Volume 1

Pediatrics : the hygienic & medical treatment of children / by Thomas Morgan Rotch.

  • Thomas Morgan Rotch
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Pediatrics : the hygienic & medical treatment of children / by Thomas Morgan Rotch. Source: Wellcome Collection.

    40/668 page 34
    According to Professor Dwight, the height of the posterior nares at birth is 6 to 7 mm., and the breadth between the pterygoid processes at the hard palate is 9 mm. In infancy, the posterior border of the vomer is very oblique. Situated just behind the nasal cavity is the upper or nasal portion of the pharynx, which shares in its changes. I may perhaps be permitted to doubt whether many practitioners who have not had the advantage of modern anatomical teaching appreciate how small a cavity the naso-pharynx is even in the adult. Its height is twenty millimetres, and its antero-posterior diameter, from the hard palate back, is twenty to twenty-two millimetres. In the infant it is very much smaller. It is less of a vestibule and more of a narrow passage running obliquely backward and downward from the constricted opening of the posterior nares. The soft palate of the child seems to be placed more horizontally than in the adult, and bounds its anterior portion below. Kostanecld gives the height at birth as ten millimetres, and its antero- posterior diameter as fourteen or fifteen millimetres. I do not give you Professor Dwight’s observations on this point, as it seems to me that its shape is so peculiar that measurements are deceptive, or at least inadequate to give the proper idea. Imagine the posterior nares (not the inferior meatus alone, but the whole opening on either side) large enough to admit the end of a medium-sized male catheter, and that this leads into the passage just mentioned, and you can conceive how a congestion of the nasal mucous membrane in infancy, with the addition of the mucous secre- tion, may effectually close the opening from the nose to the pharynx. It is, perhaps, not sufficiently recognized clinically how important a function is performed by the nasal passages in early infancy,—far more important, indeed, than at any other age. I can, in fact, say that the age of the infant is in inverse ratio to the dangers which may arise from ob- struction of the nares. These dangers, consequent on obstruction, congestion, and the resulting mechanical disturbance of neighboring parts, thus leading to actual disease of those parts, become in the new-born infant of most serious and even vital import. In my own practice I have seen an infant die of simple acute nasa catarrh in the first two or three days of life. In this case the infant was, indeed, puny and ill cared for. Nothing abnormal could be detected in the throat, or, in fact, anywhere, except in the nares, which were completely occluded by the congestion and tumefaction resulting from an acute inflam- mation of the nasal mucous membrane. Occurring, as the case did, in the earlier years of my practice, I did not appreciate as I do now the extreme importance of the naso-pharyngeal function of the young subject. Then- fore, after prescribing the usual remedies for such cases, on the second day of the infant’s life, I was surprised to learu that it had died sue t en j on the third day. , , This unfortunate experience, however, served to draw my attention
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