Objectively considered, the symptoms of post-nasal adenoid growths are most characteristic. The significant clinical signs are the dull, heavy, and stupid facial expression of the patient, the pinched nose or indrawn the de pressed inner canthi, the elevated brow, the corrugated skin of the fore head; the distorted or deformed thorax, or what is called "pigeon-breast"; the apparent mental deficiency, the decidedly affected speech, the impaired or retarded general physical development of the pa tient, etc.
Voluminous adenoids are commonly found in cases of scoliosis, and it is likely they are related as cause and effect, especially as removal of them early suffices of itself to bring about cure of the condition. ln the most seri ous cases removal of the adenoids should precede orthopdic measures where the latter are necessary to supplement the former. The deformity known as hour glass thorax is due to trophic disturb ances from microbe-infeetions gaining access by way of the adenoids. Finally, the coincidence of certain forms of tuber culosis with adenoids regarded as due to the germs gaining access through the adenoids. Their early removal would obviate such infection. Bilhaut (Bull. MM., June 26, '98).
Adenoids as an etiological factor in orthopdic deformities. Granted that adenoids have some connection with orthopredie deformities, what can that connection be? 1. Both adenoids and de formities might he an expression of de generacy. 2. Deformities might occur as a direct result of mechanical obstruc tion to breathing. 3. Orthopzedic de formities oceur in tubercular joint dis ease, which may have had their source of infection either directly or indirectly from adenoid vegetations. 4. Deformity may result directly from reflex irritation of the neighboring nerves by adenoid grom ths. 5. Lastly, and most important, adenoids may cause such a lowering of the general nervous vitality that they may be considered almost the direct cause of some of the atypieal orthopxdic deformities whose etiology is unknown. F. S. Coolidge (Medicine, July, '98).
Anmstliesia of the soft palate and the pharynx is sometimes a noticeable feature of mouth-breathers. Such patients usu ally are easily managed and offer but slight resistance when operating on the throat or naso-pharynx. Cleft-palate pa tients usually have hyperplasia of the lymphoid tissue at the vault.
The velum palati sometimes suffers markedly. It sometimes becomes thick ened as a result of follicular glandular swelling or from cedema, occasioned by constant mouth-breathing, and local irri tation of the parts. -When such a state
of the palate prevails, free movements of the organ are impeded and the voice as sumes a weak, dull, monotonous tone which may continue to be present even after the naso-pharynx has been freed. In fact, paresis of the palate is thus pro duced, dependent evidently upon the chronic congestion of the palatine glands and muscular tissue. Inflammation of the lymphatic glands in the neck is some times witnessed.
On examination of the throat and naso pharynx the mucous membrane of the lances may be found swelled, the uvula n t snit., and the faucial tonsils I I. 1 lit.‘ naso-pli.tryngeal cavity t. a :„.,ret.1111-11 MUCUS, t011gh and d t rtinoNL, hich zit the same t 1,.q. n 11111 i10\111 illC posterior wall f the ',hail nx. Sometimes the secretion rin:ains and becomes offensive ow ing to &composition. In adults post nasal at.Lninulations are apt to take place and bt.a.nn. dry during the night, which in the morning creates nausea and hawk ing.
Nutrition of the patient is ahnost al ways more or les.s disturbed. The child bcconics atlantic. The percentage of hamoglobin is materially reduced, some times to 35 per cent. The red cells diminish very much in number.
That infectious diseases, such as scarlet fever and diphtheria, become more viru lent and dangerous when post-nasal lym phoid tissue exists is not to be doubted. Adenoid tissue seems to furnish an in viting soil for the development of bac terial life, and it is also endowed with the power of absorbing infectious matter.
Diagnosis.—The diagnosis is quite easy when the general aspect of the patient is taken into consideration. The clinical picture of adenoid vegetations in the ma jcrity of cases is significant.
Conditions which may simulate ade noid diseases by causing mouth-breath ing are any obstruction in the upper assages above the uvula; devia tion.s, spurs, and ridges of the septum; eakness and falling of the alaz; ca tarrhal secretion which children neg lect to blow out, and which adheres to, and stops, up, the nose; chronic eczema of the anterior nares, with formation of crusts, which block the nostrils. It is not very common to find the openings if the nostrils too small. The specific snuffle,: of infants may siniulate adenoid John A. Farlow (Boston Med. and Surg. Jour., Apr. 21, '9S).