Preventable Diseases

by Woods Hutchinson

Take care of the nose, and the jaws will take care of themselves. An ounce of adenoids-removal in the young child is worth a pound of orthodontia—teeth-straightening—in the boy or girl; though both are often necessary.

The dull, dead tone of the voice in these children is, of course, an obvious effect of the blocked nostrils. Similarly, the broken sleep, with dreams of suffocation and of "Things Sitting on the Chest," are readily explained by the desperate efforts that the little one makes to breathe through clogging nostrils, in which the discharges, blown and sneezed out in the daytime, dry and accumulate during sleep, until, half-suffocated, it "lets go" and draws in huge gulps of air through the open mouth. No child ever became a mouth-breather from choice, or until after a prolonged struggle to continue breathing through its nose.

This brings us to the question, What are these adenoids, and how do they come to produce such serious disturbances? This can be partially answered by saying that they are tonsils and with all a tonsil's susceptibility to irritation and inflammation. But that only raises the further question, What is a tonsil? And to that no answer can be given but Echo's. They are one of the conundrums of physiology. All we know of them is that they are not true glands, as they have neither duct nor secretion, but masses of simple embryonic tissue called lymphoid, which has a habit of grouping itself about the openings of disused canals. This is what accounts for their position in the throat, as they have no known useful function. The two largest, or throat-tonsils, surround the inner openings of the second gill-slits of the embryo; the lingual tonsil, at the base of the tongue below, encircles the mouth of the duct of the thyroid gland (the goitre gland); and our own particular Pandora's Box above, in the roof of the pharynx, is grouped about the opening of another disused canal, which performs the singular and apparently most uncalled-for office of connecting the cavity of the brain with the throat. They can all of them be removed completely without any injury to the general health, and they all tend to shrink and become smaller—in the case of the topmost, or pharyngeal, almost disappear—after the twelfth or fourteenth year.

Not only have they an abundant crop of troubles of their own, as most of us can testify from painful experience, but they serve as a port of entry for the germs of many serious diseases, such as tuberculosis, rheumatism, diphtheria, and possibly scarlet fever. They appear to be a strange sort of survival or remnant,—not even suitable for the bargain-counter,—a hereditary leisure class in the modern democracy of the body, a fertile soil for all sorts of trouble.

Here, then, we have this little bunch of idle tissue, about the size of a small hazelnut, ready for any mischief which our Satan-bacilli may find for its hands to do. A child kept in a badly ventilated room inhales into his nostrils irritating dust or gases, or, more commonly yet, the floating germs of some one or more of those dozen mild infections which we term "a common cold." Instantly irritation and swelling are set up in the exquisitely elastic tissues of the nostrils, thick, sticky mucous, instead of the normal watery secretion, is poured out, the child begins to sneeze and snuffle and "run at the nose," and either the bacteria are carried directly to this danger sponge, right at the back of the nostrils, or the inflammation gradually spreads to it. The mucous membrane and tissues of the nose have an abundance of vitality,—like most hard workers,—and usually react, overwhelm, and destroy the invading germs, and recover from the attack; but the useless and half-dead tissue of the pharyngeal tonsil has much less power of recuperation, and it smoulders and inflames, though ultimately, perhaps, it may swing round to recovery. Often, however, a new cold will be caught before this has fully occurred, and then another one a month or so later, until finally we get a chronically thickened, inflamed, and enlarged condition of this interesting, but troublesome, body. What its capabilities are in this respect may be gathered from the fact that, while normally of the size of a small hazelnut, it is no uncommon thing to find a mass which absolutely blocks up the whole of the upper part of the pharynx, and may vary from the size of a robin's egg to that of a large English walnut, or even a small hen's egg, according to the age of the child and the size of the throat.

Dirt has been defined as "matter out of place," and the pharyngeal tonsil is an excellent illustration. Nature is said never to make mistakes, but she is apt to be absent-minded at times, and we are tracing now not a few of the troubles that our flesh is heir to, to little oversights of hers—scraps of inflammable material left lying about among the cogs of the body-machine, such as the appendix, the gall-bladder, the wisdom teeth, and the tonsils. One day a spark drops on them, or they get too near a bearing or a "hot-box," and, in a flash, the whole machine is in a blaze.

Never neglect snuffles or "cold in the head" in a young child, and particularly in a baby. Have it treated at once antiseptically, by competent hands, and learn exactly what to do for it on the appearance of the earliest symptoms in the future, and you will not only save the little ones a great deal of temporary discomfort and distress,—for it is perfect torment to a child to breathe through its mouth at first,—but you will ward off many of the most serious troubles of infancy and childhood. We can hardly expect to prevent all development of adenoids by these prompt and painless stitches in time, for some children seem to be born peculiarly subject to them, either from the inheritance of a particular shape of nose and throat,—"the family nose," as it has been called,—or from some peculiar sponginess and liability to inflammation and enlargement of all these tonsilar or lymphoid "glands" and "kernels" of the body generally—the old "lymphatic temperament."

We are, however, now coming to the opinion that this so-called "hereditary" narrow nose, short upper lip, and high-arched palate are, in a large percentage of cases, the result of adenoids in infancy in each successive generation of parents and grandparents. At all events, there are now on record cases of children whose parents, grandparents, and great-grandparents are known to have been mouth-breathers, and who have on that account been sharply watched for the possible development of adenoids in early life, and these removed as soon as they appeared, and they have grown up with well-developed, wide nostrils, broad, flat palates, and regular teeth, overcoming "hereditary defect" in a single generation.

Curiously enough, their origin and ancestral relations may have an important practical bearing, even in the twentieth century. At the upper end of this curious throat-brain canal lies another mass, the so-called pituitary body. This has been found to exert a profound influence over development and growth. Its enlargement is attended by giantism and another curious giant disease in which the hands, feet, and jaws enlarge enormously, known as acromegaly. It also pours into the blood a secretion which has a powerful effect upon both the circulation and the respiration. It is found shrunken and wasted in dwarfs. Some years ago it was suggested by my distinguished friend, the late Dr. Harrison Allen, and myself, that some of the extraordinary dwarfing and growth-retarding effects of adenoids might be due to a reflex influence exerted on their old colleague, the pituitary body. This view has found its way into several of the textbooks. Blood is thicker than water, and old ancestral vibrations will sometimes be set up in most unexpected places.

Now comes the cheerful side of the picture. I should have hesitated to draw at such full length and in such lugubrious detail the direful possibilities and injurious effects of adenoids if its only result could have been to arouse apprehensions which could not be relieved.