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220
Taking the cases of adenoids, enlarged tonsils with adenoids
and mouth breathers, as requiring operative measures, it is seen
that 10.3 per cent. of all school children examined in the three
groups were in need of surgical attention to the throat and nose.
In 1929, dealing with another group of children, the figure was 8
per cent.
Although the term enlarged tonsils and adenoids is always
used, the relative importance on the health of the child is the
other way round. Adenoids exert a much more pernicious
influence, in as much as they impede the proper performance of
nasal breathing. Enlarged tonsils, provided they are healthy in
other respects, do not necessarily cause trouble, except that, if the
child should unfortunately contract one of the acute infectious
diseases which gain their foothold through the portals of the nose
and throat, e.g., Scarlet Fever or Diphtheria, the attack is liable
to be of greater severity and to cause more physical discomfort,
than if the tonsils were not enlarged. Children with enlarged
tonsils or an unhealthy pharynx are also more liable to develop
complications, by far the most serious of which is inflammation of
the middle ear. When it is remembered that the throat and ear
are in direct communication through the eustachian tube, the path
of spread is readily understood. The indiscriminate removal of
healthy, though enlarged tonsils, is unnecessary and the medial
officers do not refer for treatment by operation, children whose
tonsils are healthy, even though they are enlarged.
The operation of choice for enlarged septic tonsils is enucleation.
Resection does not get rid of all the infected tonsillar tissue,
and the remains may at a later date, cause a renewal of the trouble.
The importance of education in correct breathing after the
removal of adenoids cannot be too strongly emphasised. All cases
after operation are invited to attend the Breathing Exercises classes
held at St. Andrew's Hall, but unfortunately only some 392 of
the parents appear to consider it necessary. However, the success
or otherwise of the operative procedure depends on the nose being
used for its natural purpose. If the old, incorrect habits are persisted
in, the lymphoid tissue around the posterior nares lacks the
normal stimulus of the air currents passing over it, and once more
grows into the flabby hypertrophied masses which are known as
adenoids.