this country home. This would solve the question of fresh air. Of course, he said, one can feed these children most scientifically, care for them most carefully, have a nurse for each three or four children and 1,000 cubic feet of air space to each child, and still they will not thrive. But get these same children out of doors and they will pick up at once. The asylum in which Dr. Walker is interested has a home in the country, which is used six months of the year, and the difference in the

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... dren out in the country and in the city is remarkable. He believes, therefore, that to carry out the plan of using the city quarters for receiving the children, and the country quarters as their more permanent home, will be more conducive to success. Very important to add is the fact that the care of children in the country is cheaper than caring for the same number of children in the city. Dr. C. G. Kerley, New York CHy, said that while he believes ventilation, air space, attendants, feeding, etc., are of importance, it has been impressed on him that of more value than any other one thing is the thorough emptying of the ward, if possible, in the daytime. There should be a separate place for the children during the day and a special sleeping place at night, just as in private fife. The mortality depreciates remarkably. It requires more space, a roof garden, and, perhaps, one entire floor during the remainder of the year. If the children have separate rooms day and night the results are much more satisfactory. After twenty years' work among these children this seems to him the most important feature. Dr. J. Ruhrah, Baltimore, called attention to the fact that it is very much easier to feed a child well taken care of than one not well taken care of. ADENOIDS IN INFANCY. ant Physician at the Children's Hospital and at the Infants' Hospital; Visiting Physician at the Floating Hospital. BOSTON. While the frequency and importance of adenoids in childhood is well recognized and their symptomatology pretty generally understood, this is not the case as regards adenoids in infancy. These are supposed to be uncommon and of little importance, and their symptoms are commonly overlooked or misinterpreted. They are, however, very common in infancy and of the greatest importance. Their symptomatology, while in many ways different from that in childhood, is, nevertheless, fairly characteristic, and the evil results produced are even greater in infancy than in chilhood. Although this is undoubtedly true, there is, nevertheless, a general feeling in the profession, even among the throat specialists, that adenoids should not be removed in infancy, the reason given being that they are liable to recur later. It is true that they may, and sometimes do, recur later. The fact is, however, that in the majority of cases the adenoids do not recur, but even if they do and a second operation is required, the infant is spared in the meantime all the inconveniences and dangers of adenoids and the evil results which they produce. The removal of adenoids in infancy is a comparatively simple operation and practically devoid of danger. The removal of adenoids in childhood is hardly more difficult and is not attended by any greater danger.. The dangers of either a primary or a secondary operation can not, therefore, be taken into account. Certainly there is no danger connected with either operation which should be considered for an instant in comparison with the evil and even dangerous results which adenoids may, and often do, produce in infancy. There is, therefore, no sufficient reason for delaying the operation and no justification for allowing babies unfortunate enough to be afflicted with adenoids to have their development seriously or irreparably interfered with, to be subjected to all the evils which adenoids produce and even to die, as sometimes happens, when these unfortunate results may be avoided by an early operation. Before taking up the symptomatology jf adenoids in infancy it may be well to review the anatomy of the nasopharynx and its adnexa at this age. The nasopharynx is very low at birth, but is relatively long from before backward, the distance from the back of the hard palate to the soft parts of the back of the pharynx being nearly as great at birth as in the adult. The nasopharynx at birth is, therefore, merely a narrow passage running obliquely backward and downward from the constricted opening of the posterior nares. The soft palate is placed more horizontally than in the adult. The height of the nasopharynx increases with that of the posterior nares. The nose is relatively small and the respiratory portion very small. The height of the posterior nares at birth is from 6 to 7 mm. and the breadth between the pterygoid processes at the hard palate 9 mm. The nasal cavity consists of an upper olfactory region, occupying the ethmoidal portion of the cavity, and a lower respiratory portion occupying the maxillary part. The nasal cavity is relatively long and shallow at birth and the respiratory portion is very narrow. The whole opening of the posterior nares on either side is just large enough to admit the end of a medium-sized male catheter. The nasal cavity begins to increase in height directly after birth, increasing rather rapidly during the first six months, but very slowly during the rest of infancy. The size of the posterior opening doubles in six months, after which it remains stationary until the end of the second year. At the end of the seventh month the nasal cavity begins to approach the adult shape, though it is still relatively broad. The Eustachian tube is nearly horizontal at birth, but slants a little during the latter part of infancy. The opening at birth is at the level of the hard palate. It remains at this level for nine months, but later becomes distinctly higher. The tube is not only relatively, but absolutely, wider at its narrowest point at birth and during infancy than in the adult. The nasopharynx is extremely vascular and there is an abundant supply of lymph glands and vessels, especially in the posterior wall. The lymphoid ring is well developed at birth, often more so during infancy. On account of the small size of the superior pharynx and postnasal opening, even a small amount of adenoids may cause marked obstruction to nasal respiration. In infancy this is a very serious matter, especially if it is anywhere nearly complete. Interference with nasal respiration necessitates oral respiration, which the young infant performs very imperfectly, especially when asleep. This interference with respiration results in the constant deprivation of a sufficient supply of oxygen, which, in turn, produces a disturbance of nutrition which is uninfluenced by any method of feeding or mode of life. Another serious result of the nasal obstruction is the interference with sucking and sometimes with swallowing. The effort of sucking is so great that these babies take only enough food to satisfy the acute pangs of hunger. Lack of food, therefore, also interferes with their nutrition and development. The difficulty in breathing Downloaded From: http://jama.jamanetwork.com/ by a Simon Fraser University User on 06/12/2015