectomy is one of the major phenomena of modern surgery, for it has been estimated that 200,000 of these operations are performed annually in this country and that tonsillectomies form one-third of the number of operations performed under general ancesthesia in the United States. There are, moreover, features in the age, geographical and social distribution of the incidence, so unusual as to justify the decision of the Section of Epidemiology to devote an evening to its discussion. HISTORY It seems unnecessary to review the history of operative treatment of the tonsil, and I will confine myself to pointing out that while it was natural that, in preanaesthetic and pre-Listerian days, the incidence of operation should be very small,
CERTAIN semi-isolated communities, which are under strict control, seem to be designed for epiderniological study, and of these the public schools of England offer a unique field for observation.-Few communities are more comparable and homogeneous in the age distribution, in the nationality, and in the nurture-of the individuals comprising them. Yet, with the exoeption of the classical work of Clement Dukes, little systematic epidemiological work seems to have been carried out withthis-matchless material. Surgeon Commander Dudley has, however,-'shown 'what can ie done with somiewhat similar material, and 'his 'two reports on the Roy J Naval :SchoQ. at Greenwich, based largely upon the careful records of Surgeon Captain P.' M. May, R.N., and published by tho.Medical Research Council,1 are, I think, even more important c"ontribiitions to school epidemiology than Dr.-Clement Dukes's studies at Rugby. As early as 1905 Dukes showed that the public schools were suffering an increased numnber of infectious diseases; this was largely due to the greater care exercised at home and at preparatory s&hools in 'preventing infectious disease., and to the consequent greater ppoportion of boys 'who reached public sehools unprotected by previous attack. There is, I think, a general impregsion that a further postwar increase has takenplace. OtIrer *factors may be concerned in this postwar. increase, such as: (1) the greater prevalence of influenza since the epidemic of 1918; (2) the great increase in the number .of boys sent to public schools since the war, causing overcrowding in classrooms and 3 13 192.
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