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The Common Cold
The Common Head Cold:
 Principles And Practice Of Hardening

 Home Care And Treatment

 Nasal Obstruction And Mouth Breathing

 Adenoid Problem

 Tonsil Troubles

 Sinus Situation

 Voice And Speech

 Summary And Conclusions

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Adenoid Problem

( Originally Published Early 1900's )

Intimately connected with the subject of colds is the adenoid and tonsil problem, for it is a universal observation that colds show a decided pre-dilection for persons with diseased tonsils and especially for children with adenoids.

Indeed, there is such a marked tendency for the child with adenoids to get a cold that this is regarded by physicians as one of the most convincing symptoms of their presence. Some of these little youngsters seem never to be free of cold, so closely one attack will follow upon another. They are in a constant state of "sniffles," due in reality to an inflammation of the adenoids, which has spread forward to affect the entire nasal cavity. The adenoid is an enlargement of the lymphoid structure in the post-nasal space. It is sometimes called the third tonsil, and is quite analogous in structure to the tonsils which are properly called the faucial tonsils. When this kind of structure once becomes enlarged and diseased, it constitutes a most vulnerable point of attack for hostile micro-organisms. There are a number of little pits or blind alleys opening upon the surface, and these become filled with a decayed substance (exudate) which is a breeding place for germs.

Here they multiply rapidly and carry on their nefarious activities without hindrance.

Naturally they soon overrun their boundaries and the neighboring structure becomes inflamed. An acute coryza or rhinitis follows their extension to the nasal chambers and the extension may proceed to the pneumatic spaces, setting up a sinusitis. The faucial tonsils being involved we are al-most sure to have an extension thence to the pharynx (causing pharyngitis) and often to the larynx (laryngitis), or to the bronchi (bronchitis). The question is often asked as to what are the purposes of these lymphoid structures, and assuming that they do subserve some useful purpose, the complementary question arises, will not their removal be followed by some untoward evil consequences. To the first question it must be admitted that we are still unable to give a definite answer. Several theories are put forward supported by experiment and reason, but each is disputed, and none absolutely proved. The chief theories for the reason of these structures are (1) That they are mere atavistic organs, of no use, (2) That they produce white cells that can absorb and destroy invading micro-organisms (phagocytic action) (3) That they produce white cells that enter the blood stream and form part of the cellular elements of the blood (hematopoietic action) (4) That they are of service in connection with voice production.

Most authors are inclined to hold that, considering their analogy with the lymphatic structures of the body, they are possibly intended to act, in some measure, as one of its defence mechanisms, but this with the modifying statement that the function is confined only to the earlier years of life.

Considering the special activity and tendency to overgrowth of these organs in the earlier years of life and noting their tendency to shrinkage or involution at the approach of adolescence, there seems good reason to believe with Harrison Allen that their function, whatever it is, is one closely related to growth and development of the bony framework of the body. The inference to be drawn is that while removal in the earlier days of life should not be undertaken, except for very positive evidence of harmful results, later in life their very persistence in hypertrophied form in itself makes them at least objects of just suspicion.

Whatever may be the functions of these organs at any time of life, and whether useful or not, these functions can only be performed in a perfectly satisfactory way if the organs remain nor-mal and healthy.

In the state of disease in which they are so often found, they not only fail in their intended function, but, as pointed out, they have become a favourite playground for hordes of pathogenic germs, which as a result of their activity pour continuously into the blood-stream poisonous toxins of evil import to the health of the body.

The mere frequency of the occurrence in children of the affection known as adenoids, even though it were esteemed of but little gravity, would be reason sufficient to demand for it serious and earnest study on the part of those interested in the physical welfare of the race. Estimates of the proportion of children affected differ, but they are all high. Some claim that its frequency amounts to as high an average as of one in every five children, though a fairer estimate of its prevalence is that it occurs in one of every ten. At least, every one will admit that it is a very wide-spread ailment, and that though here and there a family escapes, there are none who have not relatives, friends, or neighbours in whose family an operation has been found necessary.

But alas, frequency is not the only indictment we are compelled to bring against this affection. As you will surely soon discover, if you do not already know it, the existence of adenoids is fraught with the most serious consequences to the health of the individual, pointing eventually to the deterioration of the race. It stunts the growth and development of the child, and renders him a prey to every passing illness. It disorders his functions, robs him of his vitality, paralyses his faculties and generally impairs the physical, mental and even moral status of the unfortunate child that happens to be the subject.

The causation of the malady is but imperfectly known. It is common to hear it attributed to catching cold, and the occurrence of the various infectious or contagious diseases peculiarly incident to childhood. But it is more reasonable to consider the "colds" as effect rather than as cause, and as regards the other causes, I have seen numerous instances where adenoids in the worst form have been present in children who gave no history of eruptive fevers or of contagious or infectious diseases of any sort.

