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ADENOIDS AND TONSILS.
1284
place being found for
several classes of foods, each having a distinct and separate food value, and each prompting the gastric functions to maintain an all-round digestive capacity. But the source of protein need not always be mutton, nor the source of carbohydrate potatoes, for then the pyscho-logical factor ceases to serve, and monotony produces a true physiological revolt. Some people complain that the cycle of meat foods is a very small one, and so it is, especially with the working classes, whose choice is restricted to beef and mutton and pork. The art of cookery can, however, do much to relieve the boredom of diet, and on every ground more attention should be given to it.
adenoids come under notice.
ADENOIDS AND TONSILS. IT would be difficult to mention a surgical operation more benefit when efficiently performed in suitable It cases than that for the removal of adenoids and tonsils. would be equally difficult to mention one more often performed with little ceremony and with results by no means coming up to what is expected of it. This opinion has been held for some years by many men of experience and authority in the profession. The treatment of enlarged tonsils and adenoids, and of the conditions to which they give rise, has been frequently under discussion during recent years. At the Sheffield meeting of the British Medical Association in 1908 the Section of Laryngology, Otology, and Rhinology discussed this matter, and the sense of the meeting was to the effect that the benefits which it was predicted would result from the removal of adenoids in individual cases were far from being generally obtained. Some speakers attributed this failure to the operations being insufficient. Last year, when the Association met in London, the removal of the tonsils was again discussed, and one speaker stated that in a certain throat department a black list was kept of hospitals where tonsils had been removed and the patients had come for treatment owing to recurrent symptoms ; the list, it was stated, was impartial and nearly every throat department in London was represented. In reply it was objected that such statistics of unsatisfactory results were of little value, because they were drawn from hospital out-patient practice, and everyone knew that in most clinics the out-patient department was so overworked and the skilled assistance so insufficient that few senior members of the staffs viewed the results with complacency. At the recent meeting of the British Medical Association at Birmingham a discussion on the treatment of chronic adhesive processes in the middle ear occasioned some appropriate remarks bearing on this matter. One speaker said that in reading the reports upon school children he had been struck by the proportion of cases in which the diagnosis of enlarged tonsils had been made without any mention of adenoids. The natural inference was that the tonsils had been removed by the practitioner, and that the more imhad been left, which was greatly portant factor, the to be regretted from the point of view of prophylaxis. From the proceedings of the Section of Laryngology of the Royal Society of Medicine it is evident that, far from the operation being at times insufficiently extensive, too much zeal, on the contrary, has been displayed. Cases have been brought under observation presenting bands of adhesion between the The question arises Eustachian tube and the pharynx. whether they are due to disease or to traumatism. It was pointed out that a little less operative zeal in those corners might prevent a few of those cases.2 At times cases of malformation of the soft palate and uvula resulting from the removal of tonsils and the attempted removal of the
productive of
adenoids,
1 THE LANCET. August 12th, 1911, p. 418. Section of Laryngology, Royal Society of Medicine, Jan. 7th, 1910, 69.
2
p.
li
However simple the operation may appear to be, accidents may arise even in the hands of the experienced, but it would be as well for all of us to realise that the operation is by no means so simple as it looks. The lack of ceremony previously referred to has apparently attracted the attention of the laity. A lay contributor to the British Journal of Nursing for Sept. 23rd last, in an article on the after-care of operations on outpatients, criticises warmly the way in which children recently operated upon for adenoids and tonsils find their way, still bleeding, into public conveyances, with nothing better to mop the blood trickling from the nose than a very grimy kerchief. Many doubtless have witnessed this sight and its occurrence cannot be ignored. The author concludes her article with a practical suggestion which is doubtless already practised in some of the special hospitals. This suggestion is that "before out-patients leave the hospital after operations for the removal of tonsils or adenoids a sterilised gauze dressing shall be applied over the nose and mouth, and a regulation packet of sterilised dressings shall be provided for each patient’s use." It is added that these dressings might take the form of squares of gauze for keeping clean the month and nose until convalescence, and that these precautions should be extended to operations on the ear. However skilfully the operation may be performed good results are jeopardised by the lack of attention to the after-care, though everyone knows how difficult it is to have the instructions for aftercare carried out even when they are handed to the patient in print. Failure in realising at times the results predicted must be attributed partly to practitioners promising too much, and partly to its not being generally recognised that in cases of long standing the evils that adenoids and tonsils do live after them. It would be well if it were more commonly recognised that the satisfactory removal of adenoids and tonsils calls for genuine skill, and that a nicety of judgment must decide as to whether they should be interfered with or left alone.
