ADENOIDS.
Notwithstanding their tendency to wither or atrophy as the child grows older, the presence of these hypertrophied masses of lymphoid tissue should be regarded as an indication for surgical since, by waiting, incurable deafness, post-nasal catarrh, chest deformity, and alteration of the normal voice may supervene, although some authorities consider that operation is too frequently resorted to. Doubt less many of the cases which show symptoms during the first three months of life are due to syphilis and will yield speedily to mercurials. Ilyper trophy of the Inferior Turbinals should he looked for in adenoid cases. Owing to blockage of the flares from this cause, removal of the adenoids alone may fail to afford relief. If necessary the turbinals must also be dealt with by electro-cautery or reduction.
The choice of an anaesthetic is of primary importance; Chloride of Ethyl is sometimes used. Chloroform in the hands of a skilful anaesthetist or the A.C.E. mixture is perhaps the most convenient and safe agent if only a moderate degree of anaesthesia be induced. Where the tonsils do not require removal, gas with oxygen is admissible. Many operators prefer to dispense with general anaesthesia and rely upon Cocaine, or large doses of Bromides given for several days before the operation so as to induce of the pharynx, and some prefer to operate without any form of narcosis being induced.
The patient's head should be made to project just beyond the edge of the operating-table, so that on depressing the forehead the blood may flow into the buccal cavity and out through the angle of the mouth.
Anaesthesia being produced, short of not quite abolishing the palatal reflex, and a gag having been introduced between the teeth, the operator's left forefinger is passed into the naso-pharynx, its palmar surface being kept upwards and the soft palate hooked forwards by it. Some form of curette, such as Gottstein's, is then introduced, which enables the operator to sweep the roof of the cavity. The operation may be completed by Meyer's ring knife, which removes all abnormal tissue in proximity to the entrances of the Eustachian tubes. Some operators still rely upon the use of the sterilised finger-nail for the removal of remnants. After the complete removal of the lymphoid tissue, as ascertained by the finger-tip, the tonsils should be next excised when these are markedly enlarged. The less swabbing and syringing the better, the after-treatment of the case being left to nature unless when excessive haemorrhage should occur, which may be arrested by the local application of Adrenalin or Coagulen.
Breathing exercises should be afterwards systematically carried out so as to cause full expansion of the thoracic walls by taking deep inspira tions through the nostrils with the mouth closed, assisted by pressure upon the lower ribs in the expiratory effort. This after-treatment is of vital importance.
During convalescence removal to the seaside with a course of open-air life and Syrup of Iodide of Iron is beneficial.