Such factors as dampness, bad air, and unsanitary surroundings are admitted as having an in fluence, but they are too general to be regarded as definite causes. One theory that has been advanced is that the ingestion of a surplus of sugar is responsible for adenoids, while another is that infantile habit of thumb sucking is the chief cause. But both lack proof and neither has gained the stamp of general approval.

Wanting a specific definite cause, some authors lay chief stress upon the existence of certain systemic dispositions of the body, probably congenital. There are good grounds for supposing heredity to have an influence, especially the fact of the frequent occurrence of the disease in several members of one family. My own observations have been that adenoids occur especially in families where one or the other of the parents has been affected with some obstructive condition of the nose. This may have been adenoids or it may just as well have been an irregular or bent septum, a septal spur, or a collapsed state of the wings forming the sides of the nostrils.

The obscurity which surrounds the causation, or at least the absence of acknowledged specific causes which one may lay hold on and eliminate, is but added reason for a more earnest attention to those symptoms and sequelae which might lead to its recognition, or that may be considered as indications for its removal.

For, unable to avoid the cause, our concern must naturally be next to escape, or at least ameliorate the effects. And when it happens, as in the case of the affection we are considering, that the most brilliant results attend our therapeutic efforts, how much the greater reason for the possession of knowledge which makes such an end possible.

In so many and devious ways can adenoids produce their ill effects upon the human system that there is scarcely any part of the body that can surely escape, and no organ that will be wholly exempt.

First, by obstruction of the nasal passages, they nullify and invalidate all the highly important physiological processes of nasal respiration. The constant entrance directly into the throat of unfiltered air causes the throat to be dry and parched, and leads eventually to a catarrhal state of the entire lower respiratory tract. On account of the unhealthy state of the mucous membrane, the functions of the lungs are imperfectly per-formed, the blood is insufficiently oxygenated, and general anemia ensues. Impoverished blood circulating through the system, explains the general debility and malnutrition which these little patients usually exhibit.

Interference with the respiratory current is partially responsible also for the aural complications in adenoids, because the Eustachian tube which conveys the air from the nasopharynx to the middle ear cavity will in some measure be cut off from the normal supply. Under these circumstances the structures of the ear always suffer.

The situation of these growths, their proximity to important organs, explains many of the ill effects of their presence. When covering the mouth of the Eustachian tube they may completely in-validate the function of this organ. By inducing a congestion in the upper part of the nasal fossa and by compression they can interfere with the circulation and thus bring about congestion of the vessels at the base of the brain.

Probably in no other manner do adenoids give rise to so many and such serious disturbances, as by propagating infections. Upon microscopical examinations, they have been shown to swarm with bacteria, and being very vulnerable structures, which inflame upon the slightest provocation, it is natural that the germs should be in-cited often to increased activity, quickly spreading to other parts. Thus, travelling up the Eustachian tube, they set up a suppurative process in the middle ear, or passing downward they give rise to bronchitis and other inflammations of the lower tract.

Absorbed into the lymphatics they produce en-largement of the glands in the neck and under the jaw which are often found to be of a tuberculous nature, and are sometimes the seat of abscess formation.

Toxemia and acute general infections are said occasionally to have their origin in adenoids, and there can be at least no doubt that the infectious fevers peculiar to childhood are rendered more frequent and more severe because of their presence. The facial expression or configuration is usually modified to a very marked degree by the presence of adenoids and in its typical form it is highly characteristic. (Fig. 11.) The nose is narrow and pinched, the upper lip is generally short and often swollen and excoriated from constant nasal discharge. The mouth is nearly always open, so that the upper teeth are exposed to view. These are seen to be irregular, projecting, and discoloured. The eyes are usually lustreless and the general effect is to give a dull, stupid, vacant ex-pression.

Children with adenoids, furthermore, are likely to be anemic, ill-nourished and undeveloped, and as they often have enlarged swollen glands in the neck, the effect is to give them the appearance of being "scrofulous." The speech of the adenoid child tends to betray him; the voice is lacking in resonance, being "woody" in effect ; and the articulation is imperfect, because of impeded movement of the palate. He pronounces M like B, and N like D. Thus the phrase, "fine morning if it don't rain," he would be apt to pronounce as though it were spelled "fide bordid if it dode rade."

If we would now look inside the mouth of our adenoid child we will observe instead of the nor-mal Romanesque shaped palatal arch, a narrow, pointed arch of the Gothic type. Nearly always, too, we will find the tonsils enlarged.