MEASLES AND
VENTILATION ON BOARD SHIP.
A PAPER on The Ventilation of Emigrant Ships,"by Dr. P. H. Bryce, chief medical officer of the Dapartment of the Interior in Canada, appears in the Journal oj’ the American Public Health Association, for September. He there tells a story which shows how generalised an infection may become when once it is introduced into a community very closely packed together and without adequate ventilation. An emigrant ship left Rotterdam on June 13th for Canada. At that busy time of year she probably carried passengers nearly to the limit of her statutory capacity. On June 14th, the day after sailing, a child developed measles, and was immediately isolated with the whole of its family, but in the short interval it had done all the mischief it could. In the same compartment with it were 51 families, 279 persons in all, and amongst them the second case appeared on the thirteenth day, June 26th, which was the day of arrival in Canada. Twentyone more cases were recognised the same day before the ship arrived at quarantine, and another dozen were seen before 9 P.M. that night. In all 71 cases developed, and from that single case Dr. Bryce tells us "every non-immune person [in that compartment] was infected within the short space of twenty-four hours." Fifteen families wholly escaped, but their members were either grown up or protected by previous attacks. The cubic space available for each person was probably the same as in English emigrant ships, 105 cubic feet on a deck 7 feet high, and if we may suppose, as is not unlikely, that this ship was no better "
3 See Section of
1910, p. 131.
Laryngology, Roy al Society
of Me dicine,
April 1st,
place being found for
several classes of foods, each having a distinct and separate food value, and each prompting the gastric functions to maintain an all-round digestive capacity. But the source of protein need not always be mutton, nor the source of carbohydrate potatoes, for then the pyscho-logical factor ceases to serve, and monotony produces a true physiological revolt. Some people complain that the cycle of meat foods is a very small one, and so it is, especially with the working classes, whose choice is restricted to beef and mutton and pork. The art of cookery can, however, do much to relieve the boredom of diet, and on every ground more attention should be given to it.
adenoids come under notice.
ADENOIDS AND TONSILS. IT would be difficult to mention a surgical operation more benefit when efficiently performed in suitable It cases than that for the removal of adenoids and tonsils. would be equally difficult to mention one more often performed with little ceremony and with results by no means coming up to what is expected of it. This opinion has been held for some years by many men of experience and authority in the profession. The treatment of enlarged tonsils and adenoids, and of the conditions to which they give rise, has been frequently under discussion during recent years. At the Sheffield meeting of the British Medical Association in 1908 the Section of Laryngology, Otology, and Rhinology discussed this matter, and the sense of the meeting was to the effect that the benefits which it was predicted would result from the removal of adenoids in individual cases were far from being generally obtained. Some speakers attributed this failure to the operations being insufficient. Last year, when the Association met in London, the removal of the tonsils was again discussed, and one speaker stated that in a certain throat department a black list was kept of hospitals where tonsils had been removed and the patients had come for treatment owing to recurrent symptoms ; the list, it was stated, was impartial and nearly every throat department in London was represented. In reply it was objected that such statistics of unsatisfactory results were of little value, because they were drawn from hospital out-patient practice, and everyone knew that in most clinics the out-patient department was so overworked and the skilled assistance so insufficient that few senior members of the staffs viewed the results with complacency. At the recent meeting of the British Medical Association at Birmingham a discussion on the treatment of chronic adhesive processes in the middle ear occasioned some appropriate remarks bearing on this matter. One speaker said that in reading the reports upon school children he had been struck by the proportion of cases in which the diagnosis of enlarged tonsils had been made without any mention of adenoids. The natural inference was that the tonsils had been removed by the practitioner, and that the more imhad been left, which was greatly portant factor, the to be regretted from the point of view of prophylaxis. From the proceedings of the Section of Laryngology of the Royal Society of Medicine it is evident that, far from the operation being at times insufficiently extensive, too much zeal, on the contrary, has been displayed. Cases have been brought under observation presenting bands of adhesion between the The question arises Eustachian tube and the pharynx. whether they are due to disease or to traumatism. It was pointed out that a little less operative zeal in those corners might prevent a few of those cases.2 At times cases of malformation of the soft palate and uvula resulting from the removal of tonsils and the attempted removal of the
