MOUTH BREATHING
If the physical condition of school children is our best index to
community health, who is to read the index? Unless the story is told in
a language that does not require a secret code or cipher, unless some
one besides the physician can read it, we shall be a very long time
learning the health needs of even our largest cities, and until
doomsday learning the health needs of small towns and rural districts.
Fortunately the more important signs can be easily read by the average
parent or teacher. Fortunately, too, it is easy to persuade mothers and
teachers that they can lighten their own labors, add to their
efficiency, and help their children by being on the watch for mouth
breathing, for strained, crossed, or inflamed eyes, for decaying teeth,
for nervousness and sluggishness. Years ago, when I taught school in a
Minnesota village, I had never heard of adenoids, hypertrophied
tonsils, myopia, hypermetropia, or the relation of these defects and of
neglected teeth to malnutrition, truancy, sickness, and dullness. I now
see how I could have saved myself several failures, the taxpayers a
great deal of money, the parents a great deal of disappointment, and
many children a life of inefficiency, had I known what it is easy for
all teachers and parents to learn to-day.
[Illustration: MOUTH BREATHERS BEFORE "ADENOID PARTY"]
The features in the following cut are familiar to teachers the world
over. Parents may reconcile themselves to such lips, eyes, and mouths,
but seldom do even neglectful parents fail to notice "mouth breathing."
Children afflicted by such features suffer torment from playfellows
whose scornful epithets are echoed by the looking-glass. No fashion
plate ever portrays such faces. No athlete, thinker, or hero looks out
from printed page with such clouded, listless eyes. The more wonder,
therefore, that the meaning of these outward signs has not been
appreciated and their causes removed; conclusive reason, also, for not
being misled by recent talk of mouth breathing, adenoids, and enlarged
tonsils, into the belief that the race is physically deteriorating.
Three generations ago Charles Dickens in his _Uncommercial Traveller_
pointed out a relation between open mouths and backwardness and
delinquency that would have saved millions of dollars and millions of
life failures had the civilized world listened. He was speaking of
delinquent girls from seventeen to twenty years old in Wapping
Workhouse: "I have never yet ascertained why a refractory habit should
affect the tonsils and the uvula; but I have always observed that
refractories of both sexes and every grade, between a Ragged School and
the Old Bailey, have one voice, in which the tonsils and uvula gain a
diseased ascendency."
To-day we are just beginning to see over again the connection between
inability to breathe through the nose and inability to see clearly
right from wrong and inability to want to do what teachers and parents
wish. Physical examinations show now, and might just as well have shown
fifty years ago, that the great majority of truants and juvenile
offenders have adenoids and enlarged tonsils. A recent examination made
by the New York board of health on 150 children in one school made up
from the truant school, the juvenile court, and Randall's Island,
showed that only three were without some physical defect and that 137
had adenoids and large tonsils. Dickens wrote his observations in 1860;
in 1854 the New York Juvenile Asylum was started, and up to 1908 cared
for 40,000 children; in 1860 William Meyer pointed out, so that no one
need misunderstand, the harmful effects of adenoids. What would have
been the story of juvenile waywardness, of sickness, of educational
advancement, had examinations for defective breathing been started in
1853 or 1860 instead of 1905; if one per cent of the attention that has
been given to teaching mouth breathers the ten commandments had been
spent on removing the nasal obstructions to intelligence?
[Illustration: A "DEGENERATE" MADE NORMAL BY REMOVAL OF
ADENOIDS]
William Hegel, who is pictured on page 48, before his tonsils and
adenoids were removed was described by his father in this way: "When
playing with other boys on the street he seems dazed, and sluggish to
grasp the various situations occurring in the course of the game. When
he decides to do something he runs in a heedless, senseless way, as if
running away,--will bump against something, pedestrian or building,
before he comes to himself; seems dazed all the time. When told
something by his mother he giggles in the most exasperating way, for
which he receives a whipping quite often." The father said the whipping
was of no avail. The child was restless, talkative, and snored during
sleep. He had an insatiable appetite. He was removed or transferred
from five different schools in New York City. To get redress the father
took him to the board of education, whence he was referred to the
assistant chief medical inspector of the department of health, whose
examination revealed immensely large fungous-looking tonsils and
excessive pharyngeal granulations (adenoids). He was operated on at a
clinic. The tonsils and adenoids removed are pictured on the opposite
page, reduced one third. After the operation the child was visited by
the assistant medical inspector. There was a marked improvement in his
facial expression,--he looked intelligent, was alert and interested.
When asked how he felt, he answered, "I feel fine now." It required
about fifteen minutes to get his history, during all of which time he
was responsive and interested, constantly correcting statements of his
father and volunteering other information. Eleven days after the
operation he was reported to have had no more epileptic seizures.
"Doesn't talk in sleep. Doesn't snore. Doesn't toss about the bed. Has
more self-control. Tries to read the paper. His immoderate appetite is
not present."
