the entrance of air through each side of the nose is more evenly balanced.

If we accept the foregoing statements as facts, it is easily understood how the habit of breathing through the mouth is so difficult to overcome, and the importance of keeping a clear passage way in the respiratory tract of children is apparent, and whenever it becomes evident that there is any hindrance to normal breathing, even from a transient "cold," it should have immediate attention. Any obstructions should be removed by surgical means, and the patient encouraged in his effort to breathe through the nose. Even later in life, when the bones of the mouth and nose are completely ossified, the openings of the nares can be enlarged by proper breathing exercises.

The following axioms are recommended for keeping the nose in a normal condition:

Cool living rooms; well ventilated sleeping rooms; cold bath, especially for the neck and spine; dry clothing; simple foods; regular habits; moderate daily exercise, and always breathe through the nose.

No. 106 East Broad Street.

DISCUSSION.

Dr. A. B. Nelles.-If there is a doubt in anyone's mind that mouth breathing may produce trouble in the larynx and pharynx, I think if he will take the trouble to wake up some night after he has been breathing through his mouth for a time the condition in which he will find the membrane lining the mouth and throat will give him a very practical demonstration of what that sort of thing might be responsible for if kept up twenty-four hours out of twenty-four.

The condition of the nasal and pharyngeal mucous membrane which Dr. Linhart has called attention to as a result of breathing through the mouth makes these mouth breathers very subject to frequent colds. Now, I think the so-called ordinary simple colds have never received the consideration which they deserve. And I believe that as we learn more of the remoter consequences for which repeated colds are responsible we shall cease to treat them so contemptuously, and shall

to

devote more attention to the correction of anything either in habit of living or in local conditions that may cause them. Dr. Linhart speaks of the narrow, high-arched palate so frequently found in mouth breathers, and gives as a cause of this the pressure from the air in passing through the mouth. Now, while this may be a factor, it does not seem me that it alone could change the arch of the palate to any extent. When one breathes through the nose with the mouth closed the tongue exerts quite a decided outward pressure upon the palate and the teeth. In mouth breathing the tongue falls to the floor of the mouth and this outward pressure is no longer present, while at the same time the cheeks are keeping up not only their usual pressure inward, but a suction pressure in addition. This appeals to me as probably having more to do with changing the arch of the palate than the mere pressure of the air in passing through the mouth. Dr. Linhart has given us a good paper and an exceedingly practical one.

Dr. E. M. Hatton.-Dr. Linhart has set forth the evils from mouth breathing in a very able manner, but from the standpoint of a general practitioner, in my opinion, he has given too much prominence to mouth breathing as a cause for chronic pharyngitis. Mouth breathing, indeed, plays a most conspicuous part in preventing the functions of the respiratory apparatus, yet it is a question if in a great majority of cases it is not a secondary cause or at the utmost an associated cause. In the not being a primary factor is simply a lack of opportunity, for nature performs its function well, and all things being equal nature directs the current of air in the right channels; "into his nostrils the breath of life" was "breathed." We are apt to refer to the nose as simply the organ of smell. The nasal passage is very frequently interfered with and especially in early childhood, when the mucous membrane is very sensitive. So much is it interfered with that it fails to perform its function in the whole or in part, and necessarily respiration must be carried on with the mouth as an adjunct or a substitute fully.

It is said by many authors that nasal occlusion is the most fruitful source of chronic pharyngitis, and one might

infer consequently that the air vicariously inhaled is undoubtedly the cause for the pharyngeal troubles. Adenoid vegetation is probably the most common cause of mouth breathing in children and as a consequence there is nasal obstruction. I have seen three and four children in a row in promiscuous dispensary work, day after day, thus afflicted, but what caused these growths? The same authors give repeated attacks of acute pharyngitis as a cause. Now, what caused acute pharyngitis primarily? Surely not inhalation of air by the mouth, because the nose was performing its function. The agents are hepatic congestions, reflex cough, cold, dampness, rheumatism, digestive disturbances, membraneous sore throat, measles, diphtheria, aphthous ulcers, scarlet fever and tonsilitis. Then arise the many causes for chronic pharyngitis-repeated attacks of acute pharyngitis simple and follicular, and specific diseases, and labor, excessive smoking and drinking, and the use of the voice injudiciously.