productive of
adenoids,
1 THE LANCET. August 12th, 1911, p. 418. Section of Laryngology, Royal Society of Medicine, Jan. 7th, 1910, 69.
2
p.
li
However simple the operation may appear to be, accidents may arise even in the hands of the experienced, but it would be as well for all of us to realise that the operation is by no means so simple as it looks. The lack of ceremony previously referred to has apparently attracted the attention of the laity. A lay contributor to the British Journal of Nursing for Sept. 23rd last, in an article on the after-care of operations on outpatients, criticises warmly the way in which children recently operated upon for adenoids and tonsils find their way, still bleeding, into public conveyances, with nothing better to mop the blood trickling from the nose than a very grimy kerchief. Many doubtless have witnessed this sight and its occurrence cannot be ignored. The author concludes her article with a practical suggestion which is doubtless already practised in some of the special hospitals. This suggestion is that "before out-patients leave the hospital after operations for the removal of tonsils or adenoids a sterilised gauze dressing shall be applied over the nose and mouth, and a regulation packet of sterilised dressings shall be provided for each patient’s use." It is added that these dressings might take the form of squares of gauze for keeping clean the month and nose until convalescence, and that these precautions should be extended to operations on the ear. However skilfully the operation may be performed good results are jeopardised by the lack of attention to the after-care, though everyone knows how difficult it is to have the instructions for aftercare carried out even when they are handed to the patient in print. Failure in realising at times the results predicted must be attributed partly to practitioners promising too much, and partly to its not being generally recognised that in cases of long standing the evils that adenoids and tonsils do live after them. It would be well if it were more commonly recognised that the satisfactory removal of adenoids and tonsils calls for genuine skill, and that a nicety of judgment must decide as to whether they should be interfered with or left alone.
MEASLES AND
VENTILATION ON BOARD SHIP.
A PAPER on The Ventilation of Emigrant Ships,"by Dr. P. H. Bryce, chief medical officer of the Dapartment of the Interior in Canada, appears in the Journal oj’ the American Public Health Association, for September. He there tells a story which shows how generalised an infection may become when once it is introduced into a community very closely packed together and without adequate ventilation. An emigrant ship left Rotterdam on June 13th for Canada. At that busy time of year she probably carried passengers nearly to the limit of her statutory capacity. On June 14th, the day after sailing, a child developed measles, and was immediately isolated with the whole of its family, but in the short interval it had done all the mischief it could. In the same compartment with it were 51 families, 279 persons in all, and amongst them the second case appeared on the thirteenth day, June 26th, which was the day of arrival in Canada. Twentyone more cases were recognised the same day before the ship arrived at quarantine, and another dozen were seen before 9 P.M. that night. In all 71 cases developed, and from that single case Dr. Bryce tells us "every non-immune person [in that compartment] was infected within the short space of twenty-four hours." Fifteen families wholly escaped, but their members were either grown up or protected by previous attacks. The cubic space available for each person was probably the same as in English emigrant ships, 105 cubic feet on a deck 7 feet high, and if we may suppose, as is not unlikely, that this ship was no better "
3 See Section of
1910, p. 131.
Laryngology, Roy al Society
of Me dicine,
April 1st,