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would be suffering from symptoms calling for opera-tive interference, whereas under existing circumstancesabout 2 per cent. require it. This is a strikingly smallpercentage ; Gradenigo found in Turin that adenoidswere present in one out of every three childrencoming to his clinic, and Dan McKenzie estimatesthat over 30 per cent. of all children in Britain sufferfrom adenoids and require operation. The work of thethroat clinic now makes adenoids most prominent inearly school life, whereas, apart from surgical inter-ference, this disease, high at the entrance age, wouldincrease to a maximum at the age-group 9 to 11. Atalmost every age-period there is a clear excess amongboys as compared with girls. Some 7 per cent. of boysand 6 per cent. of girls have, or have had, definiteadenoids during school life. There is some evidencealso that the disease reaches a given degree of severitysomewhat later in school life among girls than

among boys. A comparison between schools receivingchildren from the more prosperous and the poorerdistricts respectively suggests a greater prevalenceamong the latter. Thus 4995 scholars at six schoolsserving prosperous districts furnished 60 cases of.severe adenoids, 47 cases of slight adenoids, and 128cases which had been operated upon ; whereas4534 scholars in seven schools serving the poorerdistricts furnished 90 cases of severe adenoids, 69 of.slighter adenoids, and 163 cases in which an opera-tion had been performed during school life. Thereare no data available to check whether the smallerproportion of adenoids among the entrants to the" prosperous " schools is due to more ready recourseto operative treatment during the pre-school age.Among the " prosperous " children aged 5 years,numbering 237, there were seven cases of severe

adenoids, three of slighter adenoids, and two whereoperation was performed during school life ; whereas.among the 245

" poorer " children aged 5 there werefour cases of severe adenoids, thirteen of slighteradenoids, and six cases where operation was performedduring school life.An endeavour was made in the case of 156 un-

selected cases of well-marked adenoids to ascertainthe date of onset. Where a definite history wasobtainable from the parents, it was found that half,of the cases who were mouth-breathers, one-third ofthose who were deaf, and one-quarter of those withenlarged tonsils had developed these defects beforeadmission to school. The available data yielded noevidence of any relation between adenoids and bottle-feeding or prolonged breast-feeding, nor did theysupport the theory that the use of a comforterfavoured the development of adenoids. No con-

nexion could be traced between the sanitary condi-tion of the home and the prevalence of adenoids,apart from the fact that the increased aggregationof persons per room appeared to have an influence.It was clear that adenoids cause a school child tolag behind his fellows in educational level, the effect,becoming particularly serious in the upper standardsof the school.We hope that this portion of Dr. Newsholme’s

report will be widely circulated and lead to similarinquiries in other populous districts. One thing isabundantly clear, that we must not be content withmoving the maximum incidence from the age of 10

- to the age of 5, but that serious efforts will have tobe made to tackle the toddler through the child- welfare clinics so as to cut off the supply of damaged.school entrants. Probably a considerable number ofchildren, both of the poorer and more prosperousclasses, have had their adenoids removed beforeentering school; but it is certain that many children- still suffer because the operation has been delayedtoo long, and that a large proportion of cases of,deafness and chronic otorrhcea, as well as of acuteaural suppuration and mastoiditis, could be pre-vented by more timely removal of adenoids. Although- some children first develop symptoms of adenoidhypertrophy later in life, the most suitable age fortheir removal is usually about 4 or 5 years, and in.a considerable number of children the naso-pharyngeal

tonsil is sufficiently enlarged to cause serious sym-ptoms at a far earlier age than this. A test of theefficiency of the service would be the average ageof the patients operated on ; it would be interestingto have statistics on this point from some of ourpublic clinics. Croydon should be in an ideal posi-tion to do this, as owing to the wise cooperation ofthe Health and Education Committees the child issupervised, as from September; 1924, by the samemedical and health nurse staff from infancy to school-leaving age. ____

THE THERAPEUTIC USES OF SILICA.

IN this country silicic acid and the silicates aregenerally considered unsuitable for administrationper os, although the sodium salt is used in powderedform in France. In a recent article in the WienerKlinische Wochenschrift (No. 27, 1925) Prof. FriedrichLuithlen points out that silica is the foundation of theelasticity of living tissues and that healthy activitydepends on the maintenance of a proper balancebetween the calcium and silica constituents of thebody. In youth the silica content is at its highest,decreasing with maturity until in age there is adeficiency, with a corresponding preponderance ofchalk. Hence the altered biological processes, thediminished pliability of the tissues, and the liabilityto fractures. Arguing from these facts, Prof. Luithlenhas tried the use of silica in certain senile and otherconditions attributable to silica deficiency. The bestresults have been obtained in cases of pruritus seniliswhere there is no definite metabolic cause for theirritation and the superficial layers of the epidermisare dry and brittle. In many instances where colloidtreatment, hypotonic solutions, and organotherapyhad been tried in vain, intravenous injections of silicicacid rendered the skin soft and supple and restored thecirculation. Good results have also been obtained inall kinds of senile skin disorders such as psoriasis,furunculosis, and acute weeping eczema in the aged,as well as the further advantage of increased immunityand better conditions of life resulting from the restora-tion of chemical balance in the tissues. The methodhas also been applied with satisfactory results to casesof arterio-sclerosis, stenosis of the cardiac valves, andtuberculosis of the lungs. The drug may be adminis-tered hypodermically or per os in youthful cases wherethe power to re-absorb silica has not been lost. Forthis purpose a " silicic acid tea" or the organicpreparations can be used. For older people it is best

given intravenously, in the form of a 1 per cent.watery solution of sodium silicatum purissimum.The phials should be well shaken, as sedimentation islikely to take place, and 1 c.cm. may be given onalternate days up to 15 or 20 doses. If the claims ofProf. Luithlen are substantiated by further observa-tions we shall have in silicic acid a most valuabletherapeutic weapon against a series of trying andobstinate conditions.

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CAVERNOUS OPTIC ATROPHY.

A THEORY of chronic glaucoma which is associatedwith the name of Schnabel holds that it is causednot by pressure on the optic nerve, but by primaryatrophy of that structure. The theory was long agodiscredited, but has lately been revived in a somewhatdifferent form. Mr. Ransom Pickard 1 holds that"cavernous atrophy " is a distinct entity, that ithas no necessary relation to glaucoma, but that insome cases the two conditions may be associated.According to this writer, " cavernous atrophy " ischaracterised by a cupping of the disc which may ormay not extend to the margin all round, an absenceof tension, which remains within normal limits, andretinal vessels of normal size. The persistence of anormal tension at once separates these cases fromthose of glaucoma. The fields for colour are charac-teristic. In ordinary glaucoma they are diminishedin the same proportion as the field for white. In

1 British Journal of Ophthalmology, August, 1925.