[Illustration: REASON ENOUGH FOR MOUTH BREATHING
Adenoid and tonsils reduced one third]
While the open mouth is a sure sign of defects of breathing, it is not
true that the closed mouth, when awake and with other people, is proof
that there are no such defects. Children breathe through the mouth not
because they like to, not because they have drifted into bad habits,
not because their parents did, not because the human race is
deteriorating, but because their noses are stopped up,--because they
must. A mouth breather is not only always taking unfiltered dirt germs
into his system but is always in the condition of a person who has
slept in a stuffy room. What extra effort adenoids mean can be
ascertained by closing the nostrils for a forenoon.
For many reasons it is perhaps unfortunate that we can breathe at all
when the nose is stopped up. If we could see with our ears as well as
with our eyes, we should probably not take as good care of our eyes. In
this respect the whole race has experienced the misfortune of the man
of whom the coroner reported, "Killed by falling too short a distance."
Because we can breathe through the mouth we have neglected for
centuries the nasal passages. When a cold stops the nose we necessarily
breathe through the mouth. Unfortunately children make the necessary
effort required to breathe through the nose long before other people
notice the lines along the nose and the slow mind. Mouth breathing will
show with the child asleep, before the child awake loses power to
accommodate his effort to the task. Therefore the importance of a
physical test at school to detect the beginnings of adenoids and large
tonsils before these symptoms become obvious to others.
No child should be exempted from this examination because of apocryphal
theories that only the poor, the slum child, the refractory, or the
unclean have defects in breathing. This very afternoon a friend has
told me of her year abroad with a girl of nine, whose parents are very
wealthy. The girl is anæmic. Her backwardness humiliates her parents,
especially because she gave great promise until two years ago.
High-priced physicians have prescribed for her. It happens that they
are too eminent to give attention to such simple troubles as adenoids
that can be felt and seen. They are looking for complications of the
liver or inflammation of muscles at the base of the brain. One
celebrated French savant found the adenoids, assured the mother that
the child would outgrow them, and advised merely that she be compelled
to breathe through the nose. The mother and nursemaids nag the child
all day. The poor unwise mother sits up nights to hold the child's jaws
tight in the hope that air coming through the nose will absorb the
adenoids. The mother is made nervous. Of course this makes the child
more nervous and adds to the evil effects of adenoids. If the mother
had the good fortune to be very poor, she could not sit up nights, and
would long ago have decided either to let the child alone or else to
have the trouble removed.
Adenoids are not a city specialty. Country earache is largely due to
adenoids or to inflammation that quickly leads to adenoids. In 415
villages of New York state twelve per cent were found to be mouth
breathers. For two summers I have known a lad named Fred. He lives at
the seashore. Throughout his twelve years he has lived in a veritable
El Dorado of health and nature beauty. Groves and dunes and flora vie
with the blues of ocean and sky in resting the eye and in filling the
soul with that harmony which is said to make for sound living. Yet to a
child, Fred's schoolmates are experts on patent medicines and on the
heredity that is alleged to be responsible for bad temper, running
sores, tuberculosis, anæmia, and weak eyes. Freddie is particularly
favored. His well-to-do parents have supplied him with ponies, games,
and bicycles. Nothing prevents his breathing salt air fresh from the
north pole but hermetically sealed windows. The father thinks it absurd
to make a fuss over adenoids. Didn't he have them when a boy, and
doesn't he weigh two hundred pounds and "make good money"? The mother
never knew of operations for such trifles when she taught school; she
supposes her boy needs an operation, but "just can't bear to see the
dear child hurt." As for Fred, he breathes through his mouth, talks
through his nose, grows indifferent to boy's fun, fails to earn
promotion at school, and fears that "I won't be strong in spite of all
the patent medicine I've taken." Father, mother, and Fred feel profound
pity for the city child living so far from nature.
Adenoids are not monopolized by children whose parents are ignorant of
the importance of them and of physical examination. Last summer I was
asked by a small boy to buy some chocolate. A glance at his cigar box
with its two or three uninviting things for sale showed that the boy
was really begging. He had thick lips, open mouth, "misty" eyes, and a
nasal twang. I asked him if his teacher had not told him he had lumps
back of his nose and could not breathe right. He said, "No." I
explained then that he could make a great deal more money if he talked
like other boys, stepped livelier, and breathed as other people
breathe. He said he had "been by a doctor onct but didn't want to be
op'rated." I turned to my companion and asked, "Have you never noted
those same lines on your boy's face?" Although he had been lecturing on
mouth breathers, he had never noticed his own boy's trouble. He
hastened home and found the infallible signs. The mother declared it
could not be true of her boy. About five months before, their family
physician had said of the child's earache, "The same inflammation of
the nasal passages that causes earache causes adenoids; you must be on
the lookout." Although in the country, the boy's appetite was not good
and his zest for play had flagged. They had looked for the trouble to
back generations and in psychology books,--everywhere but at the boy's
face, in his mouth, and in his nose. After the operation, which took
less than two minutes, the appetite was ravenous, the eyes cleared,
and the spirit rebounded to its old buoyancy that craved worlds to
conquer.
