Preventable Diseases

by Woods Hutchinson

Mouth-breathing is not simply a bad habit, a careless trick on the part of the child. We have come to realize that physical bad habits, as well as many mental and moral ones, have a definite physical cause, and that no child ever becomes a mouth-breather as long as he can breathe comfortably through his nose.

This clears the ground at once of a considerable amount of useless lumber in the shape of advice to train the child to keep his mouth shut. I have even known mothers who were in the habit of going around after their helpless offspring were asleep and gently but firmly pushing up the little jaw and pressing the lips together until some sort of an attempt at respiration was made through the nostrils. Advertisements still appear of sling-like apparatuses for holding the jaws closed during sleep.

To attempt to stop mouth-breathing before providing abundant air-space through the nostrils is not only irrational, but cruel. Of course, after the child has once become a mouth-breather, even after the nostrils have been made perfectly free, it will not at once abandon its habit of months or years, and disciplinary measures of some sort may then be needed for a time. But the hundred-times-repeated admonition, "For heaven's sake, child, shut your mouth! Don't go around with it hanging open like that!" unless preceded by proper treatment of the nostrils, will have just about as much effect upon the habit as the proverbial water on a duck's back. No use trying to close his mouth by any amount of opening of your own.

Fortunately, as does not always happen, with our discovery of the cause has come the knowledge of the cure; and we are able to say with confidence that, widespread and serious as are disturbances of health and growth associated with mouth-breathing, they can be absolutely prevented and abolished.

What, then, is the cause of this nasal obstruction, and when does it begin to operate? The primary cause is catarrhal inflammation, with swelling and thickening of the secretions, and it may begin to operate anywhere from the seventh month to the seventh year. A neglected attack, or series of attacks, of "snuffles," colds in the head, catarrhs, in infants and young children, will set up a slow inflammation of this glandular mass at the back of the nostrils—a tonsil, by the way—and start its enlargement.

Whether we know anything about adenoids themselves or not, we are all familiar with their handiwork. The open mouth, giving a vacant expression to the countenance, the short upper lip, the pinched and contracted nostrils, the prominent and irregular teeth, the listless expression of the eyes, the slow response to request or demand, we have seen a score of times in every schoolroom. Coupled with these facial features are apt to be found on closer investigation a lack of interest in both work and play, an impaired appetite, restless sleep, and a curious general backwardness of development, both bodily and mental, so that the child may be from one to four inches below the normal height for his years, from five to fifteen pounds under weight, and from one to three grades behind his proper school position. Very often, also, his chest is inclined to be narrow, the tip of his breastbone to be sunken, and his abdomen larger in girth than his chest. Is it possible that the mere inhaling of air directly into the lungs, even though it be imperfectly warmed, moistened, and filtered, as compared with what it would be if drawn through the elaborate "steam-coils" in the nostrils for this purpose, can have produced this array of defects? It is incredible on the face of it and unfounded in fact. Fully two-thirds of these can be traced to the direct influence of the adenoids.

These adenoids, it may briefly be stated, are the result of an enlargement of a tonsil, or group of small tonsils, identical in structure with the well-known bodies of the same name which can be seen on either side of the throat. They have the same unfortunate faculty as the other tonsils for getting into hot water, flaring up, inflaming, and swelling on the slightest irritation. And, unfortunately, they are so situated that their capacity for harm is far greater than that of the other tonsils. They seem painfully like the chip on the shoulder of a fighting man, ready to be knocked off at the lightest touch and plunge the whole body into a scrimmage. Their position is a little difficult to describe to one not familiar with the anatomy of the throat, especially as they cannot be seen except with a laryngeal mirror; but it may be roughly stated as in the middle of the roof of the throat, just at the back of the nostrils, and above the soft palate. From this coign of vantage they are in position to produce serious disturbances of two of our most important functions,—respiration and digestion,—and three out of the five senses,—smell, taste, and hearing.

We will begin with their most frequent and most serious injurious effect, though not the earliest,—the impairment of the child's power of attention and intelligence. So well known is their effect in this respect that there is scarcely an intelligent and progressive teacher nowadays who is not thoroughly posted on adenoids. Some of them will make a snap diagnosis as promptly and almost as accurately as a physician; and when once they suspect their presence, they will leave no stone unturned to secure an examination of the child by a competent physician, and the removal of the growths, if present. They consider it a waste of time to endeavor to teach a child weighted with this handicap. How keenly awake they are to their importance is typified by the remark of a prominent educator five or six years ago:—

"When I hear a teacher say that a child is stupid, my first instinctive conclusion is either that the child has adenoids, or that the teacher is incompetent."

The lion's share of their influence upon the child's intelligence is brought about in a somewhat unexpected and even surprising manner, and that is by the effects of the growths upon his hearing. You will recall that this third tonsil was situated at the highest point in the roof of the pharynx, or back of the throat. The first effect of its enlargement is naturally to block the posterior opening of the nostrils. But it has another most serious vantage-ground for harm in its peculiar position. Only about three-fourths of an inch below it upon either side open the mouths of the Eustachian tubes, the little funnels which carry air from the throat out into the drum-cavity of the ear. You have frequently had practical demonstrations of their existence, by the well-known sensation, when blowing your nose vigorously, of feeling something go "pop" in the ear. This sensation was simply due to a bubble of air being driven out through this tube from the back of the throat, under pressure brought to bear in blowing the nose. The luckless position of the third tonsil could hardly have been better planned if it had been devised for the special purpose of setting up trouble in the mouths of these Eustachian tubes.