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100
Adenoids.—Severe nasal obstruction due to adenoids,
and urgently requiring removal, was found in 1.7 per cent.
of the boys and 1.4 of the girls. Adenoids can rarely, if
ever, be directly observed during the ordinary routine
inspection. One therefore has to be guided to a diagnosis
by indirect evidence. In a few cases where the parent was
anxious for a definite diagnosis, the finger was used to
estimate the amount of the obstruction of the naso-pharynx
by adenoid overgrowth. In slight cases one often has to be
guided to a diagnosis by finding that persistent mouth
breathing, unassociated with nasal obstruction, is associated
with a fulness of the buccal pharynx, and some chronic
pharyngitis. In this way about 20 per cent. were classed as
having slight adenoid enlargement. No doubt by far the
larger number of these children grow out of this condition,
but not without leaving more or less permanent damage to
the body or mind. It must be remembered that adenoids,
while they last, starve the lungs of their natural respiratory
food. In considering the cause and prevention of adenoid
enlargement, it should be remembered that a large proportion
of infants at one time or another suffer from nasopharyngeal
or bronchial catarrh in a more or less sub-acute
or chronic stage. This tends to cause frequent nasal
obstruction. Some 5 per cent. of the children were, at the
time of inspection, suffering from nasal obstruction due to
coryza, and some 4.5 per cent. showed other nasal or throat
defect. The less patent the nasal passages are from non-use
of the handkerchief, the more liable they are to adenoid
enlargement.
Tonsils.—Tonsil enlargement is closely associated with,
and in fact partly caused, in the one case, by adenoid enlargement,
where the child is forced to breathe through the
mouth, and, on the other hand, by the constant passage over
them of purulent and other septic matter from decayed teeth.
7.26 per cent. of boys and 8.5 of girls have tonsils sufficiently