Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS, 217
any of these diseases and frequently pro- no idle fancy, but it is confirmed by the exlong
a more speedy convalescence. perieuce of all clinical observers.
I wish now to speak but a few minutes Having shown you some, not all, of the
in reference to the obstructive influence of injurious effects upon the general system
this lymphoid tissue upon the respiratory by the presence of adenoids and enlarged
and aural development of the individuai. and degenerated faucial tonsils, I wish to
The development of any chest, the ex- close with a plea for an early and radical
pansion of any lung, which is one of its operation upon these structures. The rephysiological
functions and thus indirectly suits of such an operation, when properly
the oxygenation of the blood for the purifi- done, is simply marvelous upon the general
cation of the whole body, is absolutely de- constitution of the child and in the majority
pendent upon free and unobstructive respir- of cases will make such an individual much
ation through the nose and mouth. A child more able to contend with the physical viciswith
enlarged tonsils and even more so with situdes of life. When should such an operaa
naso-pharynx filled with adenoids, has tion be performed? Preferably between the
but a feeble constitution to withstand the ages of three and six, but even earlier
numerous ailments which seem to be the should the tonsils and adenoids be found
heritage of the young. The two conditions, giving trouble. Should all faucial tonsils
adenoids in the naso-pharynx and enlarged be removed? My own opinion is that if the
tonsils, are usually associated together, al- adenoids require removal that the tonsils
though I have frequently seen a large should be removed at the same time, especamount
of adenoid vegetations without a ially if there has been a previous tonsillitis
corresponding enlargement of the tonsils, or the tonsils are enlarged enough to project
Both conditions are obstructive to free res- beyond the faucial pillars. I believe with
pirations, and in many cases enlarged ton- Lennox Browne that the tonsils are foreign
sils are just as serious offenders as a bunch bodies in the throat and as such are better
of adenoids, for they extend high up be- out than in. I know there will be strong
neath the palatal folds and can materially adverse criticism to such a position, but it
narrow and diminish tne size of the naso- has been reached only after years of experipharynx.
ence and the observing of conditions later
This leads me now to the consideration in life which could have been remedied had
of the second point, and that is the indirect the management of the same been along
influence upon the ears of this obstruction these lines earlier in life. Why wait to
to free nasal respiration. The eustachian operate later in life, or perhaps not at all,
tube acts as a chimney, and in order for it and allow abscesses and discharging ears
to be freely ventilated and likewise the to fasten themselves upon the individual
middle ear, there must be an unobstructive with all their direful consequences? Why
passage of air continuously over its mouth allow peritonsillar abscesses and enlarged
which terminates in the nasopharynx, cervical glajids to undermine the constitu-
Breathing through the mouth is absolutely tional integrity of the individual? Why
useless in exerting any influence on the allow these constant coughs every winter
middle ear, because the air cannot possibly and those recurring ear-aches in the very
reach the opening of the tube. This lack young? As Dr. Goodale says, the removal
of ventilation in the middle ear, produced of the tonsils will not always remove the
by the presence of adenoid vegetations and enlarged cervical glands after they have
enlarged tonsils, is most usually the start- become infected through the tonsils, but
ing point of the so called dry catarrhal you can frequently prevent such a condideafness
which in after years is so difliicult tion by the early and thorough removal of
to remedy, and which probdbly could have adenoid vegetations and faucial tonsils bebeen
arrested in the early years of life by fore the infection has taken place. If ademore
radical treatmetit. Both of these con- noids are present in a child afflicted with
ditions, but especially adenoids, are the hot discharging ears, you cannot heal this conbeds
for tiie production of that catarrhal dition until the adenoids and tonsils are restate
manifested in the very young by fre- moved, or if they do heal, under local treatquent
ear-aches during the winter and a ment, there will likely be a return of the
constant nasal discharge. Abscesses of the discharges with each succeeding cold,
middle ear with the possibility of the ex- In regard to the operation. The day has
tension of this pathological process to the passed when a thorough tonsil and adenoid
mastoid, jugular vein and cranical cavitv, operation should be undertaken in the office,
with
because it not only does the patient injustice
all its serious consequences, and in
.
, , . but likewise the physician. 1 he operation
. ^ , many cases be traced an infection from the
^jj^uld be considered a major one, to bepernaso-pharyiix,
engendered by the presence formed in a hospital where the necessary
of adenoids. This, fellow practitioners, is technique may be used and where the sur-
(