e Eustachian
cushions. They do not grow from the margins of the posterior nares.
Adenoids are frequently associated with hypertrophy of the faucial
tonsils, and the patient often suffers from granular pharyngitis and
chronic nasal catarrh.

These growths are sometimes met with in infants, but are most common
between the ages of five and fifteen, after which they tend to undergo
atrophy. They may, however, persist into adult life.

_Clinical Features._--The most prominent symptom in most cases is
interference with nasal respiration, so that the patient is compelled
to breathe through the mouth. The facies of adenoids is
characteristic: the mouth is kept partly open, the face appears
lengthened, the nose is flattened by the falling in of the alae nasi,
the inner angles of the eyes are drawn down, and the eyelids droop,
while the whole facial expression is dull and stupid. As the
respiratory difficulty is increased during sleep, the patient snores
loudly, and his sleep is frequently broken by sudden night terrors.
Owing to the disturbed sleep, to imperfect oxygenation of the blood,
and to frequent attacks of nasal and bronchial catarrh, the child's
nutrition is interfered with, and he becomes languid and backward at
his lessons.

When the adenoids encroach upon the Eustachian cushions, the patient
suffers from deafness, frequent attacks of earache, and sometimes from
suppurative otitis media with a discharge from the ear.

Among the rarer conditions attributed to adenoids are asthma,
inspiratory laryngeal stridor, persistent cough, chorea, and nocturnal
enuresis.

A _diagnosis_ should never be made from the symptoms alone; an attempt
must be made to examine the naso-pharynx by posterior rhinoscopy and
by digital examination. The interior of the nose must always be
examined and any further cause of obstruction excluded.

_Treatment._--Thorough removal is the only satisfactory line of
treatment, and this should be done under general anaesthesia. The
following instruments are necessary: two Gottstein's adenoid curettes,
one provided with a cradle and hooks, the other without, a Hartmann's
lateral ring knife, and one pair of adenoid forceps--Kuhn's or
Loewenberg's--a tongue depressor, a gag, and one or two throat sponges
on holders. The patient having been anaesthetised, his head should be
drawn over the end of the table. An assistant standing on the left
side inserts the gag and maintains it in position. The operator,