The history in all these cases is generally as follows: The nose is more or less stopped; there is almost constant cold in the head; and nose-bleed occurs. The catarrhal symptoms are generally worse at night, and attacks of croup may develop; during sleep the mouth is kept open, and the breathing is noisy or there may be loud snoring. Whenever the patient contracts a fresh cold all the symptoms are aggravated, and especially a great abundance of thick yellow discharge es-capes from the nose, or drops backward into the throat. In the latter case digestive symptoms arise as a result of the swallowed mucous.

Very prominent and very serious are the vocal symptoms which occur—hoarseness, loss of voice and spasm of the glottis. It is well known that a large proportion of the deafness of adults had its origin in adenoids which were not removed during childhood. Ear-ache is a quite common symptom, and should always in a child, give rise to a suspicion of adenoids. In many cases the aural trouble progresses to the stage of abscess formation, and in such cases, it is often impossible to get a permanent cessation of the discharge until the adenoids are gotten rid of.

That the presence of adenoids seems to make profound impression upon the general nervous system of the unfortunate little subject has been remarked by a great number of observers. In many instances indeed, the mental status is seen to be greatly affected, and the child not only looks stupid, but is actually possessed of a degree of mental lethargy or incapacity that seriously interferes with his school progress. Guye of Amsterdam was one of the first to note the influence of adenoids upon the mind, and in 1887 he wrote an article upon the subject and invented the term, "Aprosexia nasalis," to describe the characteristic mental condition which it produces. He emphasised especially the lack of memory, and in-ability to concentrate the attention observed in these children.

Some authors who have examined children in institutions for idiots and imbeciles claim to have noticed a significantly large proportion of the feeble minded who are afflicted with adenoids. The idea that adenoids can affect mental faculties is not a mere fancy, nor a bugaboo raised by the surgeon to frighten parents into having their children operated upon. It is based upon an actual demonstrated relationship which has been found to exist anatomically between the brain and nose. We know that the brain in part lies upon the roof of the nose, and if you will examine this roof you will see that it is a thin plate of bone, perforated by a number of holes, for the passage of the branches of the olfactory nerve; hence the name cribriform plate. Now certain German anatomists have found by careful dissection that the lymph vessels of the brain surround these nerve branches, and accompany them through the cribriform plate and into the nasal cavity. When conditions exist in the nose which cause compression of these vessels, the outflow of lymph is greatly obstructed and the cerebral activities are thereby greatly hindered, which may account for the headache, stupor and other mental symptoms so often observed.

Children with adenoids present evidence, more-over, of general nervous irritability. They are fretful, peevish, excitable or morose. Chorea, or St. Vitus Dance, as it is commonly called, may have its origin in adenoids, and nervous cough, spasms of the throat, and asthma may have a like causation.

Finally, as stated above, certain skeletal mal-formations are known to be produced by adenoids. One that has been especially remarked is what is termed the "pigeon breast" deformity. The author has seen marked examples of this and other chest deformities as a result of adenoids. They are due to the mechanical effects of obstructed breathing at a time of life when the walls of the chest are flexible, and thus more easily distorted.

Parents have a natural dread of having their child undergo an operation, and would avoid it if possible. They are inclined therefore, to listen to any one who will advise against it. They are told by some, that adenoids are normal, and therefore should not be removed. Luschka's tonsil indeed is a normal organ, but adenoids constitute an hypertrophy and are therefore not normal. Not only in this state must the organ be unable to perform any healthful function of its own, but, as we know, it is disturbing in many ways to the functions of other organs and gives rise to far-reaching systemic disorders of the most serious nature. Will the child outgrow adenoids? The most prevalent and the most persistent argument made against their removal is that if we leave them alone the child will outgrow them. This popular fallacy, which unfortunately to some extent has been encouraged by the family physician, when he hap-pens to be one of little experience, is based upon the fact that the structure tends at the age of twelve or fourteen to harden and shrink. But if allowed to take this course, it invariably leaves behind an intractable nasal catarrh. And this is one of the least of the evils, for while waiting for the adenoids to contract, which they do not always do, incalculable harm is being done to the whole organism.

It will be impossible in later years with the most painstaking care, and with the most assiduous medical attention, wholly to remedy the evils which have been wrought by the continuous presence of these small growths. For the facial contour has become permanently altered, the teeth are distorted and diseased beyond complete repair, a chronic suppuration is present in the middle ear with all its attendant dangers, the throat and general respiratory tract is so weakened that colds are contracted upon the slightest provocation, and the poor unfortunate individual is the subject of weak lungs and, it may be, the victim of tuberculosis.

Especial emphasis should be placed upon the danger to the ears of leaving the adenoids alone.

A certain amount of loss of hearing is the sure consequence, the deafness will be progressive, and because of the attendant colds and catarrh, may reach a profound degree.

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