( including Adenoids, Chronic Tonsilitis, Deviation of the Nasal Septum, Enlarged Turbinates, and Polypi ). Any obstruction in the nose causes mouth breathing and gives rise to one or more of a long train of unfortunate results. Among the disorders producing mouth breathing, enlargement of the glandular tissue in the back of the nose and in the throat of children is most important. Glandular growths in the upper part of the throat opposite the back of the nasal cavities are known as “adenoids”; they often completely block the air passage at this point, so that breathing through the nose becomes difficult. Associated with this condition we usually see enlargement of the tonsils, two projecting bodies, one on either side of the entrance to the throat at the back of the mouth. In healthy adult throats the tonsils should be hardly visible; in children they are active glands and easily visible.

We are unable to see adenoids because of their position, but can be reasonably sure of their presence in children where we find symptoms resulting from mouth breathing as described below. The surgeon assures himself positively of the existence of adenoids by inserting a finger into the mouth of the patient and hooking it up back of the roof of the mouth, when they may be felt as a soft mass filling the back of the nose passages.

Other less common causes of mouth breathing, seen in adults as well as children, are deviation of the nasal septum, swelling of the mucous membrane covering certain bones in the nose (turbinates), and polypi.

Deviation of the nasal septum means displacement of the partition dividing the two nostrils, so that more or less obstruction exists. This condition may be occasioned by blows on the nose received in the accidents common to childhood. The deformity which results leads in time to further obstruction in the nose, because when air is drawn in through the narrowed passages a certain degree of vacuum is produced and suction on the walls of the nose, as would occur if we drew in air from a large pair of bellows through a small thin rubber tube. This induces an overfilling of the blood vessels in the walls of the passages of the nose, and the continued congestion is followed by increased thickness of the lining mucous membrane, thus still further obstructing the entrance of air. A one sided nasal obstruction in a child with discharge from that side leads one to suspect that a foreign body, as a shoe button, has been put in by the child.

Polypi are small pear shaped growths which form on the membrane lining the nasal passages and sometimes completely block them. They resemble small grapes without skins.

These, then, are the usual causes of mouth breathing, but of most importance, on account of their frequency and bearing on the health and development, are adenoids and enlarged throat tonsils in children. Adenoids and enlarged tonsils are often due to inflammation of these glands during the course of the contagious eruptive disorders, as scarlet fever, measles, or diphtheria; probably, also, to constant exposure to a germ laden atmosphere, as in the case of children herded together in tenements.

Symptoms. The mouth breathing is more noticeable during sleep; snoring is common, and the breathing is of a snorting character with prolonged pauses. Children suffering from enlarged tonsils and adenoids are often backward in their studies, look dull, stupid, and even idiotic, and are often cross and sullen; the mouth remains open, and the lower lip is rolled down and prominent; the nose has a pinched aspect, and the roof of the mouth is high. Air drawn into the lungs should be first warmed and moistened by passing through the nose, but when inspired through the mouth, produces so much irritation of the throat and air passages that constant “colds,” chronic catarrh of the throat, laryngitis, and bronchitis ensue.

The constant irritation of the throat occurring in mouth breathers weakens the natural resistance against such diseases as acute tonsilitis, scarlet fever, and diphtheria, so that they are especially subject to these diseases. But these are not the only ailments to which the mouth breather is liable, for earache and deafness naturally follow the catarrh, owing to obstruction of the Eustachian tubes (see Earache, p. 40, and Deafness, p. 38). Deformity of the chest is another result of obstruction to nose breathing, the common form being the “pigeon breast,” where the breastbone is unduly prominent. The voice is altered so that the patient, as the saying goes, “talks through the nose,” although, in reality, nasal resonance is reduced and difficulty is experienced in pronouncing N and M correctly, while stuttering is not uncommon. Nasal obstruction leads to poor nutrition, and hence children with adenoids and enlarged tonsils are apt to be puny and weakly specimens.

Treatment. The treatment is purely surgical in all cases of nasal obstruction: removal of the adenoid growths, enlarged tonsils, and polypi, straightening the displaced nasal septum, and burning the thickened mucous lining obstructing the air passages in the nose. None of the operations are dangerous if skillfully performed, and should be generally done, even in the case of delicate children, as the very means of overcoming this delicacy. The after treatment is not unimportant, consisting in the use of simple generous diet, as plenty of milk, bread and butter, green vegetables and fresh meat, and the avoidance of pastries, sweets, fried food, pork, salt fish and salt meats, also the roots, as parsnips, turnips, carrots and beets, and tea and coffee. Life in the open air, emulsion of cod liver oil, daily sponging with cold water while the patient stands in warm water, followed by vigorous rubbing, will all assist the return to health.