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Throat Affections of the Nose

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Obstruction of the Nostrils and Dis charge from the Nose are extremely troublesome ailments in young children, be cause the nasal passages are so narrow that the slightest catarrhal swelling blocks them entirely. The child cannot breathe through the nostrils, and is restless and disturbed.

The nurse should always make certain that no foreign body is in the' nose, causing the swelling and discharge. The discharge should be regularly cleansed away by means of a very gentle stream of water containing soda and borax in solution. A large wine-glassful of water should contain a mere pinch of bicar bonate of soda and borate of soda (to he exact 10 grains of each) and the water should be warm. A syringe may be used to gently wash the nostrils out, or a fine spray may be em ployed.

When the acute stage has passed, an oily application is best, olive-oil or paroleine may be used containing 1 grain menthol and 1 grain camphor to each ounce, and this may be dropped into the nostrils by a dropper, or sprayed also by a fine spray.

Hypertrophy of the Lining Membrane of the Nose is a condition in which the lining of the nostrils is greatly thickened, and the fairway narrowed. The slightest cold or irritation of the nose blocks it completely, so that the child seems to be continually catching cold. It is in older children this condition develops, not in infants—at least in children after two years of age.

The children are restless, nervous, breathe noisily in sleep. They frequently stiffer from headache, and any little cold is apt to end in asthmatic or broncbitic attacks.

Such children breathe by the mouth, and have in consequence a facial expression suggest ing dulness and stupidity, going about as they do with open mouth and hanging lower lip. Hearing is very liable to be impaired.

The thickening in these cases is due to over growth of the kind of connective tissue which abounds in the deeper layers of the mucous membrane. This tissue is called adenoid tis sue (p. 277). Here and there in the mucous membrane of nose and throat, tongue, and else where, this tissue forms little clumps, and when the tissue has for any cause increased to excess, these clumps become prominent and cause the free surface of the mucous membrane to be thrown into little mounds. Such irregularities of the free surface of the lining membrane of nose and throat may vary greatly in size, from that of a tiny pin-head to that of a pea or a nut. They are called adenoid overgrowths, or adenoid vegetations, or, shortly, adenoids. Such little elevations of the surface may easily be seen on the back wall of the throat in lym phatic children, if the throat be examined in a good light. When they form considerable

masses in the space above the mouth, with which the back openings of the nostrils com municate—the naso-pharynx, as it is called,— they block the nostrils, and also the tube pass ing from the ear to the throat on each side, the eustachian tube. Deafness is a common result of such conditions in children. The space re ferred to may be seen in section in fig 101, p. 195. It is the continuation upward of the gullet between the lines b and w.

Any child who breathes persistently through the mouth, or is noisy in sleep, or goes about with hanging lip and open mouth, and is dull of hearing, should have the nose and the naso pharynx carefully examined, and no delay should be permitted in the removal of any growths present.

The operation is a very simple one in these days, devoid of danger when done by one who knows his work, and may be done•without pain to the child, either at the time or sub sequently, by the use of one of numerous anes thetic agents now available.

Inflammation (Quinsy) and Hyper trophy of Tonsils.—The tonsils are special clumps or masses of adenoid tissue, as above described, which readily take on overgrowth with repeated attacks of inflammation. Such overgrown tonsil masses should be removed. See p. 216.

Bleeding from the Nose may be controlled by the application, over the bridge of the nose, of sponges soaked in cold water. If it occurs frequently without known cause, let the child's health be inquired into. If it is a stout, evi dently full-blooded child, keep the bowels free, and let the diet be very simple. If, on the other hand, the child is delicate, it should have an iron tonic, like chemical food, and cod-liver oil, and plenty of nourishing food.

Discharge from the Ear, Earache. See p. 490.

Foreign Bodies in the Nose and Ears, If the body is in the nose, the child should be made to take a deep breath, then the free nostril is closed, and a strong effort to blow through the blocked nose will often suc ceed in dislodging the substance. (2) If the body is in the ear, syringing may be used if the body is not a pea or a substance Mat can suck up the water and swell. Pins, bodkins, &c., should be used with the utmost care, especially in the ear, where a slight thing will injure the delicate drum of the ear and destroy the power of hearing on that side. (3) If a child has swallowed a pin, a coin, or other foreign body, purgative medicines should not be given, nor much fluid food, but plenty of soft food, like porridge, rice, corn-flour, saps, he., which may surround the body and prevent it injuring the stomach or bowels. Plate VII. shows how useful an X-ray photograph may be in locating something swallowed.