The new personal experience made a deep impression upon my friend's
mind. He wanted everybody to know how easy it was to overlook a child's
distress. One person after another had a story to tell him; even the
janitor said: "You'd ought to have seen our John at sixteen. He spent a
week by the hospital." The only people who do not seem to know more
than the new convert are the mouth breathers whom he religiously stops
on the street.
The indexes to adenoids and large tonsils for the teacher to read at
school are:
1. Inability to breathe through the nose.
2. A chronically running nose, accompanied by frequent nose-bleeds
and a cough to clear the throat.
3. Stuffy speech and delayed learning to talk. "Common" is
pronounced "cobbéd"; "nose," "dose"; and "song," "sogg."
4. A narrow upper jaw and irregular crowding of the teeth.
5. Deafness.
6. Chorea or nervousness.
7. Inflamed eyes and conjunctivitis.
The adenoids and large tonsils discovered at school are an index:
1. To children needlessly handicapped in school work.
2. To teachers needlessly burdened.
3. To whole classes held back by afflicted children.
4. To breeding grounds for disease.
5. To homes where children's diseases and tuberculosis are most
likely to break out and flourish.
6. To parents who need instruction in their duty to their
children, to themselves, and to their neighbors, and who are
ignorant of the way in which "catching" diseases originate and
spread.
The riot that occurred when the adenoids of children in a school on the
"East Side" in New York City were removed without the preliminary of
convincing the parents as to the advantages of the operation was merely
a demand for the "right to knowledge," which is never overlooked with
impunity. Reluctance to permit operation on a young child, and the
natural shrinking of a parent at seeing a child under the surgeon's
knife, require the teacher or school physician or nurse to answer fully
the usual questions of the hesitant mother and father.
1. Is the operation necessary? Will the child not outgrow its adenoids?
Usually the adenoid growths atrophy or dry up after the age of puberty.
Adenoids are not uncommon in adults, however. The surgeon general of
the army reports that during the year 1905, out of 3004 operations on
officers and enlisted men in service, there were 225 operations on the
nose, mouth, and pharynx, 103 of which were operations for adenoids and
enlarged or hypertrophied tonsils. Allowing the child to "outgrow"
adenoids may mean not only that he is being subjected to infection
chronically but that his body is allowed to be permanently deformed and
his health endangered. Beginning at the age of the second dentition,
the bones of jaw, nose, throat, and chest are undergoing important
changes--nasal occlusion. Adenoids left to atrophy--if large enough to
cause mouth breathing--may mean atrophy of this developing process,
permanent disfiguration of face, and permanent deformity of chest and
lungs.
2. Will the growth recur? In a few cases it does recur; frequently
either because it was not desirable to make a complete removal of the
adenoid tissue or because the surgeon was careless. If the growths do
recur, then they must be removed again.
3. Is the operation a dangerous one?
4. Is an anæsthetic necessary?
5. Will the operation cure the child of all its troubles? These
questions are best answered by the process and results of an "adenoid
party," which was given especially for the benefit of this book, every
step and symptom of which were carefully studied.
The seven children pictured here were discovered by their school
physician to have moderately large adenoid growths,--one boy having
enlarged tonsils also.
[Illustration: MOUTH BREATHERS IMMEDIATELY AFTER "ADENOID
PARTY"]
The picture on page 46 was taken by flash light at 2.30 P.M., January
15, 1908. At 3 P.M. the principal escorted these children into the
operating room at Vanderbilt Clinic. The doctor examined the throat and
nose of each child, entered the name and age of each, together with his
diagnosis, on a clinic card, sending each child into the next room
after examination. He then called the first boy and explained that it
would hurt, but that it would be over in a minute. The principal stood
by and told him to be brave and remember the five cents he could have
for ice cream afterwards. The clinic nurse tied a large towel about him
and put him in her lap; with one hand she held his clasped hands, while
the other held his head back. The doctor then took the little
instrument--the curette--and pushed it up back of the soft palate, and
with one twist brought out the offending spongy lump. The boy's head
was immediately held over a basin of running water. He was so occupied
with spitting out the blood that rushed down to choke him that he
hadn't time to cry before the acute pain had ceased. The rush of cool
air through his nostrils was such a pleasurable sensation that he
smiled as the school nurse escorted him out into the hall to wait for
his companions. At 3.30 P.M. all seven children were out in the hall,
all seven mouths were closed, and all seven faces were clothed with the
sleepy, peaceful expression that comes with rest from the prolonged
labor of trying to get enough air. At 3.45 P.M. they had been all
reëxamined by the doctor, and a few tag ends were picked out of the
nasopharynx of one child. At 4 P.M. the "party" had returned to the
Children's Aid Society's school and to the ice cream that follows each
adenoid party.
It is worth while to tell mothers stories of the "marvelous improvement
in school progress of those children whose brains have been poisoned
and starved by the accursed adenoid growths, and how their bodies
fairly bloom when the mysterious and awful incubus is removed," to use
the words of one school principal. It is worth while to show them
"before" and "after" pictures, and "before" and "after" children, and
"before" and "after" school marks.