In many cases vicarious breathing seemingly could not have taken part whatever. We find normally patulous nostrils, well placed jaws and a properly developed palatine arch, yet in some cases a minor obstruction could have existed in the nasal passage without an extension of inflammation downward, causing an inconvenience from sensitiveness or otherwise, thereby establishing a mouth breathing habit, which undoubtedly was the primary factor. All in all, mouth breathing goes hand in hand with other agencies, and is a pernicious habit. Parents and physicians are too slow to

learn the cause of the trouble.

If the mouth breathing is simply an inexcusable habit, or from a minor trouble, breathing should be established through its natural channel by closing the mouth, raising the head when reclining, or by furnishing better and cooler air and the like. A continuous current of air is frequently a good agent for opening up a contracted nasal passage, or even a post-nasal one: H. H., 12 years of age, a poorly developed girl, with good care, nutrition was much improved, but early dietetic indiscretions with inherited tendencies had done much harm. Besides an anemic condition, there existed hypertrophical tonsils, a highly arched mouth, a contracted upper jaw,

deformed and misplaced teeth and post-nasal growths. Not until two or three years later did I succeed in making a start to rectify these latter troubles. The adenoid growth was probably the minor evil. At first the great tonsils were removed, but for cause the adenoid vegetations were not and were left. for further care. Not long afterward the work of the orthodontist began. The teeth were gradually placed properly, the arch was broadened and the upper jaw brought into juxtaposition with its mate. In the meantime, good normal breathing was established, and the adenoid growths disappeared, doubtless from improved general health and atmospheric pressure of properly cared-for air. After all, in the having of the exaggerated adenoid tissue, did it not prove a very conservative and good treatment? Is not the indiscriminate digging away of glandular and lymphoid tissue a thing to be deplored?

Dr. Linhart's remarks concerning proper house warming and ventilating are especially good. I think a great error in these days of out-door treatment of consumption is the overdoing of the hardening process, so-called, not only to children, but also to adults. The use of cool or cold baths, and especially cold rooms, is carried to excess. With tuberculosis patient's cold becomes a constant agent, and one is thoroughly prepared for it physically and by proper coverings, but with the average person, we must temporize, so as to be able to meet the frequent extreme degrees of hot and cold to which he is subjected.

Dr. Wm. C. Davis.-In speaking of the age at which adenoids develop, it is my opinion that very often babies are born with the lymphoid tissue in the vault of the pharynx already hypertrophied. It seems to me that the suction produced by the constant swallowing of a mouth breather from stenosis of the nasal passage, has considerable to do with the raising of the palatine arch. One has only to take hold of their own nose, closing the nostrils completely, and then swallow, to get a very good idea of the force produced.

As stated by the doctor in his paper, the normal secretion of the nasal passage is bactericidal in quality, thus affording a protection to the individual against infectious diseases;

mouth breathers have not this protection, consequently are much more liable to contract these diseases. It is my opinion that a normal child with normal nostrils, if their mouths are kept tight closed, could be exposed time and time again to infectious diseases without taking the disease.

We also have what is known as night mouth breathers. These little people breathe very well so long as they are up and around, but just as soon as they lay down their mouth flies open and remains open during the entire time they are asleep, due no doubt to the engorgement of the lymphoid tissue of the vault of the pharynx, from gravity. These little people often wake up entirely exhausted from having had to Struggle for breath during sleep.

Dr. F. A. Heckler. Dr. Linhart's paper is both interesting and instructive. Our school teachers are cognizant of some of the evils of mouth breathing and direct their pupils to breathe through the nose during the daily gymnastic exercises. It might be well for them to call the parents' attention to any difficulty in this respect, with the suggestion that their children be properly provided with handkerchiefs so they may not form the habit of sniffing the nose, which retains the secretion in the nasal passages, narrowing their lumen and predisposing the child to breathe through the mouth.

The doctor's remarks relative to the whirling motion given the breath during inspiration, when one nostril is occluded, possibly explains why we find some patients complaining of an ear giving them trouble, when the nostril on the opposite side is the occluded one.

On motion C. A. Hawley, D. D. S., was invited to take part in the discussion.

Dr. C. A Hawley.-It has been a great pleasure and privilege to listen to this excellent paper. In my work in orthodontia I am observing constantly the effect of mouth breathing in its relation to the deformities of the dental arch. Fully two-thirds of the cases of irregular teeth that have been brought to me for treatment, give a history of operation to remedy some obstruction of the nasal passages or are at the time in need of such an operation, so I am in the habit of sending all such patients that exhibit any signs of mouth